Bupropion 150 mg Side Effects
Bupropion 150 mg is generally well-tolerated with the most common side effects being insomnia, dry mouth, headache, nausea, and anxiety, though the most serious concern is seizure risk (approximately 0.1% at recommended doses) which requires careful screening for predisposing factors. 1, 2
Common Side Effects
The following side effects occur frequently but are typically transient and often resolve without intervention:
- Insomnia - one of the most common side effects, can be managed by ensuring the second dose is taken before 3 PM 1, 3
- Dry mouth - occurs significantly more frequently than placebo and is generally self-limited 1, 3
- Headache - commonly reported neurological effect 1, 4
- Nausea and vomiting - gastrointestinal effects occurring in 2-4% of patients 1, 4
- Dizziness - frequent neurological side effect 1, 4
- Constipation - common enough to be listed among primary adverse effects 1
- Tremor - neurological effect requiring monitoring 1
- Anxiety and agitation - though these can also be symptoms of the underlying condition being treated 3, 5
Serious Side Effects Requiring Immediate Attention
Seizure Risk
The seizure risk is approximately 0.1% (1 in 1,000) at the recommended maximum dose of 300 mg/day when patients are properly screened. 2, 3 This risk increases substantially with:
- Higher doses above recommended maximum 6
- Presence of predisposing factors including:
If a seizure occurs while taking bupropion, stop the medication immediately and do not restart. 7
Cardiovascular Effects
- Hypertension - can be severe in some patients; blood pressure should be monitored especially during the first 12 weeks 1, 7
- Tachycardia and palpitations - cardiovascular effects ranging from mild to severe 1
- The risk of hypertension may be higher when combined with nicotine replacement therapy 7
Neuropsychiatric Effects
Bupropion carries a black box warning for increased risk of suicidal thoughts and behavior, particularly in patients younger than 24 years. 8, 7 Monitor closely for:
- New or worsening depression 7
- Suicidal thoughts or actions 7
- Unusual changes in behavior or mood 7
- Severe agitation or restlessness 7
- Panic attacks 7
- New or worse irritability, aggression, or hostility 7
- Acting on dangerous impulses 7
- Manic episodes (extreme increase in activity and talking) 7
These symptoms require immediate contact with healthcare provider and may necessitate discontinuation. 7
Hypersensitivity Reactions
Severe hypersensitivity reactions occur in approximately 0.1% of patients and require immediate medical attention. 3
Cardiovascular and Metabolic Advantages
Unlike many antidepressants, bupropion has favorable characteristics:
- Significantly lower rates of sexual dysfunction compared to SSRIs 2, 9
- Minimal weight gain or even weight loss (unlike most other antidepressants) 9
- Lower rates of sedation than SSRIs 8
- 10 to 100 times less likely to induce cardiac conduction problems than tricyclic drugs 6
- Orthostatic hypotension is rare 6
Critical Contraindications
Bupropion is absolutely contraindicated in patients with:
- History of seizures or any condition predisposing to seizures 1, 2
- Current or recent (within 14 days) use of MAO inhibitors - risk of hypertensive crisis 1, 2
- Eating disorders (bulimia or anorexia nervosa) 1, 2
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs 1, 2
- Concurrent use with tamoxifen 8
- Uncontrolled hypertension 8, 1
Management of Common Side Effects
Most common side effects are transient and can be managed without discontinuation: 2, 3
- For insomnia: Ensure second dose is taken before 3 PM; consider dose reduction if severe 8, 2
- For dry mouth: Typically self-limited; symptomatic treatment as needed 2, 3
- For nausea: Usually resolves within 4-5 days; symptomatic management 9
- For agitation: Monitor closely; may require dose adjustment 5
Monitoring Requirements
- Blood pressure and heart rate - especially during first 12 weeks of treatment 8, 1
- Mental status and suicidal ideation - particularly in patients under 24 years, with close monitoring in first 1-2 weeks and throughout first 1-2 months when suicide risk is greatest 8
- Seizure warning signs - educate patients about importance of not exceeding prescribed doses 1
Important Clinical Considerations
Discontinuation rates due to adverse events in clinical trials are low (6-12%), indicating good overall tolerability. 3 However, never stop bupropion suddenly without consulting a healthcare provider, as this can cause withdrawal symptoms. 7 When discontinuation is necessary, gradual dose reduction is recommended. 8