Bupropion Hydrochloride
FULL PRESCRIBING INFORMATION: CONTENTS*
- BOXED WARNING
- BUPROPION HYDROCHLORIDE DESCRIPTION
- CLINICAL PHARMACOLOGY
- INDICATIONS & USAGE
- BUPROPION HYDROCHLORIDE CONTRAINDICATIONS
- WARNINGS
- PRECAUTIONS
- INFORMATION FOR PATIENTS
- LABORATORY TESTS
- DRUG INTERACTIONS
- CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY
- PREGNANCY
- LABOR & DELIVERY
- NURSING MOTHERS
- PEDIATRIC USE
- GERIATRIC USE
- BUPROPION HYDROCHLORIDE ADVERSE REACTIONS
- DRUG ABUSE AND DEPENDENCE
- OVERDOSAGE
- DOSAGE & ADMINISTRATION
- HOW SUPPLIED
- STORAGE AND HANDLING
- SPL MEDGUIDE
- PACKAGE LABEL.PRINCIPAL DISPLAY PANEL SECTION
FULL PRESCRIBING INFORMATION
BUPROPION HYDROCHLORIDE DESCRIPTION
CLINICAL PHARMACOLOGY
Pharmacodynamics
Pharmacokinetics
Absorption
Distribution
Metabolism
Elimination
Populations Subgroups
Hepatic
Renal
Left Ventricular Dysfunction
Age
Gender
Smokers
INDICATIONS & USAGE
BUPROPION HYDROCHLORIDE CONTRAINDICATIONS
WARNINGS
Clinical Worsening and Suicide Risk in Treating Psychiatric Disorders
Neuropsychiatric Symptoms and Suicide Risk in Smoking Cessation Treatment
Screening Patients for Bipolar Disorder
Bupropion-Containing Products
Seizures
Bupropion is associated with seizures in approximately 0.4% (4/1,000) of patients treated at doses up to 450 mg/day. This incidence of seizures may exceed that of other marketed antidepressants by as much as 4 fold. This relative risk is only an approximate estimate because no direct comparative studies have been conducted. The estimated seizure incidence for bupropion increases almost tenfold between 450 and 600 mg/day, which is twice the usually required daily dose (300 mg) and one and one-third the maximum recommended daily dose (450 mg). Given the wide variability among individuals and their capacity to metabolize and eliminate drugs this disproportionate increase in seizure incidence with dose incrementation calls for caution in dosing.
During the initial development, 25 among approximately 2,400 patients treated with bupropion experienced seizures. At the time of seizure, 7 patients were receiving daily doses of 450 mg or below for an incidence of 0.33% (3/1,000) within the recommended dose range. Twelve patients experienced seizures at 600 mg/day (2.3% incidence); 6 additional patients had seizures at daily doses between 600 and 900 mg (2.8% incidence).
A separate, prospective study was conducted to determine the incidence of seizure during an 8 week treatment exposure in approximately 3,200 additional patients who received daily doses of up to 450 mg. Patients were permitted to continue treatment beyond 8 weeks if clinically indicated. Eight seizures occurred during the initial 8 week treatment period and 5 seizures were reported in patients continuing treatment beyond 8 weeks, resulting in a total seizure incidence of 0.4%.
The risk of seizure appears to be strongly associated with dose. Sudden and large increments in dose may contribute to increased risk. While many seizures occurred early in the course of treatment, some seizures did occur after several weeks at fixed dose. Bupropion should be discontinued and not restarted in patients who experience a seizure while on treatment.
The risk of seizure is also related to patient factors, clinical situations, and concomitant medications, which must be considered in selection of patients for therapy with bupropion.
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● Patient factors: Predisposing factors that may increase the risk of seizure with bupropion use include history of head trauma or prior seizure, central nervous system (CNS) tumor, the presence of severe hepatic cirrhosis, and concomitant medications that lower seizure threshold.
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● Clinical situations: Circumstances associated with an increased seizure risk include, among others, excessive use of alcohol or sedatives (including benzodiazepines); addiction to opiates, cocaine, or stimulants; use of over-the-counter stimulants and anorectics; and diabetes treated with oral hypoglycemics or insulin.
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● Concomitant medications: Many medications (e.g., antipsychotics, antidepressants, theophylline, systemic steroids) are known to lower seizure threshold.
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● the total daily doseof bupropion doesnotexceed 450 mg,
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● the daily dose is administered 3 times daily, with each single dose not to exceed 150 mg to avoid high peak concentrations of bupropion and/or its metabolites, and
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● the rate of incrementation of dose is very gradual.
Potential for Hepatotoxicity
PRECAUTIONS
GeneralAgitation and Insomnia
Psychosis, Confusion, and Other Neuropsychiatric Phenomena
Activation of Psychosis and/or Mania
Altered Appetite and Weight
Allergic Reactions
Cardiovascular Effects
Hepatic Impairment
Renal Impairment
INFORMATION FOR PATIENTS
Clinical Worsening and Suicide Risk in Treating Psychiatric Disorders
Neuropsychiatric Symptoms and Suicide Risk in Smoking Cessation Treatment
Bupropion-Containing Products
LABORATORY TESTS
DRUG INTERACTIONS
Drugs Metabolized by Cytochrome P450IID6 (CYP2D6)
MAO Inhibitors
Levodopa and Amantadine
Drugs That Lower Seizure Threshold
Nicotine Transdermal System
Alcohol
CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY
PREGNANCY
Teratogenic EffectsPregnancy category C
When rats were administered bupropion at oral doses of up to 300 mg/kg/day (approximately 7 times the MRHD on a mg/m2 basis) prior to mating and throughout pregnancy and lactation, there were no apparent adverse effects on offspring development.
One study has been conducted in pregnant women. This retrospective, managed-care database study assessed the risk of congenital malformations overall and cardiovascular malformations specifically, following exposure to bupropion in the first trimester compared to the risk of these malformations following exposure to other antidepressants in the first trimester and bupropion outside of the first trimester. This study included 7,005 infants with antidepressant exposure during pregnancy, 1,213 of whom were exposed to bupropion in the first trimester. The study showed no greater risk for congenital malformations overall or cardiovascular malformations specifically, following first trimester bupropion exposure compared to exposure to all other antidepressants in the first trimester, or bupropion outside of the first trimester. The results of this study have not been corroborated. Bupropion should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
LABOR & DELIVERY
NURSING MOTHERS
PEDIATRIC USE
GERIATRIC USE
BUPROPION HYDROCHLORIDE ADVERSE REACTIONS
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Other Events Observed During the Development of Bupropion
Postintroduction Reports
DRUG ABUSE AND DEPENDENCE
HumansAnimals
OVERDOSAGE
Human Overdose ExperienceOverdosage Management
DOSAGE & ADMINISTRATION
General Dosing ConsiderationsUsual Dosage for Adults
Increasing the Dosage Above 300 mg/Day
Maintenance Treatment
Dosage Adjustment for Patients With Impaired Hepatic Function
Dosage Adjustment for Patients With Impaired Renal Function
HOW SUPPLIED
STORAGE AND HANDLING
SPL MEDGUIDE
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● all risks and benefits of treatment with antidepressant medicines
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● all treatment choices for depression or other serious mental illness
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● Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
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● Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
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● Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.
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● thoughts about suicide or dying
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● attempts to commit suicide
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● new or worse depression
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● new or worse anxiety
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● feeling very agitated or restless
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● panic attacks
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● trouble sleeping (insomnia)
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● new or worse irritability
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● acting aggressive, being angry, or violent
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● acting on dangerous impulses
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● an extreme increase in activity and talking (mania)
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● other unusual changes in behavior or mood
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● Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.
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● Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepressants.
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● Antidepressant medicines have other side effects. Talk to the healthcare provider about the side effects of the medicine prescribed for you or your family member.
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● Antidepressant medicines can interact with other medicines. Know all of the medicines that you or your family member takes. Keep a list of all medicines to show the healthcare provider. Do not start new medicines without first checking with your healthcare provider.
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● Not all antidepressant medicines prescribed for children are FDA approved for use in children. Talk to your child's healthcare provider for more information.
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● thoughts about suicide or dying
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● attempts to commit suicide
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● new or worse depression
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● new or worse anxiety
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● panic attacks
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● feeling very agitated or restless
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● acting aggressive, being angry, or violent
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● acting on dangerous impulses
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● an extreme increase in activity and talking (mania)
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● abnormal thoughts or sensations
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● seeing or hearing things that are not there (hallucinations)
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● feeling people are against you (paranoia)
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● feeling confused
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● other unusual changes in behavior or mood
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● Seizures: There is a chance of having a seizure (convulsion, fit) with bupropion hydrochloride tablets USP, especially in people:
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● with certain medical problems.
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● who take certain medicines.
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● High blood pressure (hypertension). Some people get high blood pressure, that can be severe, while taking bupropion hydrochloride tablets USP. The chance of high blood pressure may be higher if you also use nicotine replacement therapy (such as a nicotine patch) to help you stop smoking.
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● Severe allergic reactions. Some people have severe allergic reaction to bupropion hydrochloride tablets USP. Stop taking bupropion hydrochloride tablets USP and call your doctor right away if you get a rash, itching, hives, fever, swollen lymph glands, painful sores in the mouth or around the eyes, swelling of the lips or tongue, chest pain, or have trouble breathing. These could be signs of a serious allergic reaction.
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● Unusual thoughts or behaviors. Some patients have unusual thoughts or behaviors while taking bupropion hydrochloride tablets USP, including delusions (believe you are someone else), hallucinations (seeing or hearing things that are not there), paranoia (feeling that people are against you), or feeling confused. If this happens to you, call your doctor.
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● have or had a seizure disorder or epilepsy.
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● are taking ZYBAN(bupropion hydrochloride sustained-release tablets) (used to help people stop smoking) or any other medicines that contain bupropion hydrochloride, such as WELLBUTRIN SR(bupropion hydrochloride sustained-release tablets) or WELLBUTRIN XL(bupropion hydrochloride extended-release tablets). Bupropion is the same active ingredient that is in bupropion hydrochloride tablets USP .
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● drink a lot of alcohol and abruptly stop drinking, or use medicines called sedatives (these make you sleepy) or benzodiazepines and you stop using them all of a sudden.
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● have taken within the last 14 days medicine for depression called a monoamine oxidase inhibitor (MAOI), such as NARDIL(phenelzine sulfate), PARNATE(tranylcypromine sulfate), or MARPLAN(isocarboxazid).
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● have or had an eating disorder such as anorexia nervosa or bulimia.
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● are allergic to the active ingredient in bupropion hydrochloride tablets USP, bupropion, or to any of the inactive ingredients. See the end of this leaflet for a complete list of ingredients in bupropion hydrochloride tablets USP.
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● Tell your doctor about your other medical conditions including if you:
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● are pregnant or plan to become pregnant. It is not known if bupropion hydrochloride tablets USP can harm your unborn baby.
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● are breastfeeding. Bupropion passes through your milk. It is not known if bupropion hydrochloride tablets USP can harm your baby.
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● have liver problems, especially cirrhosis of the liver.
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● have kidney problems.
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● have an eating disorder, such as anorexia nervosa or bulimia.
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● have had a head injury.
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● have had a seizure (convulsion, fit).
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● have a tumor in your nervous system (brain or spine).
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● have had a heart attack, heart problems, or high blood pressure.
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● are a diabetic taking insulin or other medicines to control your blood sugar.
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● drink a lot of alcohol.
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● abuse prescription medicines or street drugs.
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● Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Many medicines increase your chances of having seizures or other serious side effects if you take them while you are using bupropion hydrochloride tablets USP.
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● Take bupropion hydrochloride tablets USP exactly as prescribed by your doctor.
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● Take bupropion hydrochloride tablets USP at the same time each day.
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● Take your doses of bupropion hydrochloride tablets USP at least 6 hours apart.
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● You may take bupropion hydrochloride tablets USP with or without food.
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● If you miss a dose, do not take an extra tablet to make up for the dose you forgot. Wait and take your next tablet at the regular time. This is very important. Too many bupropion hydrochloride tablets USP can increase your chance of having a seizure.
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● If you take too many bupropion hydrochloride tablets USP, or overdose, call your local emergency room or poison control center right away.
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● Do not take any other medicines while using bupropion hydrochloride tablets USP unless your doctor has told you it is okay.
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● It may take several weeks for you to feel that bupropion hydrochloride tablets USP are working. Once you feel better, it is important to keep taking bupropion hydrochloride tablets USP exactly as directed by your doctor. Call your doctor if you do not feel bupropion hydrochloride tablets USP are working for you.
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● Do not change your dose or stop taking bupropion hydrochloride tablets USP without talking with your doctor first.
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● Do not drink a lot of alcohol while taking bupropion hydrochloride tablets USP. If you usually drink a lot of alcohol, talk with your doctor before suddenly stopping. If you suddenly stop drinking alcohol, you may increase your risk of having seizures.
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● Do not drive a car or use heavy machinery until you know how bupropion hydrochloride tablets USP affect you. Bupropion hydrochloride tablets USP can impair your ability to perform these tasks.
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● Store bupropion hydrochloride tablets USP at room temperature. Store out of direct sunlight. Keep bupropion hydrochloride tablets USP in their tightly closed bottle.
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● Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use bupropion hydrochloride tablets USP for a condition for which they were not prescribed. Do not give bupropion hydrochloride tablets USP to other people, even if they have the same symptoms you have. They may harm them. Keep bupropion hydrochloride tablets USP out of the reach of children.
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL SECTION
Bupropion HydrochlorideBupropion Hydrochloride TABLET
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PLEASE, BE CAREFUL!
Be sure to consult your doctor before taking any medication!