Do Wellbutrin (bupropion), Trileptal (oxcarbazepine), Abilify (aripiprazole), and Remeron (mirtazapine) cause blurred vision?

Which of These Medications Can Cause Blurry Vision?

All four medications—Wellbutrin (bupropion), Trileptal (oxcarbazepine), Abilify (aripiprazole), and Remeron (mirtazapine)—can cause blurry vision, but they differ significantly in frequency and mechanism.

Bupropion (Wellbutrin)

Bupropion is specifically listed as a medication that can cause corneal edema 1, which directly impairs vision. A case report documented bupropion-induced diplopia (double vision) and blurred vision in a patient taking 225 mg daily, with symptoms resolving within one week after discontinuation 2. In a large-scale analysis of the FDA Adverse Event Reporting System, bupropion was not among the highest-risk medications for visual blurring, but visual disturbances have been documented 3.

• Mechanism: Likely related to corneal effects and potential anticholinergic properties
• Clinical significance: Moderate risk; symptoms typically resolve with discontinuation

Oxcarbazepine (Trileptal)

Oxcarbazepine is an antiepileptic drug with well-documented ocular side effects. A comprehensive analysis of the FDA database identified oxcarbazepine as being primarily associated with cornea-related adverse events 4. The broader literature on antiepileptic drugs confirms that diplopia, blurred vision, and nystagmus are common non-specific visual disturbances with these medications 5.

• Mechanism: Neurotoxic effects on visual pathways; corneal involvement
• Clinical significance: Common side effect, particularly with dose escalation or polytherapy

Aripiprazole (Abilify)

The FDA drug label for Abilify explicitly lists blurred vision as one of the most common side effects in adults 6. In clinical trials, blurred vision occurred frequently enough to be included in the standard adverse event profile. The label also notes this as a common side effect across multiple indications 6.

• Mechanism: Likely dopaminergic and serotonergic effects on accommodation
• Clinical significance: Well-established common side effect; listed prominently in FDA labeling

Mirtazapine (Remeron)

While mirtazapine is mentioned in multiple guidelines 7, 8, none of the guideline evidence specifically lists blurred vision as a common side effect. The drug is generally described as "well tolerated" with primary side effects being sedation, weight gain, and increased appetite 7. However, the absence of specific mention in these guidelines doesn't definitively rule out visual disturbances, as comprehensive adverse event profiles may not be fully detailed in treatment guidelines.

• Mechanism: If present, likely related to antihistaminic or anticholinergic properties
• Clinical significance: Least likely of the four to cause blurred vision based on available evidence

Clinical Approach

When evaluating blurred vision in a patient taking these medications:

1. Abilify: Check FDA label warnings—this is a recognized common side effect 6
2. Trileptal: Consider dose-related neurotoxicity; examine for nystagmus and corneal changes 5, 4
3. Wellbutrin: Assess for corneal edema; symptoms should resolve within days of discontinuation 1, 2
4. Remeron: Least likely culprit; consider other causes first

Important caveats:

• Visual symptoms with antiepileptics like Trileptal often worsen with polytherapy 5
• Bupropion-related visual changes typically occur at therapeutic doses and resolve quickly after stopping 2
• Abilify's visual effects are dose-independent and represent a class effect of atypical antipsychotics 6