Wellbutrin: instructions for use, indications and contraindications
Wellbutrin is a modern antidepressant that improves mood and sense of well-being. Its effect is based on restoring the balance of neurotransmitters in the brain. In addition, the drug eliminates cravings for smoking. The active ingredient of the drug is bupropion. Wellbutrin is available in the form of tablets of the prolonged action of two dosages - 150 mg each and 300 mg of the active substance. Auxiliary components of the tablets are: glyceryl tribehenate and polyvinyl alcohol.
Bupropion is a selective inhibitor of the neuronal uptake of catecholamines (dopamine and norepinephrine), which has virtually no effect on the uptake of serotonin and does not inhibit monoamine oxidase. The mechanism of action of the drug at the moment is not well understood. It is assumed that the antidepressant effect is achieved due to the effect on dopaminergic and noradrenergic mediator systems. When ingestion of the maximum content of the drug in the blood is observed after 3-5 hours. The active component binds to blood proteins by 84%. Wellbutrin is excreted mainly in the form of metabolites. About 87% is excreted in the urine and 10% in the feces.
Indications and contraindications for use
Wellbutrin is used to treat depression, as well as for the prevention of relapses and exacerbations of depression. The drug can be prescribed for the treatment of seasonal affective disorder and to combat obesity and nicotine addiction. Also, sometimes the drug is used in the complex treatment of neuroses of various origins.
The use of the drug is prohibited when:
- hypersensitivity to any component of the drug;
- concomitant use of other drugs containing bupropion;
- abrupt cancellation of alcohol or sedatives;
- convulsive disorders;
- taking MAO inhibitors at the same time and after less than 2 weeks after taking their last dose;
- less than 18 years old.
With extreme caution Wellbutrin prescribed to patients with a low threshold of convulsive readiness, disorders of the cardiovascular system, kidneys and liver, insulin-dependent diabetes, while taking other antidepressants, history of brain injuries, brain tumors.
Use during pregnancy and lactation
Welbutrin can be prescribed during pregnancy only in cases where the expected benefit from its use exceeds the possible risk. Contraindicated in lactation. It is recommended to stop breastfeeding during drug therapy.
Dosage regimen and dosage
Wellbutrin must be taken orally. The tablets are swallowed whole, washed down with water. Quick effect is not worth waiting. Severe antidepressant effect occurs after about 2 weeks of continuous use. The maximum daily dose should not exceed 450 mg. Treatment begins with the use of 150 mg of Wellbutrin per day in the morning. If the desired effect is not achieved, over time the dose is increased to 300 mg per day. In particularly difficult cases, in the absence of a therapeutic effect with a dose of 300 mg, it may be increased to 450 mg.
If the maximum daily dose (450 mg) is exceeded, an overdose is very likely to develop. It manifests arterial agitation with hypertension, seizures, tachycardia, agitation, drowsiness, nausea, vomiting, delusions, lethargy, visual and auditory hallucinations, coma, epileptic seizures. There is no specific antidote. It is necessary to contact the medical institution where it is necessary to conduct symptomatic therapy. In some cases, barbiturates or benzodiazepines are administered to prevent seizures. It should be borne in mind that the toxic effect may occur much later than taking it, and the seizures even 30 hours after the overdose.
Possible negative reactions of the body
Wellbutrin can have a large number of different side effects. Especially often they appear in the first weeks of admission. Treatment may be accompanied by the following side effects:
- allergic reaction (swelling of the face, lips, throat or tongue, difficulty breathing, rash);
- dry mouth;
- excessive sweating;
- irritation and anger of vertigo;
- visual impairment;
- unusual dreams;
- convulsive disorders;
- lack of coordination of movements;
- visual impairment;
- violation of urination;
- chest pain;
- The following is a list of adverse events identified in clinical studies grouped by organ systems. Criteria for the frequency of adverse reactions: very often (> 1/10), often (> 1/100, <1/10), sometimes (> 1/1000, <1/100), rarely (> 1/10 000, <1 / 1000), very rarely (<1/10 000).
- Immune system disorders: often: hypersensitivity reactions such as urticaria; very rarely: more severe hypersensitivity reactions, including angioedema, dyspnea / bronchospasm and anaphylactic shock, arthralgia, myalgia and fever accompanied by a rash, and other symptoms of a delayed tala hypersensitivity reaction. These symptoms may resemble serum sickness.
- Metabolism: often: anorexia; sometimes: weight loss; very rare: change in blood glucose concentration.
- On the part of the psyche and behavior: very often: insomnia; often: agitation, anxiety; sometimes: depression, confusion; very rarely: aggressiveness, hostility, irritability, anxiety, hallucinations, unusual dreams, depersonalization, illusions, nonsense.
- On the part of the nervous system: very often: headache; often: tremor, dizziness, disturbance of taste; sometimes: impaired ability to concentrate; seldom: convulsive disorders; very rarely: dystopia, ataxia, parkinsonism, impaired motor coordination, memory impairment, paresthesia, fainting.
- On the part of the organ of vision: often: visual disturbances.
- On the part of the organ of hearing: often: ringing in the ears.
- On the part of the cardiovascular system: often: increased blood pressure (sometimes severe), 'hot flashes'; sometimes: tachycardia; very rarely: palpitations, vasodilation, orthostatic hypotension.
- On the part of the gastrointestinal tract: very often dry mouth, gastrointestinal disorders, including nausea and vomiting; often abdominal pain, constipation; very rarely: increased liver enzymes, jaundice, hepatitis.
- On the part of the skin and subcutaneous tissues: often: rash, pruritus, sweating; very rare: erythema multiforme, Stevens-Johnson syndrome.
- On the part of the musculoskeletal system and connective tissue: very rarely: twitching of the limbs.
- On the part of the urinary system: very rarely: increased or delayed urination.
- On the part of the body as a whole: often: fever, chest pain, asthenia.
- Insomnia is a very frequent adverse reaction of a transient nature, and if necessary, reduce the dose or frequency of taking the drug. Do not take Wellbutrin at bedtime with the 24-hour interval between taking the drug.
In case of Wellbutrin overdose, in addition to the symptoms described above, drowsiness, loss of consciousness and ECG changes are observed, such as conduction disturbances (including lengthening of the QRS complex) or arrhythmias. The case of simultaneous ingestion of bupropion was reported in doses 10 times the maximum therapeutic dose.
The specific antidote for bupropion is unknown. In case of overdose, hospitalization is recommended. Monitoring of ECG and vital signs is necessary. It is required to provide airway, oxygenation and pulmonary ventilation. Immediately after taking Wellbutrin orally, the use of activated carbon is indicated. Further treatment tactics should be based on the clinical picture and recommendations of the poison control center.
If while taking the drug there are convulsions, then its reception is stopped and no longer resumes. You should refrain from driving vehicles and working with potentially dangerous machinery, in the first few weeks of administration, until the body’s response to the active ingredient of the drug is known. Minimum doses should be used to treat elderly patients. Taking the drug may give a false positive drug test. Wellbutrin is not compatible with alcohol. Special care should be taken when there are abnormalities in the functioning of the liver and kidneys.
Interaction with other drugs
It is necessary to inform the attending physician about all accepted preparations, even if they are non-prescription. You should know that Wellbutrin:
- It is forbidden to take simultaneously with MAO inhibitors and for 2 weeks after the completion of their reception;
- caution should be exercised while taking the drug with cyclophosphamide, orphenadrin, ticlopidine, ifosfamide, clopidogrel;
- when taken concomitantly with antiarrhythmic agents, tricyclic antidepressants, selective serotonin uptake inhibitors, beta-blockers and antipsychotics, a reduction in the dose of these drugs is necessary;
- increases the maximum concentration of citalopram;
- simultaneous use with Amantadine or Levodopa increase the incidence of unwanted neuropsychiatric reactions;
- can significantly increase blood pressure when used with the nicotinic transdermal system.
There are no data on the safety of the drug during pregnancy. Therefore, you should refrain from receiving it during this period. Bupropion penetrates into breast milk, which can harm the baby. It is necessary to stop breastfeeding during the period of application of the medicine. Studies on the safety of Wellbutrin in children have not been conducted, so its use is prohibited for patients aged less than 18 years.
Point of view
Reviews of the drug Wellbutrin there is a sufficient amount, not all of them are unambiguous. The drug has been used successfully to treat depression. He also found its use to alleviate the state during quitting.
- take the drug can only be prescribed by a doctor;
- You should carefully read the instructions for the drug and keep it for the entire period of treatment so that you can clarify the information as soon as necessary;
- taking along with food will reduce nausea;
- do not crush, divide and crush tablets.
Advantages and disadvantages
- jars of medicine high efficiency;
- does not cause weight gain; does not inhibit libido.
- need a recipe for the purchase;
- many side effects;
- high price.
Vacation from the pharmacy and search for analogues
Keep the drug must be out of reach of children at room temperature. From the pharmacy, the drug is released strictly on prescription. It is possible to replace Wellbutrin with similar drugs of this group, but only after consulting a doctor, among others Buspirone, Bupropion, Zyban.