Medicine & USMLE

Bupropion

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Psych Drugs (New)
  1. Mirtazapine
  2. Vortioxetine
  3. Bupropion
  4. Trazodone
  5. Vilazodone
  6. Buspirone
  7. Buprenorphine
  8. Neuroleptic Malignant Syndrome (NMS)
  9. Typical Antipsychotics
  10. Naltrexone
  11. Nicotine Replacement Therapies
  12. SSRIs
  13. Varenicline
  14. Naloxone
  15. CNS Stimulants

Summary

Bupropion is a drug that inhibits the reuptake of dopamine and norepinephrine. This increases levels of these neurotransmitters in the brain. Clinically, bupropion is used to treat depression and aid in smoking cessation.

Important side effects to remember include seizures. Bupropion should be avoided in patients with seizure disorders, and is contraindicated with alcohol, anorexia nervosa, and bulimia due to increased seizure risk. Other side effects of bupropion include insomnia, headaches, and a loss of appetite, which may lead to weight loss. Compared to other antidepressants, bupropion is less likely to cause sexual dysfunction.

Key Points

  • Bupropion (Wellbutrin)
    • Mechanism
      • Inhibits NE (norepinephrine) and DA (dopamine) reuptake
        • Increases amount of norepinephrine and dopamine that remains in the synaptic cleft
        • Does not affect serotonin levels
    • Clinical Use
      • Treats depression (antidepressant)
        • Called “atypical” because it does not belong to one of the traditional classes of antidepressants: SSRIs, SNRIs, MAOIs, or TCAs
        • Generally used as a 2nd/ 3rd line pharmacologic choice after SSRIs (which are definitive 1st line)
      • Used for smoking cessation
        • Reduces withdrawal symptoms in nicotine addiction and smoking cessation.
    • Side Effects
      • Insomnia (CNS stimulation)
        • Symptoms can include tachycardia and insomnia
      • Headache
      • Seizures
        • Lowers the seizure threshold
        • Contraindicated in patients with bulimia and anorexia nervosa
          • These patients have underlying electrolyte abnormalities which can further increase seizure risk
        • Contraindicated with alcohol use
          • Also can increase seizure risk
      • Less sexual adverse effects (compared to other antidepressants)
        • Patients unable to tolerate SSRIs and other antidepressants due to impotence may be switched to bupropion
      • Loss of appetite
        • May lead to weight loss
        • In contrast to other antidepressants, which commonly cause weight gain