Bupropion Side Effects

Brand Names: Wellbutrin, Zyban, Wellbutrin XL, Wellbutrin SR, Aplenzin

Please note - some side effects for Bupropion may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Bupropion - for the Consumer

Bupropion

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Bupropion:

Constipation; dizziness; drowsiness; dry mouth; headache; increased sweating; loss of appetite; nausea; nervousness; restlessness; taste changes; trouble sleeping; vomiting; weight changes.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; dark urine; delusions; fainting; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; hearing problems; menstrual changes; new or worsening mental or mood changes (eg, concentration problems, panic attacks, aggressiveness, agitation, anxiety, impulsiveness, irritability, hostility, exaggerated feeling of well-being, inability to sit still); red, swollen, blistered, or peeling skin; seizures; severe headache or dizziness; severe or persistent joint or muscle pain; severe or persistent nausea, vomiting, or stomach pain; severe or persistent nervousness, restlessness, or trouble sleeping; shortness of breath; suicidal thoughts or attempts; tremor; unusual swelling; vision changes; worsening depression; yellowing of the skin or eyes.

Bupropion Hydrobromide Extended-Release Tablets

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Bupropion Hydrobromide Extended-Release Tablets:

Constipation; dizziness; drowsiness; dry mouth; flushing; gas; headache; increased sweating; increased urination; loss of appetite; muscle pain; nausea; nervousness; restlessness; ringing in the ears; stomach pain; taste changes; trouble sleeping; vomiting; weakness; weight changes.

Severe allergic reactions (rash; hives; itching; difficulty breathing; painful sores in the mouth or around the eyes; tightness in the chest; swollen lymph nodes; swelling of the mouth, face, lips, or tongue); chest pain; confusion; dark urine; delusions; fainting; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; hearing problems; menstrual changes; new or worsening mental or mood changes (eg, concentration problems, panic attacks, aggressiveness, agitation, anxiety, impulsiveness, irritability, hostility, exaggerated feeling of well-being or inability to sit still); red, swollen, blistered, or peeling skin; seizures; severe headache or dizziness; severe or persistent joint or muscle pain; severe or persistent nausea, vomiting, or stomach pain; severe or persistent nervousness, restlessness, or trouble sleeping; shortness of breath; suicidal thoughts or attempts; tremor; unusual swelling; vision changes; worsening depression; yellowing of the skin or eyes.

Bupropion Extended-Release Tablets

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Bupropion Extended-Release Tablets:

Constipation; dizziness; drowsiness; dry mouth; flushing; gas; headache; increased sweating; increased urination; loss of appetite; nausea; nervousness; restlessness; ringing in the ears; stomach pain; taste changes; trouble sleeping; vomiting; weakness; weight changes.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; dark urine; delusions; fainting; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; hearing problems; menstrual changes; new or worsening mental or mood changes (eg, concentration problems, panic attacks, aggressiveness, agitation, anxiety, impulsiveness, irritability, hostility, exaggerated feeling of well-being, inability to sit still); red, swollen, blistered, or peeling skin; seizures; severe headache or dizziness; severe or persistent joint or muscle pain; severe or persistent nausea, vomiting, or stomach pain; severe or persistent nervousness, restlessness, or trouble sleeping; shortness of breath; suicidal thoughts or attempts; tremor; unusual swelling; vision changes; worsening depression; yellowing of the skin or eyes.

Bupropion Sustained-Release Tablets

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Bupropion Sustained-Release Tablets:

Anxiety; constipation; diarrhea; dizziness; drowsiness; dry mouth; loss of appetite; nausea; nervousness; stomach pain; stuffy nose; trouble sleeping.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision or other vision changes; chest pain; concentration problems, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated sense of well-being, inability to sit still, or other unusual or severe mental or mood changes; confusion; changes in sexual desire or ability; dark urine; delusions; fainting; fast or irregular heartbeat; fever or chills; hallucinations; hearing problems or ringing in the ears; joint or muscle pain; menstrual changes; red, swollen, blistered, or peeling skin; seizures; severe headache or dizziness; severe or persistent anxiety, agitation, restlessness, or trouble sleeping; severe or persistent nausea, vomiting, or stomach pain; shortness of breath; suicidal thoughts or attempts; tremor; yellowing of the skin or eyes.

Bupropion Side Effects - for the Professional

Bupropion

The information included under the Incidence in Controlled Trials subsection of ADVERSE REACTIONS is based primarily on data from controlled clinical trials with Bupropion hydrochloride extended-release tablets (SR). Information on additional adverse events associated with the sustained-release formulation of Bupropion in smoking cessation trials, as well as the immediate-release formulation of Bupropion, is included in a separate section.

Incidence in Controlled Trials With Bupropion Hydrochloride Extended-Release Tablets (SR):

In placebo-controlled clinical trials, 9% and 11% of patients treated with 300 and 400 mg/day, respectively, of Bupropion hydrochloride extended-release tablets (SR) and 4% of patients treated with placebo discontinued treatment due to adverse events. The specific adverse events in these trials that led to discontinuation in at least 1% of patients treated with either 300 or 400 mg/day of Bupropion hydrochloride extended-release tablets (SR) and at a rate at least twice the placebo rate are listed in Table 4.

Table 5 enumerates treatment emergent adverse events that occurred among patients treated with 300 and 400 mg/day of Bupropion hydrochloride extended-release tablets (SR) and with placebo in placebo-controlled trials. Events that occurred in either the 300- or 400- mg/day group at an incidence of 1% or more and were more frequent than in the placebo group are included. Reported adverse events were classified using a COSTART-based Dictionary.

Accurate estimates of the incidence of adverse events associated with the use of any drug are difficult to obtain. Estimates are influenced by drug dose, detection technique, setting, physician judgments, etc. The figures cited cannot be used to predict precisely the incidence of untoward events in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. These incidence figures also cannot be compared with those obtained from other clinical studies involving related drug products as each group of drug trials is conducted under a different set of conditions.

Finally, it is important to emphasize that the tabulation does not reflect the relative severity and/or clinical importance of the events. A better perspective on the serious adverse events associated with the use of Bupropion hydrochloride extended-release tablets (SR) is provided in

the WARNINGS and PRECAUTIONS sections.

Adverse events from Table 5 occurring in at least 5% of patients treated with Bupropion hydrochloride extended-release tablets (SR) and at a rate at least twice the placebo rate are listed below for the 300- and 400-mg/day dose groups.

Anorexia, dry mouth, rash, sweating, tinnitus, and tremor.

Abdominal pain, agitation, anxiety, dizziness, dry mouth, insomnia, myalgia, nausea, palpitation, pharyngitis, sweating, tinnitus, and urinary frequency.

Other Events Observed During the Clinical Development and Postmarketing Experience of Bupropion:

In addition to the adverse events noted above, the following events have been reported in clinical trials and postmarketing experience with the sustained-release formulation of Bupropion in depressed patients and in nondepressed smokers, as well as in clinical trials and postmarketing clinical experience with the immediate-release formulation of Bupropion.

Adverse events for which frequencies are provided below occurred in clinical trials with the sustained-release formulation of Bupropion. The frequencies represent the proportion of patients who experienced a treatment-emergent adverse event on at least one occasion in placebo-controlled studies for depression (n = 987) or smoking cessation (n = 1,013), or patients who experienced an adverse event requiring discontinuation of treatment in an open label surveillance study with Bupropion hydrochloride extended-release tablets (SR) (n = 3,100). All treatment-emergent adverse events are included except those listed in Tables 2 through 5, those events listed in other safety-related sections, those adverse events subsumed under COSTART terms that are either overly general or excessively specific so as to be uninformative, those events not reasonably associated with the use of the drug, and those events that were not serious and occurred in fewer than 2 patients. Events of major clinical importance are described in the WARNINGS and PRECAUTIONS sections of the labeling.

Events are further categorized by body system and listed in order of decreasing frequency according to the following definitions of frequency: Frequent adverse events are defined as those occurring in at least 1/100 patients. Infrequent adverse events are those occurring in 1/100 to 1/1,000 patients, while rare events are those occurring in less than 1/1,000 patients.

Adverse events for which frequencies are not provided occurred in clinical trials or postmarketing experience with Bupropion. Only those adverse events not previously listed for sustained-release Bupropion are included. The extent to which these events may be associated with Bupropion hydrochloride extended-release tablets (SR) is unknown.

Body (General): Infrequent were chills, facial edema, musculoskeletal chest pain, and photosensitivity. Rare was malaise. Also observed were arthralgia, myalgia, and fever with rash and other symptoms suggestive of delayed hypersensitivity. These symptoms may resemble serum sickness.

Cardiovascular: Infrequent were postural hypotension, stroke, tachycardia, and vasodilation.  Rare was syncope. Also observed were complete atrioventricular block, extrasystoles, hypotension, hypertension (in some cases severe, see PRECAUTIONS), myocardial infarction, phlebitis, and pulmonary embolism.

Digestive: Infrequent were abnormal liver function, bruxism, gastric reflux, gingivitis, glossitis, increased salivation, jaundice, mouth ulcers, stomatitis, and thirst. Rare was edema of tongue. Also observed were colitis, esophagitis, gastrointestinal hemorrhage, gum hemorrhage, hepatitis, intestinal perforation, liver damage, pancreatitis, and stomach ulcer.

Endocrine: Also observed were hyperglycemia, hypoglycemia, and syndrome of inappropriate antidiuretic hormone.

Hemic and Lymphatic: Infrequent was ecchymosis. Also observed were anemia, leukocytosis, leukopenia, lymphadenopathy, pancytopenia, and thrombocytopenia. Altered PT and/or INR, infrequently associated with hemorrhagic or thrombotic complications, were observed when Bupropion was coadministered with warfarin.

Metabolic and Nutritional: Infrequent were edema and peripheral edema. Also observed was glycosuria.

Musculoskeletal: Infrequent were leg cramps. Also observed were muscle rigidity/

fever/rhabdomyolysis and muscle weakness.

Nervous System: Infrequent were abnormal coordination, decreased libido, depersonalization, dysphoria, emotional lability, hostility, hyperkinesia, hypertonia, hypesthesia, suicidal ideation, and vertigo. Rare were amnesia, ataxia, derealization, and hypomania. Also observed were abnormal electroencephalogram (EEG), akinesia, aggression, aphasia, coma, delirium, delusions, dysarthria, dyskinesia, dystonia, euphoria, extrapyramidal syndrome, hallucinations, hypokinesia, increased libido, manic reaction, neuralgia, neuropathy, paranoid ideation, restlessness, and unmasking tardive dyskinesia.

Respiratory: Rare was bronchospasm. Also observed was pneumonia.

Skin: Rare was maculopapular rash. Also observed were alopecia, angioedema, exfoliative dermatitis, and hirsutism.

Special Senses: Infrequent were accommodation abnormality and dry eye. Also observed were deafness, diplopia, increased intraocular pressure and mydriasis.

Urogenital: Infrequent were impotence, polyuria, and prostate disorder. Also observed were abnormal ejaculation, cystitis, dyspareunia, dysuria, gynecomastia, menopause, painful erection, salpingitis, urinary incontinence, urinary retention, and vaginitis.

Side Effects by Body System

Nervous system

Nervous system side effects have frequently included headache (27%), insomnia (16% to 33%), dizziness (12%), tremor, somnolence, thinking abnormality, abnormal dreams (6%), sleep abnormalities, disturbed concentration, dysphoria, decreased memory, paresthesia, central nervous system (CNS) stimulation, akathisia, migraine, impaired sleep quality, pseudoparkinsonism, sedation, sensory disturbance, seizure, myoclonus, and dysarthria. Abnormal coordination, confusion, decreased libido, hyperkinesia, hypertonia, hypesthesia, vertigo, amnesia, ataxia, abnormal electroencephalogram (EEG), akinesia, aphasia, coma, dyskinesia, dystonia, extrapyramidal syndrome, hypokinesia, increased libido, neuralgia, neuropathy, unmasking tardive dyskinesia, abnormal neurological exam, impaired attention, sciatica, and aphasia have been reported rarely.

Grand mal seizures have been reported in 0.4% of patients undergoing bupropion therapy at dosages up to 450 mg daily. The incidence of seizures increases dramatically at higher dosages. The seizure rate in patients taking sustained-release bupropion up to a dosage of 300 mg/day (e.g. for smoking cessation) has been approximated at 0.1%.

The seizure risk associated with bupropion is dose-related but may also be dependent on concomitant predisposing factors, such as: a history of seizure disorder or head trauma; concomitant treatment with agents that lower seizure threshold (antipsychotics, antidepressants, theophylline, systemic steroids, etc.); or circumstances associated with increased risk of seizures (abrupt withdrawal of a benzodiazepine or alcohol, excessive alcohol intake, addiction to opiates, etc). One retrospective analysis has suggested that advancing age may be protective against bupropion- induced seizures.

Insomnia may also be dose-dependent. In a dose- response clinical study for smoking cessation, 29% of patients receiving bupropion 150 mg/day versus 35% of those receiving 300 mg/day reported insomnia. Insomnia may be minimized by reducing the dosage or avoiding administration at bedtime.

The Australian Adverse Drug Reaction Advisory Committee reported that 268 of the 780 reports it received in association with bupropion through mid- May 2001 involved nervous system disorders.

Two cases of elderly patients falling backwards have been attributed to the effects of bupropion on the basal ganglia.

Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.

Gastrointestinal

Gastrointestinal side effects have frequently included dry mouth (12% to 28%), nausea (9% to 15%), constipation (7%), diarrhea (9%), bloating (7%), cramps (7%), anorexia, vomiting, dysphagia, increase in appetite, taste perversion, abdominal pain, and dyspepsia. Bruxism, gastric reflux, gingivitis, glossitis, increased salivation, mouth ulcers, stomatitis, thirst disturbance, increased salivary flow, and flatulence have been reported infrequently. Edema of the tongue, gustatory disturbance, colitis, esophagitis, gastrointestinal hemorrhage, gum hemorrhage, intestinal perforation, pancreatitis, stomach ulcer, and stool abnormality have been reported rarely.

Genitourinary

One study in which 150 patients received the sustained released form of bupropion reported the incidence of orgasm dysfunction at 8% in patients receiving a 300 mg daily dose and 10% in patients receiving a 400 mg daily dose.

Among antidepressants, bupropion may be associated with the lowest incidence of sexual dysfunction (i.e., impotence, abnormal ejaculation, changes in libido).

Genitourinary side effects have included urinary frequency, urinary urgency, vaginal hemorrhage, urinary tract infection, impotence, menstrual complaints/irregularities, nocturia, and polyuria. Abnormal ejaculation, dyspareunia, dysuria, gynecomastia, menopause, painful erection, prostate disorder, salpingitis, urinary incontinence, urinary retention, urinary tract disorder, vaginitis, cystitis, vaginal irritation, testicular swelling, enuresis, glycosuria, ovarian disorder, pelvic infection, and painful ejaculation have been reported rarely.

Psychiatric

Psychiatric side effects have frequently included anxiety (6%), nervousness, agitation, depression, irritability, derealization, and hypomania. Depersonalization, emotional lability, hostility, suicidal ideation, aggression, delusions, euphoria, hallucinations, manic reaction, nightmares, paranoid ideation, delirium, psychosis, organic mental disorders, catatonia, and restlessness have been reported rarely.

The Australian Adverse Drug Reaction Advisory Committee reported that 285 of the 780 reports it received in association with bupropion through mid- May 2001 involved psychological disturbances.

Two cases of tactile hallucinations ("bugs crawling over skin") have been reported in association with bupropion extended-release (200 mg twice daily) therapy. In both cases the symptoms abated following a reduction in the total daily dose of bupropion (300 mg daily).

Cardiovascular

Cardiovascular side effects have frequently included palpitation, cardiac arrhythmias, hypertension (in some cases severe), hypotension, syncope, tachycardia, and edema. Postural hypotension, chest pain, electrocardiogram (ECG) abnormalities (premature beats and nonspecific ST- T changes), stroke, and vasodilation have been reported infrequently. Phlebitis and myocardial infarction have been reported rarely. There are also reports of complete atrioventricular (AV) block, extrasystoles, and myocardial infarction. Some investigators have suggested that bupropion therapy may be 10 to 100 times less likely to induce conduction problems than tricyclic antidepressants.

Hypertension has been reported regarding both patients with and without evidence of preexisting hypertension.

Dermatologic

The Australian Adverse Drug Reaction Advisory Committee reported that 307 of the 780 reports it received in association with bupropion through mid- May 2001 involved skin reactions. Urticaria was the most commonly reported event (167 cases). Other rashes (86 cases) were also reported.

Dermatologic side effects have frequently included sweating, hives(6%), rash (6%), pruritus (6%), urticaria, flushing, pallor, and dry skin. Alopecia and acne have been reported infrequently. Angioedema, exfoliative dermatitis, maculopapular rash, change in hair color, and hirsutism have been reported rarely. Two cases of erythema multiforme have also been reported.

Endocrine

Endocrine side effects have infrequently included syndrome of inappropriate antidiuretic hormone and hormone level changes.

Hematologic

Hematologic side effects have rarely included ecchymosis, anemia, leukocytosis, leukopenia, lymphadenopathy, pancytopenia, thrombocytopenia, and eosinophilia.

Hypersensitivity

Hypersensitivity side effects have rarely included reports of anaphylactoid reactions during clinical trials. In addition, there have been isolated cases of anaphylactic shock associated with bupropion.

Other

Other side effects have frequently included flu-like symptoms (3%), asthenia, pain, fatigue, fever/chills, and auditory disturbance. Facial edema, photosensitivity, peripheral edema, deafness, body odor, tinnitus, and malaise have been reported rarely.

Metabolic

Metabolic side effects have frequently included weight loss and weight gain. Hyponatremia, hyperglycemia, hypoglycemia have also been reported in patients receiving bupropion.

Musculoskeletal

Musculoskeletal side effects have frequently included arthritis. Leg cramps, musculoskeletal chest pain, muscle rigidity, rhabdomyolysis, and muscle weakness have been reported rarely.

Hepatic

Hepatic side effects have rarely included jaundice, abnormal liver function tests, hepatic damage, and hepatitis.

Respiratory

Respiratory side effects have frequently included upper respiratory complaints and cough. Bronchospasm, bronchitis, dyspnea, epistaxis, rate or rhythm disorder, pulmonary embolism, and pneumonia have been reported rarely.

Ocular

Ocular side effects have rarely included accommodation abnormality, dry eye, diplopia, mydriasis, blurred vision, and increased intraocular pressure.

Immunologic

Immunologic side effects have included isolated cases of Stevens-Johnson syndrome and serum sickness-like reactions.

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