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WELLBUTRIN

WELLBUTRIN
Wellbutrin

DESCRIPTION / DEFINITIONS: Wellbutrin ® (bupropion hydrochloride) is a norepinephine-dopamine reuptake inhibitor (NDRI).

ABUSE: Wellbutrin is a drug prescribed for the treatment of depression.

ADDICTION / DEPENDENCE: Half life and metabolism, Black Box Warning.

SIDE EFFECTS: Agitation, anxiety, insomnia (see list below).

WITHDRAWAL SYMPTOMS: Nausea, insomnia, electric shock like sensations (see list below).

TREATMENT: Medical detoxification.

DESCRIPTION / DEFINITIONS

Wellbutrin ® (bupropion hydrochloride) is a selective serotonin reuptake inhibitor (“SSRI”). Although there are no medical tests to determine if a person has insufficient serotonin, SSRI drugs like Wellbutrin increase the amount of serotonin in the brain. According to its label, “The antidepressant, antiobsessive compulsive, and antibulimic actions of fluoxetine are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.”

ABUSE

Wellbutrin is a drug prescribed for the treatment of depression.

ADDICTION / DEPENDENCE

HALF LIFE AND METABOLISM

The biological half life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.

The half life of Wellbutrin is an average of 14 hours.

Wellbutrin is mainly metabolized through the P450 pathway in the liver and the enzymes primarily handling the metabolism is CYP2B6.

The CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.

BLACK BOX WARNING

The Food and Drug Administration (FDA) has decided that some drugs pose very serious risks and have required these drugs have what is called a black box warning. Wellbutrin has a black box warning. Here is the warning.

WARNING: Suicidality and Antidepressant Drugs

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Wellbutrin or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Wellbutrin is not approved for use in pediatric patients.

(See WARNINGS: Clinical Worsening and Suicide Risk, PRECAUTIONS: Information for Patients, and PRECAUTIONS: Pediatric Use.)

SIDE EFFECTS

The following information is taken from the Wellbutrin label:

  • abnormal neurological exam

  • acne

  • aggression

  • agitation

  • akathisia

  • akinesia

  • alopecia

  • altered PT and/or INR

  • anemia

  • angioedema

  • anorexia

  • anxiety

  • aphasia

  • appetite increase

  • arthralgia

  • arthritis

  • ataxia

  • auditory disturbance

  • blurred vision

  • body odor

  • bradykinesia

  • bronchitis

  • bruxism

  • cardiac arrhythmias

  • change in hair color

  • chest pain

  • chills

  • colitis

  • coma

  • confusion

  • constipation

  • cutaneous temperature disturbance

  • cystitis

  • decrease in sexual function

  • decreased libido

  • delirium

  • delusions

  • depersonalization

  • depression

  • diarrhea

  • diplopia

  • disturbed concentration

  • dizziness

  • dream abnormalities

  • dry mouth

  • dry skin

  • dysarthria

  • dyskinesia

  • dyspareunia

  • dyspepsia

  • dysphagia

  • dysphoria

  • dyspnea

  • dystonia

  • dysuria

  • ecchymosis

  • edema

  • electroencephalogram (EEG) abnormality

  • enuresis

  • epistaxis

  • esophagitis
  • euphoria

  • excessive sweating

  • exfoliative dermatitis

  • fatigue

  • fever

  • fever with rash

  • flu-like symptoms

  • flushing

  • formal thought disorder

  • frigidity

  • gastrointestinal bleeding

  • glossitis

  • glycosuria

  • gum irritation

  • gustatory disturbance

  • gynecomastia

  • hallucinations

  • headache

  • hepatitis

  • hirsutism

  • hormone level change

  • hostility

  • hyperglycemia

  • hypertension

  • hypoglycemia

  • hypomania

  • hypotension

  • impaired attention

  • impaired sleep quality

  • impotence

  • incoordination

  • increased intraocular pressure

  • increased libido

  • increased restlessness

  • increased salivary flow

  • infection

  • insomnia

  • intestinal perforation

  • jaundice

  • leukocytosis

  • leukopenia

  • liver damage

  • lymphadenopathy

  • mania

  • medication reaction

  • memory impairment

  • menopause

  • menstrual complaints

  • migraine

  • mood instability

  • muscle rigidity

  • muscle spasms

  • muscle weakness

  • musculoskeletal chest pain

  • myalgia

  • mydriasis

  • myocardial infarction

  • myoclonus

  • nausea

  • nocturia
  • nonspecific pain

  • nonspecific rashes

  • oral edema

  • orthostatic hypotension

  • ovarian disorder

  • overdose

  • painful ejaculation

  • painful erection

  • pallor

  • palpitations

  • pancytopenia

  • paranoia

  • paranoid ideation

  • paresthesia

  • pelvic infection

  • phlebitis

  • pneumonia

  • pruritus

  • pseudoparkinsonism

  • psychosis

  • pulmonary embolism

  • rash

  • rate or rhythm disorder

  • rectal complaints

  • restlessness

  • retarded ejaculation

  • rhabdomyolysis

  • sciatica

  • sedation

  • seizure

  • sensory disturbance

  • serum hypertension

  • shortness of breath

  • stomach ulcer

  • stomatitis

  • suicidal ideation

  • surgically related pain

  • syncope

  • syndrome of inappropriate antidiuretic hormone secretion

  • tachycardia

  • testicular swelling

  • third degree heart block

  • thirst disturbance

  • thrombocytopenia

  • tinnitus

  • toothache

  • tremor

  • unmasking of tardive dyskinesia

  • upper respiratory complaints

  • urinary frequency

  • urinary incontinence

  • urinary retention

  • urinary tract infection

  • urticaria

  • vaginal irritation

  • vertigo

  • visual disturbance

  • vomiting

  • weight gain

  • weight loss

WITHDRAWAL SYMPTOMS

Wellbutrin can be a very difficult drug to stop taking. Here are some of the Wellbutrin withdrawal symptoms:

  • agitation

  • confusion

  • depression

  • diarrhea

  • dizziness

  • dreams, including vivid dreams

  • drowsiness

  • electric shock-like sensations
  • fatigue/malaise

  • feelings of being hot or cold

  • feelings of unreality

  • flatulence

  • flu-like feelings

  • headache

  • insomnia
  • irritability

  • mood swings

  • muscle spasms

  • nausea

  • other strange tingling or painful sensations

  • sweating

  • tremor

TREATMENT

Withdrawal from Wellbutrin should only be done under the care of a health practitioner. The safest way is to withdraw at an inpatient medical detox facility. At an inpatient medical detox facility with a protocol that includes hydration, vitamins and supplements, most patients can safely stop taking Wellbutrin in about seven days. Patients can withdraw from Wellbutrin on an outpatient basis but it will normally take at least four weeks.
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