Bupropion (Adverse effects)

Bupropion is used to treat depression, seasonal affective disorder (SAD), episodes of depression that occur at the same time each year (usually in the fall and winter, but rarely occur in the spring or summer months). Bupropion is also used to help people quit smoking. Bupropion belongs to a class of drugs called last generation or atypical antidepressants. Bupoprion is used not only in major depressive disorders but also to treat episodes of depression in patients with bipolar disorder and to treat attention deficit hyperactivity disorder (ADHD).

ACTION MECHANISM

Bupropion is a selective inhibitor of the neuronal reuptake of catecholamines (dopamine-norepinephrine) with minimal effect on the reuptake of indolamines; does not inhibit the action of any MAO (monoamine oxidase).

PRECAUTIONS

Notify your doctor if you take MAO inhibitors (monoamine oxidase inhibitors) such as isocarboxazid, linezolid, phenelzine, selegiline, and tranylcypromine, or if you have stopped taking a MAO inhibitor in the last 14 days.

You should not take more than one product that contains bupropion at a time since you may experience side effects.

Precautions must be taken with the combination of bupropion and the following substances: amantadine; beta blockers, cimetidine, clopidogrel, cyclophosphamide, efavirenz, insulin or oral medications for diabetes; medications for irregular heartbeat such as flecainide and propafenone, medications for mental illnesses such as haloperidol, risperidone and thioridazine; medications for seizures such as carbamazepine, phenobarbital, and phenytoin; levodopa; lopinavir and ritonavir; nelfinavir; nicotine patches; oral steroids, methylprednisolone and prednisone; orphenadrine; other antidepressants such as citalopram, desipramine, fluoxetine, fluvoxamine, imipramine, paroxetine and sertraline; ritonavir; sedatives; sleeping pills tamoxifen; theophylline; thiotepa and ticlopidine. In these cases the doctor may need to change the doses or monitor closely for side effects.

You should tell your doctor if you have or have ever had seizures, anorexia nervosa (an eating disorder) or bulimia (an eating disorder).

Inform your doctor if you drink large amounts of alcohol but expect to stop taking it suddenly or take sedatives but expect to stop taking them suddenly. The doctor probably will recommend not to take bupropion in these cases.

Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking bupropion inform your doctor immediately.

Bupropion can cause an increase in the blood pressure. The doctor should check the blood pressure before starting treatment and regularly while taking this medication, especially if you also use nicotine replacement therapy.

Bupropion can cause angle closure glaucoma (a condition where the fluid is suddenly blocked and cannot flow out of the eye causing a rapid and severe increase in eye pressure that can lead to vision loss). You should tell your doctor before you start taking this medicine. If you have nausea, eye pain, changes in vision (such as seeing colored rings around the lights and swelling or redness in or around the eye) call your doctor or get emergency medical treatment immediately.

Some people have reported symptoms such as changes in behavior, hostility, agitation, depression and suicidal thoughts while taking bupropion to quit smoking. These symptoms have also occurred in people with no history of mental illness and have worsened in people who have already had mental illness. Tell your doctor if you have or have had depression, bipolar disorder (mood that changes from depressed to abnormally excited), schizophrenia (a mental illness that causes altered thinking or unusual thinking, loss of interest in life, and strong or inappropriate emotions) or other mental illnesses. If you experience any of the following symptoms, stop taking bupropion and call your doctor immediately: suicidal thoughts or actions, new or worsening depression, anxiety or panic attacks, agitation; restlessness; angry or violent behavior; dangerous actions, mania (frantic behaviour, abnormally excitation or irritated mood); abnormal thoughts or feelings; hallucinations (seeing things or hearing voices that do not exist); feelong that people are against you; feeling confused or any other sudden or unusual change in behavior. Make sure your family or is aware of the symptoms that can be serious so they can call the doctor if you can not seek treatment on your own. The doctor must monitor closely until the symptoms improve.

SIDE EFFECTS

When taking bupropion certain side effects can occur..

Most common side effects are: drowsiness, anxiety, excitement, difficulty falling asleep or staying asleep, dizziness, headache, nausea, vomiting, stomach pain, uncontrollable trembling of any part of the body, loss of appetite, weight loss , constipation, excessive sweating, ringing in the ears, changes in the sense of taste, frequent urination, sore throat.

Less common serious side effects (you should inform the doctor immediately) are: Convulsions, confusion, hallucinations (seeing things or hearing voices that do not exist), irrational fears, muscle or joint pain, irregular, fast or heavy heart rhythm, fever, rash or blisters, hives, swelling of face, throat, tongue, eyes, hands, feet, ankles or lower legs, difficulty breathing or swallowing, chest pain.

PHARMACOLOGIC INTERACTIONS

Bupropion increases the effect of certain antidepressants (eg, desipramine, imipramine), antipsychotics (eg risperidone, thioridazine), beta-blockers (eg propafenone, flecainide).

Bupropion decreases the effect of tamoxifen.

The effect of bupropion is inhibited by carbamazepine, phenytoin, ritonavir and efavirenz. The effect of bupropion is increased by valproic acid.

Bupropion is contraindicated with MAOI antidepressants (monoamine oxidase inhibitors) as the possibility of adverse reactions increases. At least 14 days must pass between the interruption of MAOI administration and the start of treatment. Regarding reversible IMAOs, it is enough with 24 hours.

There is a risk of elevation of blood pressure if bupropion is prescribed while using a transdermal nicotine system.

Treatment with bupropion decreases digoxin levels. When treatment with bupropion is stopped, digoxin levels can be increased suddenly and therefore these levels should be monitored to avoid possible toxicity.

BRAND NAMES

  • Zyban®
  • Aplenzin®
  • Forfivo® XL
  • Wellbutrin®

Gene or region studied

  • SACM1L
  • WDFY4
  • 3p26.3
  • MAGI2
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