Wellbutrin (Bupropion) for Alcohol Use Disorder
Wellbutrin (bupropion) is not recommended for treating alcohol use disorder and may actually be less effective than other antidepressants when alcohol use disorder is present. 1
Evidence Against Bupropion Use in Alcohol Use Disorder
Reduced Efficacy in Comorbid Conditions
- In patients with major depressive disorder and comorbid alcohol use disorder, bupropion was associated with significantly lower odds of antidepressant response (OR = 0.22, p = 0.024) compared to patients without alcohol use disorder. 1
- This reduced efficacy suggests that bupropion should be avoided when treating depression in patients with concurrent alcohol problems. 1
Not Included in Evidence-Based Guidelines
- Multiple major clinical practice guidelines for alcohol use disorder management (KASL 2013, EASL 2012, AASLD 2020) do not mention bupropion as a treatment option for alcohol use disorder. 2
- The FDA-approved medications for alcohol use disorder are limited to naltrexone, acamprosate, and disulfiram—bupropion is not among them. 2, 3
Potential Safety Concerns
- The FDA label for bupropion specifically warns about minimizing or avoiding alcohol consumption during treatment, as rare reports exist of adverse neuropsychiatric events or reduced alcohol tolerance in patients drinking while on bupropion. 4
- Bupropion has documented abuse potential, particularly in patients with substance use disorder history, which raises concerns in the alcohol use disorder population. 5
Recommended Pharmacotherapy Options Instead
FDA-Approved First-Line Agents
- Naltrexone (50 mg/day orally or 380 mg monthly IM) decreases dopamine concentration and dampens the alcohol reward pathway, reducing excessive drinking and increasing abstinence duration. 2, 3
- Acamprosate (1,998 mg/day for patients ≥60 kg) reduces withdrawal effects and craving, effectively maintaining abstinence after withdrawal is complete. 2, 3
- Gabapentin has strong evidence for reducing heavy-drinking days. 3
Special Consideration for Liver Disease
- Baclofen (30-60 mg/day) is the preferred option for patients with alcoholic liver disease, as it has been specifically studied in cirrhosis patients and effectively maintains abstinence. 2
- Naltrexone should be avoided in patients with alcoholic liver disease due to hepatotoxicity risk. 2
Critical Clinical Pitfall
The most important pitfall is assuming that bupropion, because it is used for smoking cessation (another substance use disorder), would be beneficial for alcohol use disorder. The evidence demonstrates the opposite—it may actually worsen treatment outcomes when alcohol use disorder is present. 1