Commonly reported side effects of bupropion include: insomnia, nausea, pharyngitis, weight loss, constipation, dizziness, headache, and xerostomia. Other side effects include: abdominal pain, agitation, arthralgia, chest pain, migraine, skin rash, urinary frequency, anxiety, asthenia, confusion, diarrhea, hostility, hypertension, lack of concentration, myalgia, nervousness, palpitations, pruritus, tinnitus, tremor, vomiting, anorexia, diaphoresis, dysgeusia, flushing, and abnormal dreams. Continue reading for a comprehensive list of adverse effects.
Applies to bupropion: oral conventional tablets, oral extended-release tablets.
Clinical Worsening and Suicide Risk in Treating Psychiatric Disorders
- Antidepressants may increase risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (18–24 years of age) with major depressive disorder and other psychiatric disorders; balance this risk with clinical need.1 142 143 161 162 168 Bupropion is not approved for use in pediatric patients.1 142 143 168 (See Pediatric Use under Cautions.)
- In pooled data analyses, risk of suicidality was not increased in adults >24 years of age and apparently was reduced in adults ≥65 years of age with antidepressant therapy compared with placebo.161 162
- Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide.161 162 167
- Appropriately monitor and closely observe all patients who are started on bupropion therapy for clinical worsening, suicidality, or unusual changes in behavior; involve family members and/or caregivers in this process.1 142 143 162 161 167 168 (See Clinical Worsening and Suicide Risk in Treating Psychiatric Disorders under Cautions.)
Side effects include:
Agitation, dry mouth, insomnia, headache/migraine, nausea/vomiting, constipation, tremor.
For Healthcare Professionals
Applies to bupropion: oral tablet, oral tablet extended release.
In placebo-controlled clinical studies, the specific adverse events that led to discontinuation in at least 1% of patients treated with either 300 mg or 400 mg per day of Wellbutrin SR (R)included rash, nausea, agitation, and migraine. Additional events leading to discontinuation in the immediate-release formulation included mental state abnormalities, vomiting, seizures, headaches, and sleep disturbances, many of which occurred at doses greater than the recommended daily dose.
Adverse events leading to treatment discontinuation with Zyban (R) included tremors, and rashes. The most commonly observed adverse reactions were dry mouth and insomnia. Smoking cessation is often associated with nicotine withdrawal symptoms, some of which are also recognized as adverse events associated with bupropion.[Ref]
Very common (10% or more): Insomnia (up to 45%), agitation (up to 31.9%), abnormal dreams (up to 13%)
Common (1% to 10%): Anxiety, confusion, decreased/increased libido, decreased memory/memory impairment, delusions, depression, disturbed concentration, dysphoria, euphoria, hallucinations, hostility, impaired sleep quality, irritability, mania/hypomania, nervousness, thinking abnormality
Uncommon (0.1% to 1%): Aggression, bruxism, depersonalization, emotional lability, formal thought disorder, frigidity, mood instability, nightmares, paranoia, paranoid ideation, psychosis, suicidal ideation
Rare (0.01% to 0.1%): Derealization, impaired attention
Frequency not reported: Abnormalities in mental status, post-ictal confusion, sleep disturbances
Postmarketing reports: Completed suicide, delirium, manic reaction, restlessness, suicidal behavior, suicide attempt[Ref]
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).
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.[Ref]
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.
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 risk of seizure appears to be dose-related. Other risk factors are related to patient factors e.g., severe head injury, arteriovenous malformation, CNS tumor or CNS infection, or severe stroke, concomitant medications that lower the seizure threshold (e.g., other bupropion products, antipsychotics, tricyclic antidepressants, theophylline, and systemic corticosteroids), metabolic disorders, illicit drug use, abuse or misuse of prescription drugs such as CNS stimulants, diabetes mellitus treated with oral hypoglycemics or insulin, treatment with anorectic drugs, and excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates.
Two cases of elderly patients falling backwards have been attributed to the effects of bupropion on the basal ganglia.[Ref]
Very common (10% or more): Headache (up to 34%), migraine (up to 25.7%), dizziness (up to 22.3%), tremor (up to 21.1%), sedation (up to 19.8%)
Common (1% to 10%): Akathisia, ataxia/incoordination, central nervous system stimulation, dyskinesia, dystonia, feeling jittery, myoclonus, paresthesia, seizure, sensory disturbance, somnolence, syncope, taste disturbance, taste perversion
Uncommon (0.1% to 1%): Abnormal coordination, dysarthria, hypesthesia, hyperkinesia, hypertonia, vertigo
Rare (0.01% to 0.1%): Abnormal electroencephalogram, amnesia, parkinsonism
Frequency not reported: Generalized tonic-clonic seizures
Postmarketing reports: Akinesia, aphasia, coma, extrapyramidal syndrome, hypokinesia, neuropathy, neuralgia, unmasking tardive dyskinesia[Ref]
Very common (10% or more): Weight loss greater than 2.3 kg (up to 28%), weight gain greater than 2.3 kg (up to 11%)
Common (1% to 10%): Anorexia, decreased appetite, increased appetite, thirst/thirst disturbance
Rare (0.01% to 0.1%): Blood glucose disturbances
Very rare (less than 0.01%): Hyponatremia
Postmarketing reports: Hyperglycemia, hypoglycemia[Ref]
Very common (10% or more): Dry mouth (up to 27.6%), constipation (up to 26%), nausea (up to 22.9%), vomiting (up to 22.9%)
Common (1% to 10%): Abdominal pain, diarrhea, dyspepsia, dysphagia, flatulence, gastrointestinal disturbance, gustatory disturbance, mouth ulcer, stomatitis
Uncommon (0.1% to 1%): Gastric reflux, gingivitis, gum irritation, increased salivation, inguinal hernia, oral edema, toothache
Rare (0.01% to 0.1%): Edema of the tongue, intestinal perforation
Frequency not reported: Esophagitis
Postmarketing reports: Colitis, gastrointestinal hemorrhage, glossitis, gum hemorrhage, pancreatitis, stomach ulcer, stool abnormality[Ref]
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.[Ref]
Very Common (10% or more): Excessive sweating (up to 22.3%)
Common (1% to 10%): Dry skin, facial edema, pruritus, rash, sweating, urticaria
Uncommon (0.1% to 1%): Alopecia, ecchymosis, photosensitivity
Rare (0.01% to 0.1%): Erythema multiforme, exacerbation of psoriasis, Stevens-Johnson syndrome
Frequency not reported: Skin reactions
Postmarketing reports: Exfoliative dermatitis, hirsutism, maculopapular rash[Ref]
Very common (10% or more): Application site reaction (up to 15%)[Ref]
Very common (10% or more): Blurred vision (up to 14.6%)
Common (1% to 10%): Diplopia, visual disturbance
Uncommon (0.1% to 1%): Accommodation abnormality, dry eye, mydriasis
Postmarketing reports: Angle-closure glaucoma, increased intraocular pressure[Ref]
Very common (10% or more): Nasopharyngitis (up to 13%), rhinitis (up to 12%), pharyngitis (up to 11%)
Common (1% to 10%): Bronchitis, cough, dyspnea/shortness of breath, epistaxis, increased cough, sinusitis, upper respiratory tract infection
Rare (0.01% to 0.1%): Bronchospasm, pulmonary embolism
Postmarketing reports: Pneumonia[Ref]
In clinical practice, hypertension, in some cases severe, requiring acute treatment, has been reported in patients receiving bupropion alone and in combination with nicotine replacement therapy. These events have been observed in both patients with and without evidence of preexisting hypertension.
Some investigators have suggested that bupropion therapy may be 10 to 100 times less likely to induce conduction problems than tricyclic antidepressants.[Ref]
Very Common (10% or more): Tachycardia (up to 11%)
Common (1% to 10%): Cardiac arrhythmias, chest pain, edema, flushing, hot flashes, hypertension, hypotension, palpitations
Uncommon (0.1% to 1%): Electrocardiogram abnormalities, nonspecific ST-T changes, peripheral edema, postural hypotension, premature beats, stroke, vasodilation
Rare (0.01% to 0.1%): Myocardial infarction
Postmarketing reports: Cardiovascular disorder, complete atrioventricular block, extrasystoles, orthostatic hypotension, phlebitis, severe hypertension, third degree heart block[Ref]
Common (1% to 10%): Accidental injury, asthenia, auditory disturbance, chills, cutaneous temperature disturbance, fever, nonspecific fever, pain, temperature disturbance, tinnitus
Uncommon (0.1% to 1%): Inguinal hernia, nonspecific pain
Rare (0.01% to 0.1%): Malaise, overdose
Postmarketing reports: Deafness[Ref]
Common (1% to 10%): Decrease in sexual function, dysmenorrhea, impotence, menstrual complaints, nocturia, urinary frequency, urinary tract infection, urinary urgency, vaginal hemorrhage
Uncommon (0.1% to 1%): Painful erection, polyuria, prostate disorder, retarded ejaculation, testicular swelling, vaginal irritation
Rare (0.01% to 0.1%): Enuresis, urinary incontinence, urinary retention
Postmarketing reports: Abnormal ejaculation, dyspareunia, dysuria, menopause, prostate disorder, salpingitis, urinary tract disorder, vaginitis[Ref]
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).[Ref]
Common (1% to 10%): Arthralgia, arthritis, myalgia, neck pain, pain in extremity, twitch/twitching
Uncommon (0.1% to 1%): Leg cramps
Postmarketing reports: Muscle rigidity, muscle weakness, musculoskeletal chest pain, rhabdomyolysis[Ref]
Common (1% to 10%): Allergic reaction, hypersensitivity reactions
Uncommon (0.1% to 1%): Fever with rash and other symptoms suggestive of delayed hypersensitivity
Rare (0.01% to 0.1%): Angioedema, anaphylactic shock[Ref]
Common (1% to 10%): Flu-like symptoms, infection
Uncommon (0.1% to 1%): Serum sickness-like reaction[Ref]
Uncommon (0.1% to 1%): Abnormal liver function, jaundice, liver damage
Rare (0.01% to 0.1%): Elevated liver enzymes, hepatitis[Ref]
Uncommon (0.1% to 1%): Gynecomastia
Frequency not reported: Syndrome of inappropriate antidiuretic hormone[Ref]
Rare (0.01% to 0.1%): Glycosuria
Postmarketing reports: Cystitis[Ref]
Frequency not reported: Anemia, leukopenia, thrombocytopenia
Postmarketing reports: Altered prothrombin time/INR with/without hemorrhagic/thrombotic complications, leukocytosis, lymphadenopathy, pancytopenia[Ref]