Can Wellbutrin (bupropion) cause tremors?

Wellbutrin (Bupropion) and Tremors

Yes, Wellbutrin (bupropion) can definitely cause tremors or shaking, as this is a well-documented side effect listed in the FDA drug label.

Mechanism and Evidence

Bupropion works by inhibiting the reuptake of norepinephrine and dopamine, which creates a stimulating effect that can manifest as tremors. According to the FDA drug label, tremor is specifically listed among the common adverse reactions that occur in at least 5% of patients treated with bupropion sustained-release formulation at 300 mg/day 1.

The stimulating properties of bupropion can increase energy levels but may simultaneously trigger anxiety-like symptoms and tremors due to its mechanism of action 2.

Frequency and Presentation

Tremors from bupropion typically present as:

• Fine shaking of the hands
• May be more noticeable when performing precise tasks
• Can occur at therapeutic doses
• More likely at higher doses (300-400 mg/day)
• May worsen with anxiety or stress

Risk Factors for Bupropion-Induced Tremors

Several factors can increase the risk of experiencing tremors while taking Wellbutrin:

1. Dose-related effects: Higher doses (300-400 mg/day) are more likely to cause tremors than lower doses 1

2. Renal impairment: Patients with kidney disease may have reduced clearance of bupropion, potentially increasing the risk of side effects including tremors 3

3. Elderly patients: Older adults may be more susceptible to tremors due to altered drug metabolism 3

4. Concomitant medications: Combining bupropion with other medications that can cause tremors may exacerbate this side effect 2

5. Pre-existing neurological conditions: Patients with underlying tremor disorders may experience worsening of symptoms

Management of Bupropion-Induced Tremors

If a patient experiences tremors while taking Wellbutrin, consider the following approach:

1. Dose adjustment: Reducing the dose may alleviate tremors while maintaining therapeutic effect 3

2. Timing modification: Taking the medication earlier in the day may reduce the impact of tremors on daily activities

3. Gradual discontinuation: If tremors are severe or intolerable, gradual tapering is recommended rather than abrupt discontinuation 2

4. Alternative medications: For patients with significant anxiety or tremors, consider alternative antidepressants such as SSRIs or mirtazapine 2

When to Be Concerned

While tremors are a common side effect, they may sometimes indicate more serious issues:

• Severe or sudden-onset tremors
• Tremors accompanied by other neurological symptoms
• Tremors that significantly impact quality of life or daily functioning

In a case report, an 84-year-old male with renal impairment developed progressive tremor, truncal ataxia, and mental status changes after bupropion initiation, which resolved after dose reduction and eventual discontinuation 3.

Monitoring Recommendations

Regular monitoring is essential, especially during the first few weeks of treatment or after dose adjustments. Pay particular attention to:

• Tremor severity and impact on daily activities
• Blood pressure and heart rate (bupropion can also increase these) 2
• Other neuropsychiatric symptoms that may accompany tremors

Conclusion

Tremors are a recognized side effect of Wellbutrin that typically result from its norepinephrine and dopamine reuptake inhibition. While usually not dangerous, they can be bothersome to patients and may require dose adjustment or medication change if severe or persistent.