Bupropion

IR and Wellbutrin SR treat major depressive disorder; Wellbutrin XL treats MDD and prevents seasonal major depressive episodes in diagnosed seasonal affective disorder. The selected smoking-cessation SR label aids quitting with counseling/support; it is not labeled for depression.

Zyban is the associated smoking-cessation brand; dosing here is verified against the linked generic cessation label. Forfivo XL has its own adult MDD 450 mg regimen and eligibility rules. Other salts, combinations and off-label indications require their own references.

For adult MDD, one 450 mg tablet once daily with or without food. Do not initiate bupropion treatment with this product. It may replace another formulation after at least two weeks at 300 mg/day when 450 mg/day is required, or replace an established 450 mg/day regimen. Do not combine with other bupropion. It is not recommended with renal or hepatic impairment because no lower strength is available; use another formulation for tapering. These directions do not resolve the selected Wellbutrin XL label’s inconsistent ceiling.

Start 150 mg each morning in autumn before symptoms; after 7 days may increase to 300 mg. Continue through winter and individualize spring taper; reduce 300 mg to 150 mg before stopping. Above 300 mg was not assessed in SAD trials.

Start 150 mg daily for 3 days, then 150 mg twice daily ≥8 hours apart; maximum 300 mg/day. Start before the quit day, setting it within the first 2 weeks. Usually treat 7–12 weeks with support; if not abstinent by then, reassess and usually discontinue. Longer treatment is individualized.

Child-Pugh 7–15: IR maximum 75 mg/day; depression SR 100 mg/day or 150 mg every other day; XL and smoking-cessation SR 150 mg every other day. With mild hepatic impairment consider lower dose/frequency. The selected IR, depression SR, Wellbutrin XL and cessation SR labels advise considering reduced dose/frequency when GFR <90 mL/min and monitoring for accumulation.

Swallow tablets whole; do not crush, split or chew. Take XL in the morning; food is optional. Clinician-directed switching to XL uses the same total daily dose when possible within product limits. Allow ≥14 days between bupropion and a psychiatric MAOI in either direction; urgent linezolid/IV methylene blue needs a specialist interruption and monitoring plan.

Seizure disorder; current/prior anorexia nervosa or bulimia; abrupt withdrawal from alcohol, benzodiazepines, barbiturates or antiepileptics; hypersensitivity; psychiatric MAOIs concurrently or within 14 days in either direction. Do not start while receiving linezolid or IV methylene blue. Do not combine bupropion-containing products.

Selected labels carry the antidepressant warning: short-term trials found increased suicidality in children, adolescents and young adults. Monitor all ages for worsening mood, suicidality or unusual behavior, especially early and around dose changes; caregivers should report changes promptly.

Dry mouth, nausea, insomnia, dizziness, agitation, anxiety, tremor, palpitations and sweating are reported; frequencies vary by formulation and study. Overdose can cause seizures, conduction/ rhythm disturbances, coma and death. Obtain urgent assessment and Poison Control guidance (U.S. 1-800-222-1222); no specific antidote exists.

• CYP2D6 substrates such as metoprolol, selected antidepressants/antipsychotics and flecainide may need dose reduction; tamoxifen activation and efficacy may be reduced, requiring specialist review.
• CYP2B6 inhibitors (clopidogrel/ticlopidine) and inducers (including selected antivirals and anticonvulsants) alter exposure; adjust only to clinical response within formulation limits.
• Other seizure-threshold-lowering medicines require extreme caution; avoid duplicate bupropion products.
• Levodopa or amantadine can produce additive CNS toxicity. Minimize or avoid alcohol; heavy users need a supervised withdrawal plan.
• Nicotine patches can increase hypertension risk; monitor BP with a combined quit regimen.
• Digoxin concentrations may decrease; monitor with the treating clinician.
• MAOIs, linezolid and IV methylene blue carry hypertensive-reaction risk.
• Urine amphetamine immunoassays may be falsely positive, even after stopping; obtain a specific confirmatory test.

Human studies have not identified increased malformations overall; findings for specific cardiac defects are inconsistent and limited. Consider risks of untreated depression and treatment changes. Smoking-cessation decisions need an individualized benefit–risk discussion.

Bupropion and active metabolites enter milk; limited observations do not establish infant safety. Infant seizures have been reported with an unclear causal relationship. Weigh maternal need, infant health and breastfeeding benefits; monitor with the clinician.

Selected products have no established pediatric safety/effectiveness. Older adults may be more sensitive; assess renal function and concomitant medicines because active metabolites can accumulate.

The antidepressant mechanism is incompletely known; norepinephrine/dopamine reuptake inhibition is thought to contribute. Bupropion does not inhibit MAO or serotonin reuptake.

Absorption

Selected XL median time to peak approximately 5 hours; food does not materially change exposure.

Metabolism

Extensive hepatic metabolism; CYP2B6 produces active hydroxybupropion; additional active reduced metabolites form.

Half-life

Parent mean approximately 21 hours; active metabolites persist.

Disposition

Metabolites cleared renally; impairment can increase exposure.

• Assess response, suicidality and unusual mood/behavior changes, particularly at initiation or titration.
• Check BP before treatment and periodically, especially with nicotine replacement.
• Review bipolar and seizure risks, substance use and interacting medicines.
• Assess renal/hepatic function when relevant; monitor adverse effects suggesting high exposure.

• Verify IR/SR/XL, strength, indication and dose interval each refill. Never take duplicate bupropion products.
• Skip a missed dose and resume the regular schedule; do not double. Swallow whole.
• Seek immediate help for suicidality, seizure, severe allergy or acute eye pain/vision change.
• XL’s intact-looking shell may appear in stool; this does not mean the dose was unabsorbed.
• For quitting, agree on a quit date and keep counseling/support appointments.

Strength / appearance

150 or 300 mg; creamy-white to pale-yellow round tablets.

Imprint

Wellbutrin XL 150 or Wellbutrin XL 300.

Label distributor

Bausch Health US, LLC.

Example NDC

0187-0730-30 · 150 mg, 30 tablets.

U.S. status

Prescription medicine.

IR hydrochloride

75 and 100 mg in the selected label.

Depression SR hydrochloride

100, 150 and 200 mg Wellbutrin SR.

XL hydrochloride

150 and 300 mg Wellbutrin XL.

Smoking-cessation SR

150 mg in the selected generic cessation label.

Other products

Forfivo XL: 450 mg hydrochloride with separate eligibility; hydrobromide and combinations are outside this reference.

Representative Wellbutrin XL: 25°C, permitted excursions 15–30°C. Keep medicines secured from children and use the exact product’s storage directions and Medication Guide.