DRUG REPORT

BRAND NAME: Wellbutrin

GENERIC NAME: Bupropion Hydrochloride

DRUG CATEGORY: Heterocyclic antidepressant

CLINICAL USES: Depressive Affective Mood Disorders Bipolar Disorder, Depressive episode Attention Deficit Hyperactivity Disorder Smoking Cessation (active ingredient in Zyban)

TYPICAL DOSAGE: Initial recommended dosage is 100mg BID; if no clinical improvement, dosage may be increased to 100mg TID. Dosage should not be increased above 300mg daily in first 3 weeks of administration. If after 4 weeks there are no clinical improvements dosage may be increased to 150mg QID. Furthermore, dosage increases should not exceed 75-100mg daily every 2-3 days. For extended-release tablets, the initial recommended dose is 150mg daily. If the initial dose is tolerated, the dosage may be increased to 150mg BID. If no clinical improvements after 4 weeks, dosage may be increased to 200mg BID.

DURATION OF USE: The safety and efficacy of this drug beyond 6 weeks of administration has not been established in controlled studies. Therapy extending beyond 6 weeks should be maintained at lowest therapeutic dosage and reevaluated periodically.

MECH. OF ACTION: Alters the output of norepinephrine after chronic administration, through an undetermined mechanism.

ADVANTAGES: A "second-generation" antidepressant that acts similarly to tricyclic anti-depressants with the advantages of a quicker onset of action, less sedative and adverse autonomic effects, and less toxicity when overdosed. SIDE EFFECTS: Frequent: Agitation, anxiety, abdominal pain, anorexia, constipation, dizziness, dry mouth, increased sweating, insomnia, nausea, tremors, vomiting, weight loss Rare: Hives, itching, severe headache, skin rash, tinnitus, concentration difficulty, confusion, delusions, fainting, hallucinations, paranoia, seizures, ataxia, myoclonus, dyskinesia, dystonia, blurred vision, change in taste, drowsiness, feeling of well-being, palpitations, urinary frequency. Although seizures are a relatively rare adverse (~ 0.4% of those receiving dosages less than 450mg daily), caution should be used especially in those with an underlying predisposition to seizures. While this drug may sometimes be used in the treatment of depressive episodes in bipolar mood disorders, caution should be used to prevent the onset of mania or the exacerbation of psychotic behavior.

OCULAR SIDE EFFECTS: In controlled clinical studies, approximately 15% of patients complained of blurred vision; 3% acquired amblyopia. Less than 1% of patients cited visual disturbances, dry eye, mydriasis, and diplopia, although a causal relationship to the drug has not been established.

For more information, see the following references:
1. The PDR Pocket Guide to Prescription Drugs. Third Edition.
2. Katzung, BG. Basic and Clinical Pharmacology. Seventh Edition.
3. www.medscape.com