Wellbutrin IR, SR, XL Fact Sheet
GlaxoSmithKline; available as generic bupropion IR and SR; generic bupropion XL received approval in 2006.
Major Depressive Disorder
- Prevention of Seasonal Affective Disorder (Wellbutrin XL only)
- Smoking cessation (Zyban only)
Wellbutrin is chemically unrelated to SSRI, tricyclic or other known antidepressants; mediated by noradrenergic and/or dopaminergic mechanisms.
- XL: 150 mg and 300 mg tablets
- SR: 100 mg, 150 mg, and 200 mg film-coated tablets
- IR (original immediate release version): 75 mg and 100 mg tablets
- Zyban: 150 mg purple tablets
- XL beginning dose: 150 mg QAM; may increase to usual dose of 300 mg QAM if adequately tolerated after at least 4 days; maximum dose 450 mg QAM.
- SR beginning dose: Start at 100 mg QAM, and gradually titrate to usual dose of 150 mg BID; maximum dose 200 mg BID.
- Zyban: Begin two weeks before quit date at 150 mg QD, increase to 150 mg BID after 3 days.
- Dose must be reduced in patients with kidney or liver impairment.
Most common (for Wellbutrin SR 300 mg/day) are: anorexia, dry mouth, rash, sweating, tinnitus, and tremor (>5% and > twice placebo rate).
- Seizure risk at 300 mg/day or less is 0.1%, similar to risk with other ADs; seizure risk at 450 mg/day is about 0.4%, and at 600 mg/day almost 4%.
- Black Box Warning: In clinical trials, SSRIs and SNRIs increased the risk of suicidality in children (from 2% to 4%). No actual suicides occurred in these trials.
- Pregnancy Risk Category C
Luvox (fluvoxamine) inhibits the metabolism of bupropion, possibly increasing levels.
- Wellbutrin can increase levels of a variety of antidepressants, most notably Effexor.
All four formulations are equally effective, and there is no demonstrated difference in risk of seizure; XL has a slight convenience advantage for the patient (once-daily dosing).
Earn CME Credit Instantly!
Not quite ready for a one-year subscription to The Carlat Psychiatry Report? Need CME credits on a particular topic or on a tight deadline?
Try our A la Carte CME! You can buy single or multiple credits of continuing education, without committing to a year-long newsletter subscription.
Already an A la Carte subscriber?
Steve Balt Interviewed by NPR
Our own Steve Balt was interviewed on NPR's "Talk of the Nation" on psychiatry's shift toward drugs and away from talk therapy.
After 10 years at the helm of TCPR, Dr. Carlat has handed over editor-in-chief duties to Dr. Steve Balt. We’re excited to welcome him aboard! Read More...