Bupropion Side Effects
Bupropion is generally well-tolerated with common side effects including insomnia, dry mouth, headache, nausea, and anxiety, but carries a critical seizure risk of approximately 0.1% (1 in 1,000) at recommended doses that requires careful patient screening for predisposing factors. 1
Common Side Effects
The most frequently reported side effects include: 1, 2, 3
- Neurological effects: Insomnia, headache, dizziness, tremor, and feeling anxious or "jittery" 1, 2, 3
- Gastrointestinal effects: Dry mouth, nausea, constipation, and vomiting 1, 2, 3
- Other effects: Stuffy nose, joint aches 3
Only insomnia and dry mouth occur significantly more frequently with bupropion compared to placebo. 4 These common side effects are generally transient and often resolve without intervention, though dose reduction or timing adjustments can help if needed. 1
A notable advantage: bupropion has significantly lower rates of sexual dysfunction compared to SSRIs and causes minimal weight gain, making it particularly suitable for patients concerned about these side effects. 1
Serious Side Effects Requiring Immediate Attention
Seizure Risk
The seizure risk is approximately 0.1% (1 in 1,000) at the maximum recommended dose of 300 mg/day when patients are properly screened, but increases substantially with higher doses or in patients with predisposing factors. 1, 4
Absolute contraindications for seizure risk include: 1, 2
- Prior history of seizures or structural brain lesions (from stroke, tumor, or trauma) 1, 2
- Brain metastases 1
- Eating disorders (bulimia or anorexia nervosa) due to electrolyte disturbances 1, 2
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs 1
If a seizure occurs while taking bupropion, stop the medication immediately and do not restart it. 3
Cardiovascular Effects
- Hypertension: Some patients develop high blood pressure that can be severe, particularly when combined with nicotine replacement therapy 3
- Tachycardia and palpitations: Monitor blood pressure and heart rate, especially during the first 12 weeks of treatment 2
Neuropsychiatric Effects
Bupropion carries FDA black box warnings for suicidal thoughts and behavior, particularly in young adults under age 24. 3 Watch for: 3
- New or worsening depression
- New or worsening anxiety or panic attacks
- Agitation, restlessness, or aggressive behavior
- Suicidal thoughts or attempts
- Mania or hypomania (extreme increase in activity and talking)
Hypersensitivity Reactions
Severe allergic reactions occur in approximately 0.1% of patients. 1 Notably, delayed hypersensitivity reactions (including pruritus and urticaria) can appear 2 or more weeks after starting bupropion, with highest risk in males aged 17-40 years. 5
Critical Drug Interactions and Contraindications
Absolute contraindications include: 1, 2
- Concurrent use with MAO inhibitors or within 14 days of discontinuing MAOIs (risk of hypertensive crisis) 1, 2
- Concurrent use with tamoxifen 1
- Patients with closed-angle glaucoma 1
Special Precautions
Alcohol Use
Limit or avoid alcohol during bupropion treatment. 3 If you typically drink heavily, coordinate with your healthcare provider for safe alcohol cessation—abrupt alcohol discontinuation while on bupropion significantly increases seizure risk. 1, 3
Dosing Considerations
Do not exceed 300 mg/day for smoking cessation or 450 mg/day for depression. 1 Take doses at least 24 hours apart for XL formulation. 3 Never crush, chew, or cut extended-release tablets, as this releases the medication too quickly and increases seizure risk. 3
Timing to Minimize Insomnia
Take the first dose in the morning and any second dose before 3 PM to minimize insomnia risk. 1 Do not take bupropion too close to bedtime. 3
Warning Signs Requiring Immediate Medical Attention
Contact your healthcare provider immediately if you experience: 1
- Seizure activity
- Severe agitation or "jittery" feeling
- Severe allergic reactions (rash, hives, difficulty breathing)
- Chest pain or severe palpitations
- Severe hypertension symptoms
- New or worsening suicidal thoughts
Management Approach
Most common side effects resolve spontaneously within the first few weeks of treatment. 1, 4 If side effects persist, consider dose reduction or timing adjustments before discontinuing the medication. 1 Never stop bupropion abruptly without consulting your healthcare provider. 3
Important note: Bupropion may cause false-positive urine drug screens for amphetamines; inform testing personnel that you are taking this medication. 3