What are the key counseling points for patients taking Wellbutrin XL (bupropion)?

Key Counseling Points for Wellbutrin XL (Bupropion)

Patients taking Wellbutrin XL should be counseled to swallow tablets whole with or without food in the morning, never to crush, divide or chew them, and to avoid taking multiple bupropion-containing products simultaneously to prevent overdose and seizure risk. 1

Administration Instructions

• Take Wellbutrin XL once daily in the morning, with or without food 1
• Swallow tablets whole - never crush, divide, or chew the tablets as this alters the release rate and increases seizure risk 1
• If a dose is missed, skip it and take the next dose at the regular time - do not double up to make up for missed doses 1
• Standard dosing typically starts at 150 mg once daily for 3 days, then increases to 300 mg once daily if tolerated 2

Safety Warnings

Seizure Risk

• Bupropion lowers seizure threshold - avoid in patients with:
  • History of seizures
  • Eating disorders
  • Brain tumors or structural abnormalities
  • Current alcohol/substance abuse 2
• Maximum daily dose should not exceed 450 mg to minimize seizure risk 2
• Avoid excessive alcohol use while taking Wellbutrin XL 1

Drug Interactions

• Inform healthcare provider about all medications, including over-the-counter drugs and supplements 1
• Do not take with other bupropion-containing products (Zyban, Wellbutrin SR, Aplenzin) 1
• Use caution with medications that lower seizure threshold 2
• May interact with medications metabolized by CYP2D6 enzyme 3
• Avoid use with MAO inhibitors or within 14 days of stopping an MAO inhibitor 2

Neuropsychiatric Effects

• Monitor for changes in mood, behavior, or thoughts, especially during the first few weeks of treatment or with dose changes 1
• Report any suicidal thoughts, agitation, hostility, or unusual behavior changes to healthcare provider immediately 1
• Young adults (under 24) require closer monitoring for suicidal thoughts 2

Other Important Warnings

• May cause mild pupillary dilation that could trigger angle-closure glaucoma in susceptible individuals 1
• May impair ability to drive or operate machinery - use caution until effects are known 1
• May decrease alcohol tolerance 1
• Report any severe skin reactions, including rash, hives, or swelling 2

Common Side Effects

• Insomnia and sleep disturbances (take medication in the morning to minimize this) 2
• Dry mouth 3
• Anxiety/jitteriness 2
• Headache 3
• Decreased appetite 2
• Nausea 3
• Potential for increased blood pressure and heart rate (periodic monitoring recommended) 2

Special Populations

• Pregnancy: Notify healthcare provider if pregnant or planning pregnancy 1
• Renal impairment: Dose should be reduced by half in moderate to severe renal impairment 2
• Hepatic impairment: Maximum one tablet daily 2
• Elderly: Consider lower starting doses 2

Discontinuation

• If discontinuation is necessary, implement gradual tapering (e.g., reducing to 150 mg once daily for 1-2 weeks before stopping) to minimize withdrawal symptoms 2
• Withdrawal symptoms may include neuropsychiatric symptoms, insomnia, headache, and mood changes 2

Unique Benefits

• Unlike many antidepressants, Wellbutrin XL has minimal sexual side effects 3
• May be beneficial for patients who are also trying to quit smoking 4
• May be helpful for patients with depression and ADHD symptoms 5

Remember that Wellbutrin XL is a once-daily formulation that offers convenience compared to other formulations of bupropion that require multiple daily doses. Adherence to these counseling points will help maximize benefits while minimizing risks.