What are the side effects of Bupropion (Wellbutrin)?

From the Guidelines

Wellbutrin (bupropion) is associated with several common side effects, including dry mouth and insomnia, which are dose-related and may lead to drug discontinuation in some cases, as reported in a study published in the Mayo Clinic Proceedings 1. When considering the side effects of Wellbutrin, it's essential to weigh the benefits against the potential risks, particularly in terms of morbidity, mortality, and quality of life.

• Common side effects of Wellbutrin include:
  • Dry mouth
  • Insomnia
  • Headache
  • Rash
  • Urticaria
  • Tremor
• Less common but more severe side effects include:
  • Seizures, with a rate of 1/1000, particularly among those with a history of seizures or structural brain lesions 1
  • Allergic reactions
• It's crucial to monitor patients for potential increases in blood pressure and heart rate, especially those with pre-existing cardiovascular conditions.
• Starting with a lower dose and gradually increasing can help minimize side effects, which often improve after the first few weeks of treatment as the body adjusts to the medication.
• The medication's stimulating properties can lead to anxiety, agitation, or tremors in some patients, and weight loss may occur, which can be beneficial for some but problematic for others.
• Given the potential for serious side effects, it is essential to carefully evaluate the risks and benefits of Wellbutrin treatment for each patient, taking into account their individual medical history and health status, as supported by the study published in the Mayo Clinic Proceedings 1.

From the FDA Drug Label

Bupropion hydrochloride extended-release tablets (XL) can cause serious side effects The most common side effects of bupropion hydrochloride extended-release tablets (XL) include: • trouble sleeping • feeling anxious • stuffy nose • nausea • dry mouth • constipation • dizziness • joint aches Some people have even experienced suicidal thoughts when trying to quit smoking without medication. Sometimes quitting smoking can lead to worsening of mental health problems that you already have, such as depression Some people have had serious side effects while taking bupropion to help them quit smoking, including: New or worse mental health problems, such as changes in behavior or thinking, aggression, hostility, agitation, depression, or suicidal thoughts or actions

Common side effects of Wellbutrin (bupropion) include:

• Trouble sleeping
• Feeling anxious
• Stuffy nose
• Nausea
• Dry mouth
• Constipation
• Dizziness
• Joint aches Serious side effects of Wellbutrin (bupropion) may include:
• Suicidal thoughts or actions
• New or worse mental health problems, such as changes in behavior or thinking, aggression, hostility, agitation, depression
• Seizures
• High blood pressure (hypertension)
• Manic episodes 2 2

From the Research

Wellbutrin Side Effects

• The most common side effects of Wellbutrin (bupropion) include agitation/excitement, which was the most common cause for discontinuation in clinical trials 3.
• There is a risk of about 1 in 1000 of seizures associated with bupropion use 4, 5, 6, 3.
• Bupropion has been associated with suicide risk, but whether this is causal is unclear 4, 6.
• Bupropion may increase the number of adverse events, including psychiatric adverse events, and there is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo 7.
• The observed incidence of seizures with bupropion doses of 450 mg/day or less ranged from 0.35%-0.44% 5.
• Bupropion has been associated with major motor seizure, with an incidence of less than 1 per 1,000 at usual outpatient doses and less than 1 per 100 at usual inpatient doses 3.

Serious Adverse Events

• Meta-analyses did not detect a significant increase in the rate of serious adverse events amongst participants taking bupropion, though the confidence interval only narrowly missed statistical significance 4.
• There is insufficient evidence to establish whether participants taking bupropion are more likely to report serious adverse events compared to those taking placebo 7.
• Nortriptyline has the potential for serious side-effects, but none have been seen in the few small trials for smoking cessation 4, 6.

Comparison with Other Medications

• Bupropion appears to be equally effective and of similar efficacy to nicotine replacement therapy 4, 6.
• Bupropion may be less effective than varenicline 4, 7, 6.
• There is no evidence that selective serotonin reuptake inhibitors (e.g. fluoxetine) aid smoking cessation 4, 7, 6.