From the Guidelines
Bupropion (Wellbutrin) is associated with an increased risk of muscle twitching, although the evidence is limited and mostly indirect, as it can increase neuronal excitability and has been linked to seizures and other movement disorders 1. When considering the use of bupropion, it's essential to weigh the potential benefits against the risks, including the possibility of muscle twitching.
- The mechanism by which bupropion causes muscle twitching is not fully understood but is thought to be related to its effects on the central nervous system, particularly its ability to increase the levels of certain neurotransmitters like norepinephrine and dopamine.
- While the study by the American College of Physicians does not directly address muscle twitching as a common side effect of bupropion, it does mention that weak evidence indicates bupropion may be associated with an increased risk for seizures 1.
- It's crucial for patients experiencing muscle twitching while on bupropion to consult their healthcare provider, as the severity and persistence of the twitching can vary and may necessitate a dosage adjustment or a switch to a different medication.
- Patients should not stop taking bupropion abruptly without medical guidance to avoid potential withdrawal symptoms.
- Maintaining good hydration and ensuring adequate levels of essential electrolytes like magnesium and potassium may help mitigate muscle twitching in some cases, although this is more of a general health recommendation rather than a bupropion-specific guideline.
From the FDA Drug Label
Musculoskeletal Myalgia 3% 2% 6% Arthralgia 1% 1% 4% Arthritis 0% 0% 2% Twitch - 1% 2% Leg cramps, fever/rhabdomyolysis, and muscle weakness Muscle rigidity, rhabdomyolysis
Bupropion (Wellbutrin) is associated with muscle twitching, as evidenced by the reported adverse reactions of "Twitch" in 1-2% of patients, as well as other musculoskeletal symptoms such as myalgia, arthralgia, and muscle weakness. 2
From the Research
Bupropion and Muscle Twitching
- Bupropion has been associated with various movement disorders, including myoclonus, which is characterized by sudden, involuntary muscle twitching 3.
- A case report described a 58-year-old male who experienced abnormal movements in his upper limbs and diffuse facial twitching after doubling his bupropion dosage without medical advice 3.
- Another case report discussed a patient who developed acute dystonia, characterized by prolonged muscle contraction, after taking a single dose of 75 mg bupropion 4.
- While muscle twitching is not a commonly reported side effect of bupropion, it is essential to be aware of the potential risk, especially when combining bupropion with other medications that affect serotonin reuptake 4.
- A review of adult, acute, unintentional therapeutic error, single substance bupropion ingestions reported to four poison centers found that "jittery"/anxious/agitated symptoms were present in 27% of cases, which may be related to muscle twitching 5.
Mechanism and Risk Factors
- The mechanism of bupropion-induced myoclonus is thought to be associated with the serotoninergic pathway 3.
- The risk of bupropion-induced movement disorders may be higher when the medication is combined with other drugs that affect serotonin reuptake 4.
- Patients with a history of allergic reactions or those who experience delayed hypersensitivity reactions to bupropion may be at a higher risk of developing movement disorders 6.
Management and Treatment
- Discontinuation of bupropion is often the most effective management strategy for patients who experience myoclonus or other movement disorders 3.
- In some cases, clonazepam may be initiated to help manage symptoms 3.
- It is essential to monitor patients for signs of movement disorders, especially when starting or adjusting bupropion therapy 4.