How does this medication work? What will it do for me?

Bupropion belongs to the family of medications known as antidepressants. It is used in addition to counselling, as an aid for quitting smoking. It may also be used with nicotine replacement products. In general, nicotine replacement therapy alone should be tried before using bupropion. Bupropion works by affecting the balance of chemicals that occur naturally in the brain. This helps reduce withdrawal symptoms and the urge to smoke.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each purple, round, biconvex, film-coated, sustained-release tablet, printed "ZYBAN 150", contains bupropion HCl 150 mg. Nonmedicinal ingredients: carnauba wax, cysteine hydrochloride, edible black ink, FD&C Blue No. 2 Lake, FD&C Red No. 40 Lake, hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, and titanium dioxide.

How should I use this medication?

The recommended dose as an aid for smoking cessation is 150 mg daily for 3 days, followed by 150 mg twice daily. You should start taking bupropion at least one week before stopping smoking.

Multiple daily doses should be taken at least 8 hours apart. It is very important that bupropion tablets be swallowed whole and not chewed, broken, or crushed. Bupropion may be taken with food or on an empty stomach.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose of this skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to bupropion or to any of the ingredients of this medication
  • are currently taking thioridazine (an antipsychotic medication) or have taken it in the past 2 weeks
  • are having abrupt withdrawal issues from alcohol, benzodiazepines (e.g., diazepam, clonazepam, lorazepam), or other sedatives (e.g., phenobarbital)
  • are taking another medication that contains bupropion (e.g., Wellbutrin XL® or Wellbutrin® SR)
  • have a seizure disorder
  • have or have had an eating disorder (bulimia or anorexia nervosa)
  • have taken a monoamine oxidase inhibitor (MAO inhibitor; e.g., phenelzine, tranylcypromine) within the past 2 weeks

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • blurred vision
  • change in sense of taste
  • constipation
  • decrease in appetite
  • dizziness
  • drowsiness
  • dry mouth
  • feeling of fast or irregular heartbeat
  • frequent need to urinate
  • increased sweating
  • joint or muscle pain
  • nausea or vomiting
  • sore throat
  • stuffy or runny nose
  • trembling or shaking
  • trouble concentrating
  • trouble sleeping
  • weight changes
  • unusual feeling of well-being

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • agitation
  • anxiety
  • buzzing or ringing in ears
  • confusion
  • extreme distrust
  • fainting
  • false beliefs that cannot be changed by facts
  • hallucinations
  • headache (severe)
  • increased blood pressure
  • shakiness
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • skin rash, hives, or itching
  • trouble concentrating

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • seizures
  • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Drowsiness/reduced alertness: Bupropion may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

Heart disease: It is not known whether bupropion is safe for use by people with a recent history of heart attack or unstable heart disease. If you have heart problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Identical medications: Wellbutrin®, Zyban® and several other medications contain the same active ingredient (bupropion). If you are taking one of these medications, do not take the other, or any other product containing bupropion, as the risk of seizures increases with an increased dosage. To reduce the risk of seizures, the total daily dose of this medication should not be greater than 300 mg.

Kidney function: Bupropion is removed from the body by the kidney. Decreased kidney function can cause this medication to build up in the body, causing side effects. If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Bupropion is removed from the body by the liver. Decreased liver function can cause this medication to build up in the body, causing side effects. If you have liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

This medication may also cause a decrease in liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Seizure risk: This medication may increase the risk of seizures.  If you are at risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Things which increase the risk of seizures include:

  • addiction to cocaine, stimulants, or opiates (such as morphine)
  • diabetes treated with oral medications or insulin
  • excessive alcohol use
  • history of head trauma or seizures (including epilepsy)
  • severe liver problems
  • tumours of the brain or spinal cord
  • use of other medications that make seizures more likely (e.g., antipsychotics, antidepressants, lithium, theophylline, steroids)
  • use of over-the-counter stimulants or appetite suppressants

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour, or other behaviour changes: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. Your doctor will monitor you for emotional and behavioural changes while you are taking bupropion.

Pregnancy: The safety of bupropion during pregnancy has not been established. It has been reported that babies born to pregnant women who have taken medications of this kind during the last trimester of pregnancy may be adversely affected. Physicians and pregnant women should carefully consider the benefits and the risks of all treatment options. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Bupropion passes into breast milk. Because this medication presents risks to breast-feeding infants, a decision should be made whether to discontinue breast-feeding or to discontinue bupropion, taking into account the importance of the medication to the mother. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of bupropion have not been established for children and adolescents under 18 years old. The use of this medication in children below the age of 18 may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

Seniors: Because this medication is removed from the body by the kidney and liver, seniors may be at an increased risk of side effects, including seizures, if they use this medication. If you are over 65, discuss with your doctor whether any special monitoring is required.

What other drugs could interact with this medication?

There may be an interaction between bupropion and any of the following:

  • alcohol
  • amantadine
  • antihistamines (e.g., doxylamine, diphenhydramine, hydroxyzine)
  • anti-malarial medications (e.g., chloroquine, mefloquine)
  • antipsychotics (e.g., chlorpromazine, haloperidol, risperidone, thioridazine)
  • aripiprazole
  • atomoxetine
  • beta-blockers (e.g., metoprolol, propranolol, timolol)
  • bromocriptine
  • captopril
  • carbamazepine
  • clopidogrel
  • codeine
  • corticosteroids (e.g., prednisone)
  • cyclophosphamide
  • doxorubicin
  • dextromethorphan
  • droperidol
  • flecainide
  • fosphenytoin
  • HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine, nevirapine)
  • irinotecan
  • ketamine
  • linezolid
  • levodopa
  • linezolid
  • lithium
  • lopinavir
  • metformin
  • methadone
  • methamphetamine
  • methotrimeprazine
  • mexiletine
  • mirtazapine
  • monoamine oxidase inhibitors (MAO inhibitors; e.g., phenelzine, tranylcypromine, moclobemide, selegilene) - bupropion should not be started until at least 14 days after MAO inhibitors are stopped
  • nicotine replacement therapy (e.g., nicotine patch)
  • orphenadrine
  • nefazodone
  • peginterferon Alfa-2b
  • phenobarbital
  • phenytoin
  • pimozide
  • primaquine
  • primidone
  • procainamide
  • promethazine
  • propafenone
  • propofol
  • quinolone antibiotics (e.g., ciprofloxacin, moxifloxacin)
  • rifampin
  • ritonavir
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
  • sorafenib
  • tamoxifen
  • tetrabenazine
  • theophylline
  • thioridazine - bupropion should not be started until at least 14 days after thioridazine is stopped
  • ticlopidine
  • tolterodine
  • tramadol
  • tricyclic antidepressants (e.g., nortriptyline, imipramine, desipramine)
  • venlafaxine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.