will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.Minor (1)thioridazine increases toxicity of bupropion by unspecified interaction mechanism. Minor/Significance Unknown. May lower seizure threshold; keep bupropion dose as low as possible.ticarcillinMonitor Closely (1)ticarcillin increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.timololMonitor Closely (1)bupropion will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tolterodineMonitor Closely (1)bupropion will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tramadolMonitor Closely (1)bupropion will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tranylcypromineContraindicated (1)tranylcypromine and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropiontrazodoneSerious - Use Alternative (1)trazodone increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.trifluoperazineMonitor Closely (1)bupropion will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Minor (1)trifluoperazine increases toxicity of bupropion by unspecified interaction mechanism. Minor/Significance Unknown. May lower seizure threshold; keep bupropion dose as low as possible.trimipramineMonitor Closely (2)trimipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible. bupropion will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tropisetronMinor (1)bupropion will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.valbenazineMonitor Closely (1)bupropion will increase the level or effect of valbenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Consider reducing valbenazine dose based on tolerability if coadministered with a strong CYP2D6 inhibitor.venlafaxineMonitor Closely (1)bupropion will increase the level or effect of venlafaxine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)venlafaxine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.vortioxetineSerious - Use Alternative (1)bupropion, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug. >10% Headache (25-34%) Dry mouth (17-28%) Nausea (1-18%) Weight loss (15-20%) Insomnia (11-20%) Agitation (2-32%) Dizziness (6-22%) Pharyngitis (3-13%) 1-10% Constipation (5-10%) Infection (8-9%) Abdominal pain (2-9%) Anxiety (5-7%) Diarrhea (5-7%) Tinnitus (3-6%) Tremor (3-6%) Nervousness (3-5%) Anorexia (3-5%) Palpitation (2-6%) Myalgia (2-6%) Sweating (2-5%) Rash (1-5%) Sinusitis (1-5%) Weight gain (4%) Chest pain (3-4%) Urinary frequency (2%) Vaginal hemorrhage (2%) Pruritus (2-4%) Vomiting (2-4%) Arthralgia (1-4%) Flushing (1-4%) Migraine (1-4%) Decreased memory (<3%) Irritability (2-3%) Somnolence (2-3%) Dysphagia (<2%) Arthritis (2%) Paresthesia (1-2%) Fever (1-2%) Twitch (1-2%) Seizures (0.4% [<450 mg/day], >3% [>450 mg/day]; may be increased risk with concomitant ECT) Frequency Not Defined Confusion Cystitis Erythema Ataxia Coma EEG abnormality Euphoria Gastric reflux Postmarketing reports Hyperglycemia Hypoglycemia Hyponatremia Syndrome of inappropriate antidiuretic hormone secretion Nervous system: Abnormal electroencephalogram (EEG), aggression, akinesia, aphasia, completed suicide, delirium, delusions, dysarthria, extrapyramidal syndrome (dyskinesia, dystonia, hypokinesia, parkinsonism), hallucinations, increased libido, manic reaction, neuralgia, neuropathy, paranoid ideation, restlessness, suicide attempt, and unmasking tardive dyskinesia Skin reactions: Maculopapular rash, alopecia, angioedema, exfoliative dermatitis, hirsutism, Stevens-Johnson syndrome, urticaria, and acute generalized exanthematous pustulosis Black Box Warnings Not FDA approved for bipolar depression Suicidality In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses; this increase was not seen in patients >24 years Slight decrease in suicidal thinking was seen in adults >65 years In children and young adults, risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy; this drug is not approved for use in pediatric patients Contraindications Hypersensitivity to bupropion or other ingredients History of anorexia/bulimia; patients undergoing abrupt discontinuation of ethanol or sedatives including anticonvulsants, barbiturates, or benzodiazepines Coadministration of any other medications that contain bupropion, because seizures are dose dependent Aplenzin contraindications Seizure disorder or conditions that increase seizure risk (arteriovenous malformation, severe head injury, CNS tumor, CNS infection, severe stroke, anorexia nervosa or bulimia (current or prior diagnosis) Coadministration with MAOIs Coadministration may cause serotonin syndrome Do not use concomitantly or initiate bupropion within 14 days of stopping an MAOI Conversely, at least 14 days should be allowed after stopping bupropion before starting an MAOI antidepressant Starting bupropion in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome If linezolid or IV methylene blue must be administered, discontinue bupropion immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first Cautions Caution in severe hepatic cirrhosis (do not exceed 150 mg every other day), mild-moderate hepatic impairment, head trauma and prior seizure history, CNS tumor, concomitant meds lowering seizure threshold Observe patients for neuropsychiatric symptoms, such as changes in behavior, hostility, agitation, depressed mood, and suicide-related events, including ideation, behavior, and attempted suicide (see Black Box Warnings); therapy may cause delusions, hallucinations, psychosis, paranoia, confusion, and concentration disturbance; symptoms may abate with dose reduction Healthcare provider should evaluate severity of adverse events and extent to which patient is benefiting from treatment, and consider options including continued treatment under closer monitoring, or discontinuing treatment; in many postmarketing cases, resolution of symptoms after discontinuation of bupropion reported; however, symptoms persisted in some cases; ongoing monitoring and supportive care should be provided until symptoms resolve Potential risk of hepatotoxicity Assess blood pressure before initiating treatment with sustained release formulation, and monitor periodically during treatment; risk of hypertension is increased if sustained release formulation is used concomitantly with MAOIs or other drugs that increase dopaminergic or noradrenergic activity; use caution in patients with cardiovascular disease May cause weight loss; use caution if weight loss not desirable May cause CNS depression and impair ability to operate heavy machinery Extended-release: Do not administer less than 8 hr apart Seizure risk is dose-related; can minimize risk by limiting daily dose to 522 mg and gradually increasing dose; discontinue permanently in patients who experience seizures May cause sexual dysfunction Screen patients for bipolar disorder and monitor for these symptoms; may precipitate manic, hypomanic or mixed episodes in patients with bipolar disorder Instruct patients to contact a healthcare professional if neuropsychiatric reactions occur Perform thorough cardiovascular assessment to identify risk factors of sudden cardiac death in pediatric ADHD patients Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy; use caution False-positive urine immunoassay screening tests for amphetamines have been reported; confirmatory test (eg, gas chromatography, mass spectrometry) will distinguish bupropion from amphetamines Some patients who stopped smoking reported to have experienced symptoms of nicotine withdrawal, including depressed mood; depression, rarely including suicidal ideation, reported in smokers undergoing a smoking cessation attempt without medication; however, some of these adverse events occurred in patients taking bupropion who continued to smoke Neuropsychiatric adverse events reported in patients without and with pre-existing psychiatric disease; some patients experienced worsening of their psychiatric illnesses; observe patients for occurrence of neuropsychiatric adverse events; patient should stop therapy and contact healthcare provider immediately if agitation, depressed mood, or changes in behavior or thinking that are not typical for patient are observed, or if patient develops suicidal ideation or suicidal behavior; symptoms may persist after discontinuation of therapy; in some cases; monitoring and supportive care should be provided until symptoms resolve Bupropion hydrobromide extended-release tablets are intended for oral use only; inhalation of crushed tablets or injection of dissolved bupropion reported; seizures and/or cases of death reported when administered intranasally or by parenteral injection Abuse warning XL and SR tablets are intended for oral use only Inhaling crushed tablets or injecting dissolved tablets has been reported to cause seizures and/or death Pregnancy There is an independent pregnancy exposure registry that monitors pregnancy outcomes in women exposed to any antidepressants during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-4056185 or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants Data from epidemiological studies of pregnant women exposed to bupropion in first trimester have not identified an increased risk of congenital malformations overall; there are risks to the mother associated with untreated depression in pregnancy A prospective, longitudinal study followed 201 pregnant women with a history of major depressive disorder who were euthymic and taking antidepressants during pregnancy at beginning of pregnancy; the women who discontinued antidepressants during pregnancy were more likely to experience a relapse of major depression than women who continued antidepressants; consider risks to the mother of untreated depression and potential effects on tfetus when discontinuing or changing treatment with antidepressant medications during pregnancy and postpartum Animal data When bupropion was administered to pregnant rats during organogenesis, there was no evidence of fetal malformations at doses up to approximately 10 times maximum recommended human dose (MRHD) of 450 mg/day; when given to pregnant rabbits during organogenesis, non-dose–related increases in incidence of fetal malformations and skeletal variations were observed at doses approximately equal to the MRHD and greater; decreased fetal weights were seen at doses twice the MRHD and greater Lactation Data from published literature report presence of drug and its metabolites in human milk; there are no data on effects of bupropion or metabolites on milk production; limited data from postmarketing reports have not identified a clear association of adverse reactions in the breastfed infant; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal conditionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Not well understood; structurally unrelated to SSRIs, TCAs, MAOIs; does not inhibit the activity of monoamine oxidase or the reuptake of serotonin Norepinephrine dopamine reuptake inhibitor; may act through dopaminergic or noradrenergic pathways Absorption Peak serum time: 2 hr (immediate-release); 3 hr (extended-release) Distribution Protein bound: 84% Vd: 20-47 L/kg Metabolism Hepatic, via CYP2B6 Metabolites: Hydroxybupropion (50% potency of parent compound) Elimination Half-life: 8-24 hr (immediate-release); 21 +/- 7 hr (extended-release) Excretion: Urine (87%); feces (10%) Oral Administration Swallow extended/sustained-release tablets whole; do not chew, crush, or split; this may lead to adverse effects including seizures BRAND FORM. UNIT PRICE PILL IMAGE Wellbutrin SR oral- 150 mg tabletWellbutrin SR oral- 100 mg tabletWellbutrin SR oral- 200 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 300 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 100 mg tabletbupropion HCl oral- 100 mg tabletbupropion HCl oral- 75 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 100 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 300 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 300 mg tabletbupropion HCl oral- 200 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 100 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 300 mg tabletbupropion HCl oral- 300 mg tabletbupropion HCl oral- 300 mg tabletbupropion HCl oral- 150 mg tabletbupropion HCl oral- 100 mg tabletbupropion HCl oral- 75