Wellbutrin and Stevens-Johnson Syndrome Risk
Bupropion (Wellbutrin) is associated with rare but documented cases of Stevens-Johnson syndrome (SJS), and the FDA drug label explicitly warns of this potentially life-threatening hypersensitivity reaction. 1
FDA-Recognized Risk
The official FDA prescribing information for bupropion clearly states that there have been rare, spontaneous postmarketing reports of Stevens-Johnson syndrome associated with bupropion use. 1 The drug label also documents related severe hypersensitivity reactions including:
- Erythema multiforme 1
- Anaphylactic shock 1
- Anaphylactoid/anaphylactic reactions characterized by pruritus, urticaria, angioedema, and dyspnea 1
Clinical Evidence
A documented case report confirms bupropion-induced Stevens-Johnson syndrome in a 56-year-old woman who began taking bupropion for depression, demonstrating this is not merely theoretical but occurs in clinical practice. 2 This case also revealed concomitant acute psoriatic exacerbation, though the FDA label does not specifically mention worsening of psoriasis. 2
Comparative Context
While bupropion can cause SJS, the absolute risk remains extremely low. Large epidemiologic studies examining drug-induced SJS/TEN show that the highest-risk medications include: 3
- Sulfonamide antibiotics (relative risk 172) 3
- Anticonvulsants during first 2 months: carbamazepine (RR 90), phenytoin (RR 53), phenobarbital (RR 45) 3
- Oxicam NSAIDs (RR 72) 3
- Allopurinol (RR 52) 3
Bupropion is not listed among the most notorious SJS-causing medications in major dermatology guidelines. 4
Clinical Management Recommendations
Immediately discontinue bupropion if any signs of hypersensitivity reaction develop, including: 1
- Skin rash
- Pruritus or hives
- Chest pain
- Edema
- Shortness of breath
- Mucosal lesions (oral, genital, ocular)
Patients should be counseled at initiation that while rare, severe skin reactions can occur and require immediate medical attention and drug discontinuation. 1
Special Populations at Higher Risk
Exercise particular caution when prescribing bupropion to patients with: 2, 5
- Pre-existing psoriasis (documented cases of acute exacerbation) 2
- History of drug hypersensitivity reactions 4
- Concurrent use of other medications known to cause SJS (avoid polypharmacy when possible) 6
Timeline Considerations
Drug-induced SJS/TEN typically occurs 5-28 days following drug initiation, unless there is previous exposure to the same drug, in which case the latency may be shorter. 4 Monitor patients most closely during the first month of therapy.
Key Pitfall to Avoid
Do not confuse early drug-associated rash with other benign dermatologic reactions. 4 Any mucosal involvement, target lesions, skin pain, or positive Nikolsky's sign warrants immediate evaluation for SJS/TEN and drug discontinuation. 7