WELLBUTRIN SR SIDE EFFECTS
- Generic Name: bupropion hydrochloride sustained-release
- Brand Name: Wellbutrin SR
SIDE EFFECTS
The following adverse reactions are discussed in greater detail in other sections of the labeling:
- Suicidal thoughts and behaviors in adolescents and young adults
- Neuropsychiatric symptoms and suicide risk in smoking cessation treatment
- Seizure
- Hypertension
- Activation of mania or hypomania
- Psychosis and other neuropsychiatric reactions
- Angle-closure glaucoma
- Hypersensitivity reactions
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
Adverse Reactions Leading To Discontinuation Of Treatment
In placebo-controlled clinical trials, 4%, 9%, and 11% of the placebo, 300-mg-per-day, and 400-mg per- day groups, respectively, discontinued treatment due to adverse reactions. The specific adverse reactions leading to discontinuation in at least 1% of the 300-mg-per-day or 400-mg-per-day groups and at a rate at least twice the placebo rate are listed in Table 1.
Table 1: Treatment Discontinuations Due to Adverse Reactions in Placebo-Controlled Trials
| Adverse Reaction | Placebo (n = 385) |
WELLBUTRIN SR 300 mg/day (n=376) |
WELLBUTRIN SR 400 mg/day (n = 114) |
| Rash | 0.0% | 2.4% | 0.9% |
| Nausea | 0.3% | 0.8% | 1.8% |
| Agitation | 0.3% | 0.3% | 1.8% |
| Migraine | 0.3% | 0.0% | 1.8% |
Commonly Observed Adverse Reactions
Adverse reactions from Table 3 occurring in at least 5% of subjects treated with WELLBUTRIN SR and at a rate at least twice the placebo rate are listed below for the 300- and 400-mg-per-day dose groups.
WELLBUTRIN SR 300 mg per day: Anorexia, dry mouth, rash, sweating, tinnitus, and tremor.
WELLBUTRIN SR 400 mg per day: Abdominal pain, agitation, anxiety, dizziness, dry mouth, insomnia, myalgia, nausea, palpitation, pharyngitis, sweating, tinnitus, and urinary frequency.
Adverse reactions reported in placebo-controlled trials are presented in Table 2. Reported adverse reactions were classified using a COSTART-based Dictionary.
Table 2: Adverse Reactions Reported by at Least 1% of Subjects and at a Greater Frequency than Placebo in Controlled Clinical Trials
| Body System/ Adverse Reaction | WELLBUTRIN SR 300 mg/day (n=376) |
WELLBUTRIN SR 400 mg/day (n = 114) |
Placebo (n = 385) |
| Body (General) | |||
| Headache | 26% | 25% | 23% |
| Infection | 8% | 9% | 6% |
| Abdominal pain | 3% | 9% | 2% |
| Asthenia | 2% | 4% | 2% |
| Chest pain | 3% | 4% | 1% |
| Pain | 2% | 3% | 2% |
| Fever | 1% | 2% | — |
| Cardiovascular | |||
| Palpitation | 2% | 6% | 2% |
| Flushing | 1% | 4% | — |
| Migraine | 1% | 4% | 1% |
| Hot flashes | 1% | 3% | 1% |
| Digestive | |||
| Dry mouth | 17% | 24% | 7% |
| Nausea | 13% | 18% | 8% |
| Constipation | 10% | 5% | 7% |
| Diarrhea | 5% | 7% | 6% |
| Anorexia | 5% | 3% | 2% |
| Vomiting | 4% | 2% | 2% |
| Dysphagia | 0% | 2% | 0% |
| Musculoskeletal | |||
| Myalgia | 2% | 6% | 3% |
| Arthralgia | 1% | 4% | 1% |
| Arthritis | 0% | 2% | 0% |
| Twitch | 1% | 2% | — |
| Nervous system | |||
| Insomnia | 11% | 16% | 6% |
| Dizziness | 7% | 11% | 5% |
| Agitation | 3% | 9% | 2% |
| Anxiety | 5% | 6% | 3% |
| Tremor | 6% | 3% | 1% |
| Nervousness | 5% | 3% | 3% |
| Somnolence | 2% | 3% | 2% |
| Irritability | 3% | 2% | 2% |
| Memory decreased | — | 3% | 1% |
| Paresthesia | 1% | 2% | 1% |
| Central nervous system stimulation | 2% | 1% | 1% |
| Respiratory | |||
| Pharyngitis | 3% | 11% | 2% |
| Sinusitis | 3% | 1% | 2% |
| Increased cough | 1% | 2% | 1% |
| Skin | |||
| Sweating | 6% | 5% | 2% |
| Rash | 5% | 4% | 1% |
| Pruritus | 2% | 4% | 2% |
| Urticaria | 2% | 1% | 0% |
| Special senses | |||
| Tinnitus | 6% | 6% | 2% |
| Taste perversion | 2% | 4% | — |
| Blurred vision or diplopia | 3% | 2% | 2% |
| Urogenital | |||
| Urinary frequency | 2% | 5% | 2% |
| Urinary urgency | — | 2% | 0% |
| Vaginal hemorrhagea | 0% | 2% | — |
| Urinary tract infection | 1% | 0% | — |
| aIncidence based on the number of female subjects. — Hyphen denotes adverse events occurring in greater than 0 but less than 0.5% of subjects. |
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Other Adverse Reactions Observed During The Clinical Development Of Bupropion
In addition to the adverse reactions noted above, the following adverse reactions have been reported in clinical trials with the sustained-release formulation of bupropion in depressed subjects and in nondepressed smokers, as well as in clinical trials with the immediate-release formulation of bupropion.
Adverse reaction frequencies represent the proportion of subjects who experienced a treatment-emergent adverse reaction on at least one occasion in placebo-controlled trials for depression (n = 987) or smoking cessation (n = 1,013), or subjects who experienced an adverse reaction requiring discontinuation of treatment in an open-label surveillance trial with WELLBUTRIN SR (n = 3,100). All treatment-emergent adverse reactions are included except those listed in Table 3, those listed in other safety-related sections of the prescribing information, those subsumed under COSTART terms that are either overly general or excessively specific so as to be uninformative, those not reasonably associated with the use of the drug, and those that were not serious and occurred in fewer than 2 subjects.
Adverse reactions are further categorized by body system and listed in order of decreasing frequency according to the following definitions of frequency: Frequent adverse reactions are defined as those occurring in at least 1/100 subjects. Infrequent adverse reactions are those occurring in 1/100 to 1/1,000 subjects, while rare events are those occurring in less than 1/1,000 subjects.
Body (General): Infrequent were chills, facial edema, and photosensitivity. Rare was malaise.
Cardiovascular: Infrequent were postural hypotension, stroke, tachycardia, and vasodilation. Rare were syncope and myocardial infarction.
Digestive: Infrequent were abnormal liver function, bruxism, gastric reflux, gingivitis, increased salivation, jaundice, mouth ulcers, stomatitis, and thirst. Rare was edema of tongue.
Hemic and Lymphatic: Infrequent was ecchymosis.
Metabolic and Nutritional: Infrequent were edema and peripheral edema.
Musculoskeletal: Infrequent were leg cramps.
Nervous System: Infrequent were abnormal coordination, decreased libido, depersonalization, dysphoria, emotional lability, hostility, hyperkinesia, hypertonia, hypesthesia, suicidal ideation, and vertigo. Rare were amnesia, ataxia, derealization, and hypomania.
Respiratory: Rare was bronchospasm.
Special Senses: Infrequent were accommodation abnormality and dry eye.
Urogenital: Infrequent were impotence, polyuria, and prostate disorder.
Changes In Body Weight
In placebo-controlled trials, subjects experienced weight gain or weight loss as shown in Table 3.
Table 3: Incidence of Weight Gain and Weight Los s ( ≥ 5 lbs ) in Placebo-Controlled Trials
| Weight Change | WELLBUTRIN SR 300 mg/day (n=339) |
WELLBUTRIN SR 400 mg/day (n = 112) |
Placebo (n=347) |
| Gained > 5 lbs | 3% | 2% | 4% |
| Lost > 5 lbs | 14% | 19% | 6% |
In clinical trials conducted with the immediate-release formulation of bupropion, 35% of subjects receiving tricyclic antidepressants gained weight, compared with 9% of subjects treated with the immediate-release formulation of bupropion. If weight loss is a major presenting sign of a patient’s depressive illness, the anorectic and/or weight-reducing potential of WELLBUTRIN SR should be considered.
Postmarketing Experience
The following adverse reactions have been identified during post-approval use of WELLBUTRIN SR and are not described elsewhere in the label. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Body (General)
Arthralgia, myalgia, and fever with rash and other symptoms suggestive of delayed hypersensitivity. These symptoms may resemble serum sickness.
Cardiovascular
Complete atrioventricular block, extrasystoles, hypotension, hypertension (in some cases severe), phlebitis, and pulmonary embolism.
Digestive
Colitis, esophagitis, gastrointestinal hemorrhage, gum hemorrhage, hepatitis, intestinal perforation, pancreatitis, and stomach ulcer.
Endocrine
Hyperglycemia, hypoglycemia, and syndrome of inappropriate antidiuretic hormone.
Hemic and Lymphatic
Anemia, leukocytosis, leukopenia, lymphadenopathy, pancytopenia, and thrombocytopenia. Altered PT and/or INR, infrequently associated with hemorrhagic or thrombotic complications, were observed when bupropion was coadministered with warfarin.
Metabolic and Nutritional
Glycosuria.
Musculoskeletal
Muscle rigidity/fever/rhabdomyolysis and muscle weakness.
Nervous System
Abnormal electroencephalogram (EEG), aggression, akinesia, aphasia, coma, completed suicide, delirium, delusions, dysarthria, euphoria, extrapyramidal syndrome (dyskinesia, dystonia, hypokinesia, parkinsonism), hallucinations, increased libido, manic reaction, neuralgia, neuropathy, paranoid ideation, restlessness, suicide attempt, and unmasking tardive dyskinesia.
Respiratory
Pneumonia.
Skin
Alopecia, angioedema, exfoliative dermatitis, hirsutism, and Stevens-Johnson syndrome.
Special Senses
Deafness, increased intraocular pressure, and mydriasis.
Urogenital
Abnormal ejaculation, cystitis, dyspareunia, dysuria, gynecomastia, menopause, painful erection, salpingitis, urinary incontinence, urinary retention, and vaginitis.
SRC: NLM .