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
BOXED WARNING
WARNINGS: Clinical Worsening and Suicide Risk in Treating Psychiatric DisordersPRECAUTIONS: Information for PatientsPRECAUTIONS: Pediatric Use
WARNINGS: Neuropsychiatric Symptoms and Suicide Risk in Smoking Cessation TreatmentPRECAUTIONS: Information for Patients
BUPROPION HYDROCHLORIDE DESCRIPTION
CLINICAL PHARMACOLOGY
Pharmacodynamics
Pharmacokinetics
Absorption
Distribution
Metabolism
PRECAUTIONS: Drug Interactions
Elimination
Populations Subgroups
Hepatic
WARNINGSPRECAUTIONSDOSAGE AND ADMINISTRATION
Renal
PRECAUTIONS: General: Renal Impairment
Left Ventricular Dysfunction
Age
PRECAUTIONS: Geriatric Use
Gender
Smokers
INDICATIONS & USAGE
WARNINGSBUPROPION HYDROCHLORIDE CONTRAINDICATIONS
WARNINGS
Clinical Worsening and Suicide Risk in Treating Psychiatric Disorders
Neuropsychiatric Symptoms and Suicide Risk in Smoking Cessation Treatment
BOXED WARNINGADVERSE REACTIONS
Screening Patients for Bipolar Disorder
Bupropion-Containing Products
Seizures
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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.
Recommendations for Reducing the Risk of Seizure
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● the total daily dose of bupropion does not exceed 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.
Hepatic Impairment
CLINICAL PHARMACOLOGYPRECAUTIONSDOSAGE AND ADMINISTRATION
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
CLINICAL PHARMACOLOGYWARNINGSDOSAGE AND ADMINISTRATION
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
CONTRAINDICATIONS
Levodopa and Amantadine
Drugs that Lower Seizure Threshold
WARNINGS
Nicotine Transdermal System
PRECAUTIONS: General: Cardiovascular Effects
Alcohol
CONTRAINDICATIONS
CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY
PREGNANCY
Teratogenic Effects. Pregnancy Category CLABOR & DELIVERY
NURSING MOTHERS
PEDIATRIC USE
BOX WARNINGWARNINGS: Clinical Worsening and Suicide Risk in Treating Psychiatric DisordersGERIATRIC USE
CLINICAL PHARMACOLOGY
PRECAUTIONS: General: Renal ImpairmentDOSAGE AND ADMINISTRATION
BUPROPION HYDROCHLORIDE ADVERSE REACTIONS
WARNINGSPRECAUTIONSWARNINGSPRECAUTIONS
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Other Events Observed During the Development of Bupropion
WARNINGSPRECAUTIONS
WARNINGS
Neuropsychiatric: (SeePRECAUTIONS
Oral Complaints: Frequent was stomatitis; infrequent were toothache, bruxism, gum irritation, and oral edema; rare was glossitis.
Respiratory: Infrequent were bronchitis and shortness of breath/dyspnea; rare were epistaxis, rate or rhythm disorder, pneumonia, and pulmonary embolism.
Special Senses: Infrequent was visual disturbance; rare was diplopia.
Nonspecific: Frequent were flu-like symptoms; infrequent was nonspecific pain; rare were body odor, surgically related pain, infection, medication reaction, and overdose.
Postintroduction Reports
Voluntary reports of adverse events temporally associated with bupropion that have been received since market introduction and which may have no causal relationship with the drug include the following:
Body (General): arthralgia, myalgia, and fever with rash and other symptoms suggestive of delayed hypersensitivity. These symptoms may resemble serum sickness (seePRECAUTIONS).
Cardiovascular: hypertension (in some cases severe, seePRECAUTIONS), orthostatic hypotension, third degree heart block
Endocrine: syndrome of inappropriate antidiuretic hormone secretion, hyperglycemia, hypoglycemia
Gastrointestinal: esophagitis, hepatitis, liver damage
Hemic and Lymphatic: ecchymosis, leukocytosis, leukopenia, thrombocytopenia. Altered PT and/or INR, infrequently associated with hemorrhagic or thrombotic complications, were observed when bupropion was coadministered with warfarin.
Musculoskeletal: arthralgia, myalgia, muscle rigidity/fever/rhabdomyolysis, muscle weakness
Nervous: aggression, coma, completed suicide, delirium, dream abnormalities, paranoid ideation, paresthesia, restlessness, suicide attempt, unmasking of tardive dyskinesia
Skin and Appendages: Stevens-Johnson Syndrome, angioedema, exfoliative dermatitis, urticaria
Special Senses: tinnitus, increased intraocular pressure
DRUG ABUSE AND DEPENDENCE
HumansAnimals
OVERDOSAGE
Human Overdose ExperienceOverdosage Management
DOSAGE & ADMINISTRATION
General Dosing Considerations
WARNINGS
Usual Dosage for Adults
Increasing the Dosage Above 300 mg/day
Maintenance Treatment
Dosage Adjustment for Patients with Impaired Hepatic Function
CLINICAL PHARMACOLOGYWARNINGSPRECAUTIONS
Dosage Adjustment for Patients with Impaired Renal Function
CLINICAL PHARMACOLOGYPRECAUTIONS
HOW SUPPLIED
STORAGE AND HANDLING
SPL MEDGUIDE
MEDICATION GUIDE BUPROPION HYDROCHLORIDE TABLETS, USP
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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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● 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. 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 reactions to bupropion. Stop taking bupropion 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, 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(used to help people stop smoking) or any other medicines that contain bupropion hydrochloride, such as WELLBUTRIN SRSustained-Release Tablets or WELLBUTRIN XLExtended-Release Tablets. Bupropion is the same 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, bupropion, or to any of the inactive ingredients. See the end of this leaflet for a complete list of ingredients in bupropion hydrochloride tablets.
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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 can harm your unborn baby.
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● are breast-feeding. Bupropion passes through your milk. It is not known if bupropion 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.
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● Take bupropion exactly as prescribed by your doctor.
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● Take bupropion at the same time each day.
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● Take your doses of bupropion at least 6 hours apart.
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● You may take bupropion 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 much bupropion can increase your chance of having a seizure.
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● If you take too much bupropion, 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 unless your doctor has told you it is okay.
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● It may take several weeks for you to feel that bupropion is working. Once you feel better, it is important to keep taking bupropion exactly as directed by your doctor. Call your doctor if you do not feel bupropion is working for you.
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● Do not change your dose or stop taking bupropion without talking with your doctor first.
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● Do not drink a lot of alcohol while taking bupropion. 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 affects you. Bupropion can impair your ability to perform these tasks.
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● Store bupropion hydrochloride tablets at room temperature. Store out of direct sunlight. Keep bupropion hydrochloride tablets in its 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 for a condition for which it was not prescribed. Do not give bupropion to other people, even if they have the same symptoms you have. It may harm them. Keep bupropion 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!