Can blurry vision be a side effect of taking Wellbutrin (bupropion)?

Blurry Vision with Wellbutrin (Bupropion)

Yes, blurry vision can occur as a side effect of Wellbutrin (bupropion), though it is relatively uncommon and typically resolves after discontinuation of the medication. 1, 2

Documented Evidence of Visual Side Effects

The FDA-approved prescribing information for bupropion specifically warns that the medication can cause "blurred vision" as part of its potential to impair cognitive and motor function. 1 Additionally, case reports have documented visual disturbances including:

• Diplopia (double vision) occurring after 4 weeks of treatment at 225 mg daily, which resolved within one week of discontinuation 2
• Blurred vision as part of the anticholinergic-like effects common to antidepressants 3

Mechanism and Clinical Presentation

Bupropion's visual side effects likely occur through multiple mechanisms:

• Pupillary dilation (mydriasis) can occur with bupropion, similar to other antidepressants, which may cause transient blurred vision 3
• Accommodation interference affecting the eye's ability to focus, particularly for near vision 3
• The medication's stimulant properties affecting the autonomic nervous system 4

Risk of Angle-Closure Glaucoma

A critical safety concern is that bupropion can cause mild pupillary dilation, which in susceptible individuals may trigger an episode of angle-closure glaucoma. 1 The FDA labeling specifically advises:

• Patients should be examined to determine if they are susceptible to angle closure
• Those at risk may benefit from prophylactic iridectomy before starting treatment 1
• Pre-existing open-angle glaucoma is NOT a risk factor for this complication 1

Management Algorithm

When a patient on bupropion reports blurred vision:

1. Immediate assessment: Determine if vision changes are accompanied by eye pain, halos around lights, or headache (suggesting acute angle-closure glaucoma requiring emergency ophthalmology referral) 1

2. For non-emergent blurred vision:

   • Document onset timing relative to medication initiation or dose changes 2
   • Check for other anticholinergic symptoms (dry mouth, constipation, urinary retention) 3
   • Assess if symptoms interfere with driving or daily activities 1

3. Consider dose reduction first: If symptoms are mild and tolerable, reducing the bupropion dose may resolve the issue while maintaining therapeutic benefit 1

4. Discontinue if severe: For persistent or bothersome blurred vision, discontinue bupropion and switch to an alternative antidepressant 2

5. Ophthalmology referral: Obtain consultation if symptoms persist after discontinuation or if any concerning features are present 2

Important Caveats

• Maximum daily dose should not exceed 450 mg to minimize all adverse effects including visual disturbances 4
• Visual symptoms typically resolve within days to one week after discontinuation 2
• Patients should be instructed to report visual changes immediately, as the FDA labeling emphasizes that bupropion may impair tasks requiring visual judgment 1
• The combination of bupropion with other medications affecting the autonomic nervous system may increase risk of visual side effects 4