Zyban (Bupropion) is Contraindicated in Patients with Seizure Disorders
Bupropion should NOT be used in patients taking carbamazepine for a seizure disorder, as bupropion is absolutely contraindicated in anyone with a current or prior seizure disorder. 1
FDA Contraindication
The FDA drug label for bupropion explicitly states: "Do not take bupropion hydrochloride extended-release tablets (XL) if you have or had a seizure disorder or epilepsy." 1 This is an absolute contraindication, not a relative one requiring careful consideration.
Mechanism and Risk
Bupropion lowers the seizure threshold and can precipitate generalized tonic-clonic seizures even in patients without prior seizure history. 2
The incidence of seizures at the standard 300 mg/day dose is approximately 1 in 1,000 patients treated. 2
The risk increases with higher doses of bupropion, making dose escalation particularly dangerous in seizure-prone patients. 1
Case reports document generalized tonic-clonic seizures occurring within days of starting bupropion at standard doses, even in patients with no personal seizure history. 2
Additional Contraindications from FDA Label
Beyond active seizure disorders, bupropion is also contraindicated if the patient: 1
- Has a history of eating disorders (anorexia nervosa or bulimia)
- Is taking any other bupropion-containing products (Wellbutrin, Wellbutrin SR, Aplenzin, Forfivo XL)
- Abruptly stops alcohol, sedatives, benzodiazepines, or anti-seizure medications
- Is taking or recently stopped MAOIs (within 2 weeks)
Clinical Implications
There is no safe way to use bupropion in a patient with an active seizure disorder being treated with carbamazepine. 1 The contraindication exists regardless of how well-controlled the seizures are on carbamazepine.
If smoking cessation is the goal, alternative pharmacotherapy options that are NOT contraindicated in seizure disorders include: 3
- Nicotine replacement therapy (NRT) - patches, gum, lozenges, nasal spray, or oral inhaler
- Varenicline (Chantix) - though it should be used with caution in patients with brain metastases due to seizure risk 3
Common Pitfall to Avoid
Do not attempt to use bupropion at lower doses or with "careful monitoring" in patients with seizure disorders. 1 The contraindication is absolute because seizure occurrence with bupropion is an idiosyncratic, unpredictable adverse effect that cannot be reliably prevented through dose adjustment or monitoring. 2