Initiating Wellbutrin (Bupropion) in Daily Marijuana Users
Initiating Wellbutrin (bupropion) in patients who smoke marijuana daily is not recommended as bupropion can worsen marijuana withdrawal symptoms and mood disturbances during periods of marijuana abstinence. 1
Interaction Between Bupropion and Marijuana
Evidence of Negative Interactions
Research specifically examining bupropion use in marijuana users found that during marijuana withdrawal, bupropion significantly increased symptoms of:
- Irritability
- Restlessness
- Depression
- Sleep disturbances 1
These exacerbated withdrawal symptoms suggest bupropion may be counterproductive for patients who regularly use marijuana, especially if they might reduce or stop their marijuana use during treatment.
Pharmacological Considerations
- Bupropion acts on dopaminergic and noradrenergic systems, which also interact with the endocannabinoid system affected by marijuana use 1
- This pharmacological overlap may explain the negative interaction observed in clinical studies
Alternative Approaches for Patients Using Marijuana
Smoking Cessation Options
- For patients seeking smoking cessation treatment who also use marijuana daily:
- Nicotine replacement therapy may be a safer first-line option
- Varenicline has demonstrated greater efficacy than bupropion for smoking cessation (without the specific marijuana interaction concerns) 2
If Bupropion Is Clinically Necessary
If a provider determines bupropion is still clinically indicated despite marijuana use:
- Discuss the potential for worsened mood symptoms if marijuana use is reduced
- Monitor more frequently for adverse effects, particularly mood changes
- Consider starting at lower doses (150 mg daily) and titrating slowly 3
- Be vigilant for signs of:
- Increased irritability
- Depression
- Sleep disturbances
- Anxiety 1
Additional Considerations
Cardiovascular Monitoring
- Both bupropion and cannabis can affect cardiovascular parameters
- Regular monitoring of blood pressure and heart rate is necessary, especially during the first 12 weeks of bupropion treatment 4
Seizure Risk
- Bupropion carries a dose-dependent risk of seizures (approximately 0.1% at recommended doses)
- Patients should be screened for predisposing seizure risk factors
- Maximum daily dose should not exceed 300mg 3
Common Side Effects to Monitor
- Insomnia (most common side effect)
- Dry mouth
- Anxiety/jitteriness
- Decreased appetite
- Headache 3
Conclusion
Given the evidence showing bupropion worsens mood during marijuana withdrawal and the availability of alternative treatments for common indications, initiating bupropion in daily marijuana users should generally be avoided unless the potential benefits clearly outweigh the risks of worsened mood symptoms and other potential adverse effects.