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bupropion
Wellbutrin SR/XL · Aplenzin · Forfivo XL · Zyban
Atypical antidepressant⚠ Unverified beta content
At a glance
- Class
- Norepinephrine-dopamine reuptake inhibitor (aminoketone)
- Black box
- ⚠ Suicidal thoughts and behaviors
- Key monitoring
- Seizure risk factors / seizure activity
- Suicidality / mood / agitation
- Usual adult dose
- XL (once daily): 150–300 mg/day
- Call provider / escalate if
- Seizure • Thoughts of suicide or self-harm, agitation, aggression, hallucinations • Rash, hives, swelling, trouble breathing
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- bupropion (Wellbutrin SR/XL, Aplenzin, Forfivo XL) — norepinephrine-dopamine reuptake inhibitor (aminoketone).
- Used for: Major depressive disorder; Seasonal affective disorder prevention; Smoking cessation aid.
Usual adult dosing
- XL (once daily): 150–300 mg/day (Start 150 mg qAM; may increase to 300 mg after ≥4 days; max 450 mg/day.)
- SR (twice daily): 150–300 mg/day (max 400 mg/day) (Single SR dose should not exceed 200 mg; separate doses ≥8 h.)
- IR: TID dosing; max 450 mg/day, single dose ≤150 mg
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24). Monitor closely, especially at start and with dose changes.
Monitor
- Seizure risk factors / seizure activity
- Suicidality / mood / agitation [Every contact]
Nursing priorities
- Baseline mood, suicidal ideation (ask directly), sleep, appetite, anxiety.
- Screen for history of mania/bipolar disorder.
- Assess suicidal ideation each contact, especially early and after dose changes; follow facility safety protocols.
- Benefit often delayed 4–6 weeks; reinforce adherence.
- Do not stop abruptly.
Major interactions
- MAOIs: Contraindicated (hypertensive reactions); allow 14-day washout.
- Agents that lower seizure threshold (antipsychotics, tramadol, theophylline, systemic steroids, stimulants): Increased seizure risk.
Key teaching
- Take it every day as prescribed, even when you feel better. Full effect can take several weeks.
- Do not stop suddenly; ask your provider about slowly lowering the dose.
- Report any new or worse thoughts of hurting yourself, or big changes in mood or behavior, right away.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24). Monitor closely, especially at start and with dose changes.
Other serious warnings
- Dose-related seizure risk – contraindicated in seizure disorders, bulimia/anorexia nervosa, or abrupt discontinuation of alcohol, benzodiazepines, barbiturates or antiepileptics
- Hypertension (esp. with nicotine patch)
- Activation of mania / psychosis
- Neuropsychiatric symptoms (agitation, hostility)
- Angle-closure glaucoma
- Serious hypersensitivity reactions
- Do not crush, chew, or split SR/XL tablets (dose dumping → seizure)
Sources: FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET,
- Seizure risk factors / seizure activityRisk rises with dose >450 mg/day and with SR/IR single doses above limit
- Blood pressureWhen: Baseline and periodically (esp. with nicotine replacement)
- Suicidality / mood / agitationWhen: Every contact
- Weight
Sources: FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET,
Assessment
- Baseline mood, suicidal ideation (ask directly), sleep, appetite, anxiety.
- Screen for history of mania/bipolar disorder.
- Medication/supplement list for interactions.
- Seizure history, head injury, eating disorder, alcohol/benzodiazepine use or withdrawal risk – these are contraindications/high risk.
- Baseline blood pressure.
Interventions
- Assess suicidal ideation each contact, especially early and after dose changes; follow facility safety protocols.
- Benefit often delayed 4–6 weeks; reinforce adherence.
- Do not stop abruptly.
- Give XL in the morning; give last SR dose early (not at bedtime) to limit insomnia.
- Do not crush or split extended-release forms.
- Watch for seizure precautions in at-risk patients per facility policy.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Seizure
- Thoughts of suicide or self-harm, agitation, aggression, hallucinations
- Rash, hives, swelling, trouble breathing
- Severe headache or very high blood pressure
- Fever, joint pain with rash (serum-sickness-like reaction)
- Manic symptoms
Sources: FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET, · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Dry mouth
- Insomnia
- Headache
- Nausea
- Agitation / anxiety / tremor
- Constipation
- Sweating
- Weight loss / decreased appetite
Sources: FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET,
- MAOIs MajorContraindicated (hypertensive reactions); allow 14-day washout.
- Agents that lower seizure threshold (antipsychotics, tramadol, theophylline, systemic steroids, stimulants) MajorIncreased seizure risk.
- CYP2D6 substrates (e.g., TCAs, metoprolol, some antipsychotics, venlafaxine)Bupropion inhibits CYP2D6 → higher levels of those drugs.
- AlcoholRare neuropsychiatric events/lower seizure tolerance; abrupt alcohol cessation raises seizure risk.
Sources: FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET,
- Take it every day as prescribed, even when you feel better. Full effect can take several weeks.
- Do not stop suddenly; ask your provider about slowly lowering the dose.
- Report any new or worse thoughts of hurting yourself, or big changes in mood or behavior, right away.
- Check with your pharmacist before taking new medicines, supplements or herbal products.
- Avoid or limit alcohol.
- Swallow SR/XL tablets whole. Do not crush, chew, or cut them.
- Take it in the morning (and the last dose of twice-daily form by mid-afternoon) to help sleep.
- Tell your provider if you drink alcohol heavily or take sedatives or anti-anxiety pills (like benzodiazepines). Stopping those suddenly while on bupropion raises the risk of seizures.
- Tell your provider if you have ever had a seizure or an eating disorder.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Major depressive disorder
- Seasonal affective disorder prevention (XL)
- Smoking cessation aid (SR/Zyban)
Dosing
- XL (once daily): 150–300 mg/dayStart 150 mg qAM; may increase to 300 mg after ≥4 days; max 450 mg/day.
- SR (twice daily): 150–300 mg/day (max 400 mg/day)Single SR dose should not exceed 200 mg; separate doses ≥8 h.
- IR: TID dosing; max 450 mg/day, single dose ≤150 mg
Sources: FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET,
Prescriber-oriented details; limited in this beta.
renal Adjustment
- Consider reduced dose/frequency in renal impairment (metabolites accumulate).
hepatic Adjustment
- Severe hepatic impairment: max 150 mg every other day (IR/SR/XL per label).
Sources: FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET,
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): WELLBUTRIN SR (BUPROPION HYDROCHLORIDE) TABLET, FILM COATED [GLAXOSMITHKLINE LLC]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified
Reviewer notes – please double-check
- Boxed warning content differs by label version (smoking-cessation neuropsychiatric boxed warning was removed by FDA in 2016) – verify against the current label.