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Wellbutrin (bupropion) Disease Interactions

There are 8 disease interactions with Wellbutrin (bupropion):

Major

Bupropion (Includes Wellbutrin) ↔ Liver Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Bupropion is primarily metabolized by the liver. The systemic exposure and half-life of bupropion and its metabolites may be increased in patients with hepatic impairment, and drug accumulation may occur to a greater extent than usual. Therapy with bupropion should be administered cautiously in patients with impaired hepatic function, including mild to moderate hepatic cirrhosis. A reduced dose and/or dosing frequency should be considered. Extreme caution is advised in patients with severe hepatic cirrhosis. A dosage reduction is required in these patients, and the dosage should not exceed 75 mg once a day. All patients with hepatic impairment should be closely monitored for possible adverse effects that could indicate high drug or metabolite levels.

References

  1. DeVane CL, Laizure SC, Stewart JT, et al. "Disposition of bupropion in healthy volunteers and subjects with alcoholic liver disease." J Clin Psychopharmacol 10 (1990): 328-32
  2. Findlay JW, Van Wyck Fleet J, Smith PG, et al. "Pharmacokinetics of bupropion, a novel antidepressant agent, following oral administration to healthy subjects." Eur J Clin Pharmacol 21 (1981): 127-35
  3. "Product Information. Zyban (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.
View all 5 references
Major

Bupropion (Includes Wellbutrin) ↔ Seizure Disorders

Severe Potential Hazard, Moderate plausibility

Applies to: Seizures, Head Injury, Anorexia Nervosa, Bulimia, Diabetes Mellitus, Alcoholism, Drug Abuse/Dependence, CNS Disorder

The use of bupropion is contraindicated in patients with a seizure disorder. Bupropion may trigger seizures in a dose-dependent manner up to a frequency of 0.4% at 450 mg/day, the maximum recommended dosage. The incidence of seizures increases dramatically at higher dosages (almost 10-fold at 600 mg/day). Because of the wide variability in individual capacity to metabolize drugs and the disproportionate increase in seizure incidence with dosage escalation, bupropion should not be used in patients with underlying seizure disorders. The use of bupropion is also contraindicated in patients with a current or prior diagnosis of bulimia or anorexia because of a higher reported incidence of seizures in such patients treated with the drug. Therapy with bupropion should be administered extremely cautiously in patients with other predisposing factors for seizures, including underlying neurologic abnormalities such as head trauma, brain damage or CNS tumor; excessive use of or abrupt withdrawal from alcohol; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin; and concomitant use of medications that lower seizure threshold. A more gradual titration may be appropriate.

References

  1. "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Dufresne RL, Weber SS, Becker RE "Bupropion hydrochloride." Drug Intell Clin Pharm 18 (1984): 957-64
  3. "Product Information. Zyban (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.
View all 9 references
Moderate

Antidepressant/Antipsychotic Agents (Includes Wellbutrin) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression, Bipolar Disorder

Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset.

Moderate

Antidepressants (Includes Wellbutrin) ↔ Angle Closure Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma (Narrow Angle)

Some antidepressants exert mydriatic activity that can induce increased intraocular pressure and result in angle-closure (narrow angle) glaucoma in a patient with anatomically narrow angles who does not have a patent iridectomy. Prior to initiating therapy with these agents patients should be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e.g., iridectomy), if they are susceptible. The use of these drugs in patients with untreated anatomically narrow angles should be avoided.

Moderate

Bupropion (Includes Wellbutrin) ↔ Mixed/Manic Episode

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression, Bipolar Disorder, Mania

Therapy with bupropion may cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.

Moderate

Bupropion (Includes Wellbutrin) ↔ Psychosis

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis

Bupropion may precipitate or aggravate psychotic symptoms, including delusions, hallucinations, confusion, and paranoia. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. Patients with psychotic disorders should be monitored for exacerbation of symptoms during bupropion therapy, and the dosing reduced or discontinued and/or additional medications (e.g., tranquilizers) administered as necessary.

References

  1. Dager SR, Heritch AJ "A case of bupropion-associated delirium." J Clin Psychiatry 51 (1990): 307-8
  2. Liberzon I, Dequardo JR, Silk KR "Bupropion and delirium." Am J Psychiatry 147 (1990): 1689-90
  3. Golden RN, James SP, Sherer MA, Rudorfer MV, Sack DA, Potter WZ "Psychoses associated with bupropion treatment." Am J Psychiatry 142 (1985): 1459-62
View all 9 references
Moderate

Bupropion (Includes Wellbutrin) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Bupropion metabolites, some of which are pharmacologically active with one-fifth to one-half the potency of the parent drug, are excreted by the kidney. Although pharmacokinetic studies have not been conducted in patients with renal impairment, it is conceivable that bupropion and its metabolites may accumulate in such patients to a greater extent than usual. Therefore, therapy with bupropion should be administered cautiously in the presence of significant renal impairment. A reduced dose and/or dosing frequency should be considered, and patients should be closely monitored for possible adverse effects that could indicate high drug or metabolite levels.

References

  1. "Product Information. Zyban (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.
  2. "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.
Moderate

Bupropion (Includes Wellbutrin) ↔ Weight Loss

Minor Potential Hazard, Moderate plausibility

Applies to: Malnourished, Weight Loss/Failure to Thrive, Anorexia/Feeding Problems

The use of bupropion is associated with weight alterations. Both weight gain and weight loss may occur, although the latter is much more common. The incidence of weight loss greater than 5 pounds is approximately 28%, which may be undesirable in patients suffering from anorexia, malnutrition or excessive weight loss. Weight change should be monitored during therapy if bupropion is used in these patients.

References

  1. "Product Information. Zyban (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Dufresne RL, Weber SS, Becker RE "Bupropion hydrochloride." Drug Intell Clin Pharm 18 (1984): 957-64
  3. "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.

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Wellbutrin (bupropion) drug Interactions

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Wellbutrin (bupropion) alcohol/food Interactions

There are 2 alcohol/food interactions with Wellbutrin (bupropion)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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