Which Medication is Most Likely Causing Your Pain?
Bupropion (Wellbutrin) is the most likely culprit for your joint and muscle pain, particularly since you recently restarted it. 1, 2
Evidence for Bupropion-Induced Musculoskeletal Pain
Bupropion has documented associations with joint and muscle symptoms that can occur within 24-48 hours of starting or increasing the dose. 1 Specifically:
- Acute dystonia (neck stiffness, jaw muscle tightness, TMJ pain) has been reported with bupropion, particularly at doses of 150 mg twice daily 1
- Serum sickness-like reactions with arthralgia and urticaria occur as hypersensitivity reactions to bupropion 2
- Acute monoarthritis has been documented, though rare, starting within days of bupropion initiation 2
- Arthralgias are listed among reported adverse effects of bupropion 3
The timing is critical here: your pain coincides with restarting Wellbutrin, and previous exposure may have sensitized you to these effects 1.
Why Not the Other Medications?
Sertraline (recently discontinued): You stopped this medication, so it's unlikely to be causing current symptoms. Withdrawal from sertraline does not typically cause joint or muscle pain 4, 5.
Ezetimibe (longest duration): While the FDA label mentions muscle pain as a potential side effect, this occurs primarily when combined with statins 6. The label states: "Your chances of getting muscle problems are higher if you are also taking statins or fibrates" 6. Since you've been on ezetimibe the longest without prior pain issues, and you're not on a statin, this is the least likely cause 6.
What to Do Next
Stop the bupropion immediately and contact your prescriber. 1, 2 The evidence shows:
- Symptoms typically resolve within days of discontinuation 1, 2
- If bupropion is reintroduced, use the lowest effective dose (150 mg once daily) rather than higher doses 1
- Antihistamines may help if you're experiencing a hypersensitivity reaction with urticaria 2
Monitor for these specific warning signs:
- Unexplained muscle pain, tenderness, or weakness that persists 6
- Fever or feeling more tired than usual 6
- Neck stiffness, jaw tightness, or TMJ symptoms 1
- Rash or urticaria suggesting hypersensitivity 2
Common Pitfall to Avoid
Do not assume the pain is simply "depression-related" or an exacerbation of your underlying condition—this is a documented misinterpretation that can delay recognition of medication-induced symptoms 4. The temporal relationship between restarting bupropion and your pain onset is the key diagnostic clue 1, 2.