Generic Name

Bupropion Hydrochloride

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Classification

FDA Approved Indications

• Depressive Disorders (Major Depressive Disorder, Dysthymia)
• Seasonal Affective Disorder (SAD)
• Prevention of Nicotine Dependence (smoking cessation)

Mechanism of Action

Bupropion inhibits the reuptake of norepinephrine and dopamine, increasing their levels in the synaptic cleft, which contributes to its antidepressant and smoking cessation effects.

Dosage and Administration

Adult: Typically 150 mg once daily, increased gradually to 300 mg/day in divided doses or as a single dose, depending on formulation and response.

Pediatric: Not typically used in pediatric patients.

Geriatric: Start with lower doses; monitor closely due to increased risk of side effects.

Renal Impairment: Dose adjustment recommended in severe impairment; consult prescribing information.

Hepatic Impairment: Use with caution; dose adjustment may be necessary.

Pharmacokinetics

Absorption: Well absorbed with peak plasma concentrations in 2 hours (immediate release).

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Extensively metabolized in the liver via hydroxylation and glucuronidation.

Excretion: Excreted mainly in urine; some in feces.

Half Life: Approximately 21 hours, allowing once-daily dosing in its extended-release formulation.

Contraindications

• Seizure disorder
• History of anorexia nervosa or bulimia
• Abrupt discontinuation of alcohol or sedatives due to seizure risk
• Concurrent use of other forms of bupropion
• Use within 14 days of MAOI therapy

Precautions

• Increased risk of seizures, neuropsychiatric symptoms, hypertension; monitor patients carefully.

Adverse Reactions - Common

• Dry mouth ( Frequent)
• Insomnia ( Frequent)
• Sweating ( Frequent)
• Nausea ( Frequent)

Adverse Reactions - Serious

• Seizures ( Rare (dose-dependent))
• Psychiatric symptoms (psychosis, hallucinations, worsening depression) ( Rare)
• Hypertension ( Less common)

Drug-Drug Interactions

• Other medications that lower seizure threshold (e.g., antipsychotics, theophylline)
• MAOIs (must discontinue 14 days prior)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Report any seizures, worsening mood, agitation, or unusual thoughts.
• Avoid alcohol and sedatives.
• Do not abruptly discontinue; consult provider before stopping.

Special Considerations

Black Box Warnings:

• Increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
• Risk of seizure at doses exceeding 450 mg/day.

Genetic Factors: Pharmacogenetics may influence metabolism and response.

Lab Test Interference: May cause false positives for amphetamines on urine drug tests.

Overdose Management

Signs/Symptoms: Seizures, hallucinations, loss of consciousness, tachycardia, hypotension.

Treatment: Supportive care, seizure management, cardiopulmonary support, activated charcoal if appropriate, no specific antidote.

Storage and Handling

Storage: Store at room temperature, 20°-25°C (68°-77°F).

Stability: Stable for the duration of labeled expiration date.