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buPROPion HCl ER (XL)
BuPROPion HCl ER (XL) is the extended-release formulation of buPROPion hydrochloride, an atypical antidepressant commonly used to treat major depressive disorder (MDD) and seasonal affective disorder (SAD). It is also used as an aid to help people quit smoking under the brand name Zyban. The XL formulation allows for once-daily dosing, which can be more convenient for patients. BuPROPion works by affecting neurotransmitters in the brain, such as dopamine and norepinephrine, to improve mood and reduce cravings associated with nicotine withdrawal.
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Frequently Asked Questions
How long does it take for BuPROPion HCl ER (XL) to start working?
For depression, it may take several weeks to notice the full effects. For smoking cessation, BuPROPion typically starts reducing cravings and withdrawal symptoms within 1 to 2 weeks.
Can BuPROPion HCl ER (XL) be used with nicotine replacement therapy (NRT)?
Yes, BuPROPion can be used in combination with nicotine replacement therapy. However, patients should be monitored for an increase in blood pressure when using both treatments together.
What should I do if I miss a dose of BuPROPion HCl ER (XL)?
If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for the missed one.
Is BuPROPion HCl ER (XL) safe to use during pregnancy?
The safety of BuPROPion during pregnancy is not well-established, and it should be used during pregnancy only if the potential benefits justify the potential risks to the fetus. Pregnant women should consult their healthcare provider before using BuPROPion.
Can BuPROPion HCl ER (XL) cause weight gain?
BuPROPion is less likely to cause weight gain compared to other antidepressants. In fact, some patients may experience weight loss as a side effect of the medication. However, individual responses vary, and lifestyle factors such as diet and exercise play a significant role in managing weight.
Comprehensive Drug Guide
How Does buPROPion HCl ER (XL) Work?
BuPROPion works by inhibiting the reuptake of dopamine and norepinephrine, two neurotransmitters involved in mood regulation and reward processing. By increasing the levels of these neurotransmitters in the brain, BuPROPion helps to improve mood in individuals with depression and reduce cravings and withdrawal symptoms in those attempting to quit smoking.
What is buPROPion HCl ER (XL) Used For?
Major Depressive Disorder (MDD): To treat the symptoms of depression.
Seasonal Affective Disorder (SAD): To prevent seasonal depression that typically occurs in the fall and winter months.
Smoking Cessation: As an aid to help people quit smoking by reducing nicotine cravings and withdrawal symptoms, often marketed under the brand name Zyban.
Common Dosages
BuPROPion HCl ER (XL) is available by prescription only and is supplied in extended-release tablets designed for once-daily administration.
Administration: BuPROPion HCl ER (XL) tablets should be swallowed whole and not crushed, chewed, or broken, as this could release the drug too quickly and increase the risk of side effects. The medication is usually taken in the morning to avoid insomnia.
Duration of Use: The duration of treatment for depression varies depending on the patient's response and the severity of the condition. For smoking cessation, treatment typically continues for 7 to 12 weeks.
Typical Dosing
FDA Approved Indications
For Major Depressive Disorder (MDD) and Seasonal Affective Disorder (SAD):
- Initial Dose: 150 mg once daily in the morning.
- Maintenance Dose: The dose may be increased to 300 mg once daily, usually after several days. Some patients may require an increase to 450 mg once daily, depending on their response and tolerance.
For Smoking Cessation:
- Initial Dose: 150 mg once daily for the first 3 days.
- Maintenance Dose: After 3 days, the dose is typically increased to 300 mg once daily. Treatment usually continues for 7 to 12 weeks, but some patients may require longer treatment.
Who Shouldn't Take buPROPion HCl ER (XL)?
BuPROPion HCl ER (XL) is contraindicated in patients with:
- A history of seizure disorders, as BuPROPion can lower the seizure threshold.
- Current or prior diagnosis of bulimia or anorexia nervosa, as these conditions increase the risk of seizures.
- Abrupt discontinuation of alcohol or sedatives (including benzodiazepines), which can increase the risk of seizures.
- Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within 14 days of stopping an MAOI.
Advice From The Pharmacist
Patients using BuPROPion HCl ER (XL) should be advised to:
- Take the medication exactly as prescribed and not to exceed the recommended dose, as this increases the risk of seizures.
- Be aware that it may take several weeks to feel the full effects of the medication for depression. It is important to continue taking it even if they do not feel immediate improvements.
- Avoid alcohol or significantly reduce alcohol consumption, as it can increase the risk of seizures.
- Report any unusual mood changes, such as agitation, depression, or suicidal thoughts, to their healthcare provider immediately.
- For smoking cessation, set a quit date within the first 2 weeks of starting BuPROPion and use the medication as part of a comprehensive program that includes behavioral support.
Side Effects of buPROPion HCl ER (XL)
Common Side Effects
- Insomnia or difficulty sleeping
- Dry mouth
- Dizziness or lightheadedness
- Weight loss
- Increased sweating
Uncommon/Severe Side Effects
- Seizures: The most significant risk associated with BuPROPion, especially at higher doses or in patients with risk factors.
- Mood Changes: Including depression, anxiety, agitation, or suicidal thoughts, particularly in the first few weeks of treatment or when adjusting the dose.
- Hypertension: BuPROPion can increase blood pressure, so it should be monitored regularly, especially in patients with pre-existing hypertension.
Risks and Warnings of buPROPion HCl ER (XL)
- Seizure Risk: BuPROPion lowers the seizure threshold, and the risk is dose-dependent. It is crucial not to exceed the prescribed dose and to report any history of seizures to the healthcare provider.
- Neuropsychiatric Symptoms: Some patients may experience changes in mood or behavior, including depression, hostility, agitation, or suicidal thoughts. These symptoms require immediate medical attention.
- Hypertension: Blood pressure should be monitored, especially in patients with pre-existing hypertension or those using nicotine replacement therapy concurrently.
Interactions with buPROPion HCl ER (XL)
Common Drug Interactions
BuPROPion HCl ER (XL) may interact with other medications, including:
- Monoamine Oxidase Inhibitors (MAOIs): Concurrent use is contraindicated due to the risk of hypertensive crisis.
- Antidepressants and Antipsychotics: May increase the risk of seizures when used with BuPROPion.
- Drugs Metabolized by CYP2B6: BuPROPion is metabolized by the liver enzyme CYP2B6, and drugs that inhibit this enzyme (such as orphenadrine) can increase BuPROPion levels, raising the risk of side effects.
- Nicotine Replacement Therapy: Concurrent use with nicotine patches may increase the risk of hypertension.
Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.
Alternatives to buPROPion HCl ER (XL)
Alternative treatments for depression and smoking cessation include:
- Other Antidepressants: Such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline, or serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine.
- Nicotine Replacement Therapy (NRT): Such as nicotine patches, gum, lozenges, nasal sprays, or inhalers, which help reduce withdrawal symptoms by providing low levels of nicotine.
- Varenicline (Chantix): Another prescription medication for smoking cessation that works by blocking nicotine receptors in the brain, reducing the pleasurable effects of smoking and easing withdrawal symptoms.
- Counseling and Behavioral Therapy: Often combined with pharmacotherapy, these approaches address the psychological aspects of depression and nicotine addiction.
The choice of treatment depends on the individual’s preferences, the severity of their condition, and their response to previous treatments.
