buPROPion HCl ER (XL)

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.

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.

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.

• Insomnia or difficulty sleeping
• Dry mouth
• Dizziness or lightheadedness
• Weight loss
• Increased sweating

• 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.

• 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.

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.

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.