Should Wellbutrin (bupropion) be discontinued in a patient who experiences a seizure while taking Wellbutrin (bupropion)?

From the Guidelines

Yes, Wellbutrin (bupropion) should be discontinued in a patient who experiences a seizure while taking the medication. According to the study published in Gastroenterology in 2022 1, bupropion may lower the seizure threshold, and naltrexone-bupropion ER should be avoided in patients with epilepsy and used with caution in patients with a history of seizures or with clinical factors that may increase the risk of seizures.

Key Considerations

• The risk of seizures with bupropion is dose-dependent, with higher doses carrying greater risk 1.
• Predisposing factors for seizures include history of seizures, head trauma, CNS tumors, severe hepatic cirrhosis, eating disorders, or concomitant medications that lower seizure threshold.
• After discontinuing Wellbutrin, the healthcare provider should evaluate the patient for underlying seizure risk factors, consider neurological consultation, and discuss alternative antidepressant options.

Alternative Treatment Options

• Alternative antidepressant options such as SSRIs, SNRIs, or mirtazapine, which have minimal seizure risk, should be considered.
• The healthcare provider should weigh the benefits and risks of each alternative option and choose the most suitable one for the patient based on their individual needs and medical history.

Monitoring and Follow-up

• Patients who have experienced a seizure while taking Wellbutrin should be closely monitored for any further seizure activity or other adverse effects.
• Regular follow-up appointments with the healthcare provider are essential to assess the patient's response to alternative treatment options and adjust the treatment plan as needed.

From the FDA Drug Label

Discontinue bupropion hydrochloride extended-release tablets (XL) and do not restart treatment if the patient experiences a seizure Instruct patients to discontinue and not restart bupropion hydrochloride extended-release tablets (XL) if they experience a seizure while on treatment

Discontinuation of Wellbutrin is recommended if a patient experiences a seizure while on treatment with the medication, as stated in the drug label 2 and 2.

From the Research

Seizure Risk Associated with Wellbutrin

• Wellbutrin, also known as bupropion, has been associated with an increased risk of seizures, particularly at high doses 3, 4, 5, 6, 7.
• Studies have shown that the risk of seizure is higher with bupropion doses above the recommended maximum, and predisposing factors were noted in over half of the reported cases 4.
• The incidence of seizure at 300 mg per day is estimated to be 1/1000 patients treated 5.
• Bupropion can lower the seizure threshold, and the risk of seizure appears to be higher in patients with a history of seizure disorders or other predisposing factors 3, 5, 6.

Discontinuation of Wellbutrin after Seizure

• If a patient experiences a seizure while taking Wellbutrin, it is likely that the medication will be discontinued due to the increased risk of further seizures 3, 4, 5, 6, 7.
• The decision to discontinue Wellbutrin should be made on a case-by-case basis, taking into account the individual patient's medical history and the severity of the seizure 3, 4.
• Alternative treatments may be considered for patients who experience seizures while taking Wellbutrin, such as switching to a different antidepressant or adjusting the dose 3, 4.

Key Findings

• Bupropion is associated with an increased risk of seizures, particularly at high doses 3, 4, 5, 6, 7.
• The risk of seizure is higher in patients with a history of seizure disorders or other predisposing factors 3, 5, 6.
• Discontinuation of Wellbutrin may be necessary if a patient experiences a seizure while taking the medication 3, 4, 5, 6, 7.