Wellbutrin (Bupropion) Contraindications
Bupropion is absolutely contraindicated in patients with seizure disorders, current or prior bulimia/anorexia nervosa, those undergoing abrupt discontinuation of alcohol/benzodiazepines/barbiturates/antiepileptics, concurrent MAOI use (or within 14 days), and uncontrolled hypertension. 1
Absolute Contraindications
Seizure-Related Contraindications
- Any history of seizure disorder or epilepsy is an absolute contraindication due to bupropion's dose-dependent reduction of seizure threshold 2, 1
- Current or prior diagnosis of bulimia or anorexia nervosa carries higher seizure incidence and is contraindicated 1, 2
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs is contraindicated due to additive seizure risk 1
- Patients with brain metastases should avoid bupropion due to increased seizure risk 2
The seizure risk is approximately 0.1% (1/1000 patients) at doses up to 300 mg/day, increasing at higher doses 2, 3. This risk is comparable to other antidepressants when dosing guidelines are followed 4, 5.
MAOI Interactions
- Concurrent use with MAOIs or within 14 days of MAOI discontinuation is contraindicated due to hypertensive crisis risk 1, 2
- Reversible MAOIs (linezolid, intravenous methylene blue) are also contraindicated; if urgent treatment is needed, stop bupropion promptly and monitor for 2 weeks or 24 hours after last MAOI dose 1
Cardiovascular Contraindications
- Uncontrolled hypertension is a contraindication, as bupropion can elevate blood pressure and heart rate 6, 2
Other Absolute Contraindications
- Acute angle-closure glaucoma (bupropion may worsen this condition) 6, 2
- Chronic opioid use when bupropion is combined with naltrexone (due to opioid antagonism) 6, 2
- Known hypersensitivity to bupropion, including anaphylactoid/anaphylactic reactions and Stevens-Johnson syndrome 1
Pregnancy and Lactation
- Contraindicated in pregnancy and breastfeeding, particularly when used in combination formulations (naltrexone/bupropion) for obesity treatment 6, 2
- Women of reproductive potential require counseling on reliable contraception 6
Critical Warnings
Black Box Warning
- Risk of suicidal behavior/ideation in patients younger than 24 years with depression, requiring close monitoring especially during initial treatment months 6
Dose-Dependent Risks
- Maximum dose should not exceed 450 mg/day to minimize seizure risk 7
- Seizure incidence increases significantly above 300 mg/day 3
Common Pitfalls to Avoid
- Do not overlook remote seizure history or family history of seizures - even patients without personal seizure history can develop new-onset seizures on bupropion 8, 3
- Screen for eating disorders carefully - patients may not volunteer this history 1
- Assess for recent benzodiazepine or alcohol discontinuation - this creates additive seizure risk 1
- Check all concurrent medications for MAOI interactions and drugs that lower seizure threshold 7, 1
- Monitor blood pressure before and during treatment, especially in patients with borderline hypertension 6