Can Wellbutrin (bupropion) cause pruritis?

Wellbutrin (Bupropion) and Pruritus

Yes, Wellbutrin (bupropion) can cause pruritus (itching) as documented in the FDA drug label, with pruritus occurring in approximately 4% of patients taking the medication. 1

Evidence from Drug Labeling

• The FDA drug label for bupropion specifically lists pruritus as an adverse reaction occurring in 4% of patients taking the medication, compared to 2% in placebo groups 1
• Hypersensitivity reactions to bupropion have been characterized by pruritus, urticaria, angioedema, and dyspnea, requiring medical treatment 1
• The FDA label instructs patients to discontinue bupropion and consult a healthcare provider if they develop allergic reactions including pruritus and other symptoms 1

Timing and Presentation of Bupropion-Induced Pruritus

• Pruritus from bupropion can present as:
  • Immediate hypersensitivity reaction (anaphylactoid/anaphylactic) 1
  • Delayed hypersensitivity reaction (often appearing 2-4 weeks after initiation) 2
• Delayed allergic reactions may be particularly underrecognized when onset occurs more than 2 weeks after starting bupropion 2
• The risk of delayed hypersensitivity reactions may be highest in males aged 17 to 40 years and those with a history of allergic reactions 2

Associated Dermatological Manifestations

• Bupropion-induced pruritus may occur with or without visible skin manifestations 1
• When skin manifestations are present, they commonly include:
  • Urticaria (hives) 2, 3
  • Rash 1
  • In rare cases, more severe reactions like Stevens-Johnson syndrome 4
• Patients with pre-existing skin conditions like psoriasis may experience exacerbation when taking bupropion 4, 5

Management of Bupropion-Induced Pruritus

• If pruritus develops while taking bupropion, the drug should be discontinued 1
• For mild symptoms, antihistamines may provide relief 2
• For more severe reactions involving angioedema or extensive skin involvement, emergency medical treatment may be required 6
• Switching to an alternative antidepressant from a different class is recommended 2

Important Clinical Considerations

• Pruritus may be the first sign of a potentially more serious hypersensitivity reaction 1
• There have been rare reports of more severe reactions including erythema multiforme, Stevens-Johnson syndrome, and anaphylactic shock associated with bupropion 1
• Patients should be educated about this potential side effect and instructed to report any itching or skin changes promptly 1
• The British Association of Dermatologists guidelines note that medication-induced pruritus is an important differential diagnosis in patients presenting with generalized pruritus without an underlying dermatosis 7

While most cases of bupropion-induced pruritus resolve with discontinuation of the medication, clinicians should remain vigilant for signs of progression to more severe hypersensitivity reactions that may require immediate intervention 1, 6.