Overview of Wellbutrin
This is a kind of antidepressant medication that is used to treat major depressive episodes or disorders and sometimes seasonal affective disorders.
During the first days of taking in Wellbutrin, the patient might feel agitation, restlessness and fatigue, and insomnia. If this is the case, try reducing the dosage temporarily and avoid taking in the doses during bedtime.
One of the major side effects of Wellbutrin aside from sleep disorders is a seizure. In a population of 1,000 that use Wellbutrin, one person is at risk of seizure. The medicine Wellbutrin is not recommended to people who have experienced or are still very susceptible to seizures because it will lower the threshold of seizure, which makes it easier for seizures to occur. If a person has a history of epilepsy or any other type of seizure, currently withdrawing from alcohol or benzodiazepine; currently has an active brain tumor, has anorexia and bulimia nervosa, if he has experienced head traumas, and if ever he is taking drugs that affect the brain like antipsychotics, antidepressants, systemic steroids, theophylline, and any other drug that can lower a person’s threshold, he shall not be taking in Wellbutrin.
A person who experiences seizure when using Wellbutrin must immediately stop taking in the medicine and must tell their physicians as soon as possible.
The medicine Wellbutrin also has other adverse effects on the body. Some of the most common side effects that affect more than 1 out of 10 people include dry mouth, headache, feeling sick, nausea and vomiting, and having difficulty sleeping.
On the other hand, one out of 10 people feels chest pains, anxiety and agitation, restlessness, dizziness, high blood pressure, blurry vision, low appetite, and other intestinal problems, ringing in the ears, fever, sweating, low energy or weakness, tremors and shaking.
There is also a possibility that one out of a hundred people may feel an increased heart rate, confusion, and difficulty in focusing, and weight loss, while one of the 1,000 people will experience seizures.
Certain psychological effects might also be experienced, like feeling hostility and restlessness, experiencing delusions, and a deep sense of depersonalization
There is also a great risk of increased suicidal thinking and behavior, which was linked to the usage of many several antidepressants, however, it is not clear if the use of the drugs increases the risk. Each patient shall be monitored to see the signs and symptoms of worsening depression.
Dosage and Administration
The general usage instructions
To be able to minimize that heightened risk of seizure to patients, it is important to slowly and gradually increase the dose. Each increase in the dosage must not go beyond 100mg every day.
The increase in dosage shall not be more than 100mg per day in three days. Wellbutrin must be swallowed and taken in as a whole and should not be crushed, chewed, or even divided. This medicine can also be taken in with or even without food.
The recommendation as a starting dosage for Wellbutrin is 200 mg a day, taken twice a day on a 100mg basis. After the third day of intake, the dosage can be increased up to 300mg daily, taken thrice a day, on a 100mg basis, with a 6 hours difference between every intake. If a person’s dosage is above 300mg daily, this can be accomplished by using the 75mg or the 100mg tablets.
The maximum dosage each patient should take must not exceed 450mg daily. This should be given in to dosages divided into not more than 150mg per intake, and should only be considered for the patients that show no visible clinical improvement even after the several weeks of treatment in the 300mg daily.
Generally, it is known that the more acute the episode of depression is, the more it requires a long month of using antidepressant drug treatments that are beyond the response when an acute episode occurs. There are no known studies that prove whether the dosage of the medicine Wellbutrin that is needed for the treatment and maintenance must be identical to the dosage that is prescribed as the initial response treatment. It is imperative to frequently reassess the need for the treatment and maintenance and what is the appropriate dosage for those specific treatments.
Dosage for patients with hepatic impairment
For the patients that suffer from moderate to very severe hepatic impairment, the limit or the maximum dosage of the medicine Wellbutrin is only up to 75mg daily. Meanwhile, for the patients that experience only mild hepatic impairment, try decreasing either the dosage or the frequency of taking in Wellbutrin.
Adjustment of Dosage for Patients with Renal Impairment
For the patients with renal impairment, consider reducing the dosage and the frequency of taking in Wellbutrin. This can be less than 90ml.
Changing of prescription either to of from the monoamine oxidase inhibitor (MAOI) antidepressant
There should be at least a 14 days elapse between the day the patient discontinues that use of any MAOI that was used to treat depression to the start of the therapy with Wellbutrin. This is also the case vice versa, and a 14-day rest should be practiced between stopping Wellbutrin and starting an MAOI antidepressant.
Your doctor must know all the prescription medicines, vitamins, and other drugs that you are taking. This way, drug interaction can be managed, and there will be no added harm to you.
One of the drugs that have the most potential to affect or have an interaction with Wellbutrin is any drugs that contain hydroxybupropion by the CYP2B6. Any drugs that inhibit or induce the substance CYP2B6 might have an interaction with Wellbutrin.
In a vitro study made in animals, the data stated that bupropion could be an inducer of the drug that metabolizes enzymes with humans. In one of the trials, when they followed the administration of the bupropion, thrice a day in the 100mg basis to the eight volunteers that were healthy males in 14 days, there was no evidence that suggested the induction of its metabolism. However, there are possibilities of the alteration on the blood levels of the co-administered drugs.
Other drugs that are metabolized by the CYP2D6 greatly impact the drug interaction while using the Wellbutrin. A clinical study made on 15 male adults that were very extensive in metabolizing CYP2D6, the bupropion of 300mg daily followed by one dose of a 50mg desipramine, has resulted in the increase of Cmax, AUC and t1/2. These interactions were present in the blood for at least seven days of the last dosage. However, there are no formal studies made yet for the use of bupropion when mixed with other drug metabolizers.
Warnings and Precautions on Wellbutrin
Increased suicidal thoughts in the behavior of children to young adults.
For patients with major depressive disorder, there is a possibility to experience worsening depression and even the emergence of suicidal ideas and behavior. There is also a risk of unusual changes in the behavior of the patient, whether or not drinking antidepressants. This risk might also persist until there is an occurrence of a significant remission.
Generally, suicide is one of the known risks of depression and other mental health disorders. These psychiatric disorders themselves are among the strongest predictors of suicide. For a long time now, there has been huge concern about the long-standing effects of the antidepressants, which include the worsening of depression and the emergence of the suicidal tendencies of the patients when on the early phases of the treatment.
In the analyses of the pooled studies about the short-term placebo trials in these antidepressant drugs, there is a significant increase in suicidality on the children, adolescents, and young adults that are suffering from a major depressive disorder or any other psychiatric disorders. However, there are no signs of the increased risk of suicidal behaviors in the short-term clinical trials made to adults after the age of 24. In fact, it has shown a reduced number of usage of antidepressants when compared to the placebo group in the adults aged 65 and older that were tested.
In the studies made for the children and adolescents who experience the obsessive-compulsive disorder, major depressive disorder, and any other psychiatric disorder, the results show the various risks of suicidality with the drugs but show increased suicidality to towards the younger groups studied.
There were no suicides that occurred during all the pediatric trials, and a number of suicides noted on the adult trials. However, the number was insufficient to form any conclusion about the effects of the drugs om suicide.
It is also unknown whether the risk of suicidality has the possibility to extend on a longer-term usage, or beyond several months. On the other hand, there was substantial evidence derived from the placebo-controlled trials with adults who were experiencing depression, stating that the use of antidepressants has the power to delay the recurrence of depression.