Adverse effects
• CNS: Agitation, insomnia, headache, migraine, tremor, ataxia, incoordination, seizures, mania, increased libido, hallucinations, visual disturbances
• CV: Dizziness, tachycardia, edema, ECG abnormalities, chest pain, shortness of breath
• Dermatologic: Rash, alopecia, dry skin
• GI: Dry mouth, constipation, nausea, vomiting, stomatitis
• GU: Nocturia, vaginal irritation, testicular swelling
• Other: Weight loss, flulike symptoms
Interactions
Drug-drug
• Increased risk of adverse effects with levodopa
• Increased risk of toxicity with MAOIs
• Increased risk of seizures with drugs that lower seizure threshold, including alcohol
Nursing considerations
Assessment
• History: Hypersensitivity to bupropion, history of seizure disorder, bulimia or anorexia, head trauma, CNS tumor, treatment with MAOI, renal or liver disease, heart disease, lactation
• Physical: Skin, weight; orientation, affect, vision, coordination; P, rhythm, auscultation; R, adventitious sounds; bowel sounds, condition of mouth
Interventions
• Give drug three times a day for depression; do not administer more than 150 mg in any one dose. Administer sustained-release forms twice a day with at least 8 hr between doses.
• Increase dosage slowly to reduce the risk of seizures.
• Administer 100-mg tablets four times a day for depression, with at least 4 hr between doses, if patient is receiving > 300 mg/day; use combinations of 75-mg tablets to avoid giving > 150 mg in any single dose.
• Arrange for patient evaluation after 6 wk.
• Discontinue MAOI therapy for at least 14 days before beginning bupropion.
• Monitor liver and renal function tests in patients with a history of liver or renal impairment.
• Have patient quit smoking within first 2 wk of treatment for smoking cessation; may be used with transdermal nicotine.
• WARNING: Monitor response and behavior; suicide is a risk in depressed patients.
Teaching points
• Take this drug in equally divided doses three to four times a day as prescribed for depression. Take SR forms twice a day, at least 8 hr apart. Do not combine doses or make up missed doses. Take once a day, or divided into two doses at least 8 hr apart for smoking cessation.
• Avoid or limit the use of alcohol while on this drug. Seizures can occur if these are combined.
• May be used with transdermal nicotine; most effective for smoking cessation if combined with behavioral support program.
• You may experience these side effects: Dizziness, lack of coordination, tremor (avoid driving or performing tasks that require alertness); dry mouth (use frequent mouth care; suck sugarless lozenges); headache, insomnia (consult with care provider if these become a problem; do not self-medicate); nausea, vomiting, weight loss (eat frequent small meals).
• Report dark urine, light-colored stools; rapid or irregular heart beat; hallucinations; severe headache or insomnia; fever, chills, sore throat.