What is bupropion extended release, and how does it work (mechanism of action)?
Bupropion hydrochloride is an antidepressant medication that affects chemicals within the brain that nerves use to send messages to each other. (Forfivo XL is an extended release form of bupropion hydrochloride.) Chemical messengers are called neurotransmitters. Many experts believe that depression is caused by an imbalance among the amounts of neurotransmitters that are released. Nerves may recycle neurotransmitters by a process referred to as reuptake in which the released neurotransmitters are taken up and reused (released again) by the nerves. Bupropion works by inhibiting the reuptake of dopamine, serotonin, and norepinephrine by the nerves after they have been released, an action that results in more dopamine, serotonin, and norepinephrine to transmit messages to other nerves. Bupropion is unique and unlike other antidepressants in that its major effect is on dopamine, an effect that is not shared by the related selective serotonin reuptake inhibitors or SSRIs (for example, paroxetine [Paxil], fluoxetine [Prozac], sertraline [Zoloft]) or the tricyclic antidepressants or TCAs (for example, amitriptyline [Elavil, Endep], imipramine [Tofranil], desipramine [Norpramin]). The FDA approved Forfivo in December 1985.
What brand names are available for bupropion hydrochloride extended release?
Forfivo XL
Is bupropion hydrochloride extended release available as a generic drug?
Yes (other extended release formulations of bupropion)
Do I need a prescription for bupropion hydrochloride extended release?
Yes
What are the side effects of bupropion extended release?
The most common side effects associated with bupropion are:
- agitation,
- dry mouth,
- insomnia,
- headache,
- nausea,
- constipation, and
- tremor.
In some people, the agitation or insomnia is most marked shortly after starting therapy. Some patients may experience weight loss. Uncommonly, patients may experience manic episodes or hallucinations. Four of every 1000 persons who receive bupropion in doses less than 450 mg/day experience seizures. When doses exceed 450 mg/day, the risk increases ten-fold. Other risk factors for seizures include past injury to the head and medications which can lower the threshold for seizures. (See drug interactions.)
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Forfivo or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
What is the dosage for bupropion extended release?
Bupropion is given as 450 mg once daily without regards to meals. It is given to patients receiving 300 mg of another bupropion formulation daily for at least 2 weeks and require 450 mg daily. Those receiving 450 mg daily of another bupropion formulation can be switched directly to Forfivo.
Which drugs or supplements interact with bupropion extended release?
Bupropion should be used cautiously in patients receiving drugs that reduce the threshold for seizures. Such drugs include prochlorperazine (Compazine), chlorpromazine (Thorazine), and other antipsychotic medications of the phenothiazine class. Additionally, persons who are withdrawing from benzodiazepines (for example, diazepam [Valium], alprazolam [Xanax]) are at increased risk for seizures.
Carbamazepine (Tegretol) may reduce the effect of bupropion by reducing its blood concentration. Monamine oxidase inhibitors should not be combined with bupropion because of the risk of severe reactions. At least 14 days should elapse between discontinuation of an monoamine oxidase inhibitor and initiation of bupropion. bupropion may affect the action of warfarin (Coumadin).
Ritonavir (Norvir) may increase the breakdown and elimination of bupropion. In some studies ritonavir reduced the concentration of bupropion in the body by 22% to 66%.
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Is bupropion extended release safe to take if I’m pregnant or breastfeeding?
There are no adequate studies of bupropion in pregnant women. In one study, there was no difference between bupropion and other antidepressants in the occurrence of birth defects. Bupropion should only be used in pregnancy if the benefit outweighs the potential risk.
Bupropion is secreted in breast milk.
What else should I know about bupropion extended release?
What preparations of bupropion hydrochloride extended release are available?
- Tablets: 75, 100, and 150 mg.
- Sustained Release tablets: 100, 150 and 200 mg.
- Extended Release tablets: 150 and 300 mg.
How should I keep bupropion hydrochloride extended release stored?
Tablets should be kept at room temperature, 15 C to 25 C (59 F to 77 F).