From the FDA Drug Label
The elimination of the major metabolites of bupropion may be reduced by impaired renal function Bupropion hydrochloride extended-release tablets (XL) should be used with caution in patients with renal impairment, and a reduced frequency and/or dose should be considered An inter-trial comparison between normal subjects and subjects with end-stage renal failure demonstrated that the parent drug C max and AUC values were comparable in the 2 groups, whereas the hydroxybupropion and threohydrobupropion metabolites had a 2.3- and 2.8-fold increase, respectively, in AUC for subjects with end-stage renal failure.
Bupropion may cause impaired renal function indirectly by accumulating its metabolites in the body due to reduced renal function. The drug label recommends using bupropion with caution in patients with renal impairment and considering a reduced frequency and/or dose 1.
From the Research
Bupropion (Wellbutrin) is generally not known to cause impaired renal function in most patients, as it is primarily metabolized by the liver rather than the kidneys. However, patients with pre-existing kidney disease should inform their healthcare provider before starting Wellbutrin, as dosage adjustments may be necessary. The most common side effects of Wellbutrin include dry mouth, insomnia, headache, nausea, and anxiety, rather than kidney problems 2. A study published in 2007 found that bupropion pharmacokinetics were affected in patients with impaired kidney function, with a 126% increase in AUC and a 63% decrease in CL/F compared to healthy subjects 2. However, the clinical significance of these findings is unclear, and no dosage adjustment is typically needed for patients with mild to moderate kidney impairment. In patients with severe kidney disease, careful monitoring and potential dosage adjustments may be necessary to minimize the risk of adverse effects. It is essential to note that any unusual symptoms while taking Wellbutrin, such as changes in urination patterns, swelling in the extremities, or unexplained weight gain, should prompt immediate medical attention. Overall, the available evidence suggests that bupropion is not a significant cause of impaired renal function, but patients with pre-existing kidney disease should be closely monitored while taking this medication 2.
Some key points to consider when prescribing bupropion to patients with kidney disease include:
- Bupropion is primarily metabolized by the liver, but its metabolites are renally excreted
- Patients with severe kidney disease may require dosage adjustments or careful monitoring
- The most common side effects of bupropion are not related to kidney function
- Any unusual symptoms while taking bupropion should prompt immediate medical attention
- The clinical significance of changes in bupropion pharmacokinetics in patients with kidney disease is unclear, but careful monitoring is recommended 2.
In terms of specific dosage recommendations, no clear guidelines are available for patients with kidney disease, but careful monitoring and potential dosage adjustments may be necessary to minimize the risk of adverse effects. It is essential to weigh the potential benefits and risks of bupropion therapy in patients with kidney disease and to closely monitor these patients for any signs of adverse effects. Overall, the available evidence suggests that bupropion is a relatively safe medication for patients with kidney disease, but careful monitoring and potential dosage adjustments may be necessary to minimize the risk of adverse effects 2.