Bupropion SR: Effective Relief for Major Depressive Disorder
Bupropion
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Bupropion SR (sustained-release) is a widely prescribed antidepressant medication belonging to the class of norepinephrine-dopamine reuptake inhibitors (NDRIs). Unlike many conventional antidepressants, it works by modulating key neurotransmitters in the brain without significantly affecting serotonin levels. This unique mechanism offers a favorable side effect profile for many patients, particularly with respect to sexual function and weight. Clinically indicated for the treatment of major depressive disorder (MDD) and seasonal affective disorder (SAD), as well as an aid to smoking cessation, Bupropion SR provides a balanced approach to managing depressive symptoms while supporting overall functional improvement. Its sustained-release formulation ensures stable plasma concentrations, enhancing tolerability and adherence.
Features
- Active ingredient: Bupropion hydrochloride
- Dosage form: Sustained-release (SR) oral tablets
- Available strengths: 100 mg, 150 mg, 200 mg
- Pharmacologic class: Norepinephrine-dopamine reuptake inhibitor (NDRI)
- Half-life: Approximately 21 hours
- Bioavailability: ~87% following oral administration
- Excretion: Primarily renal (87%) and fecal (10%)
Benefits
- Reduces core symptoms of depression, including low mood, anhedonia, and fatigue
- Lower incidence of sexual dysfunction and weight gain compared to SSRIs/SNRIs
- Improves concentration, energy levels, and motivation
- Supports smoking cessation efforts by reducing nicotine cravings and withdrawal symptoms
- Sustained-release formulation minimizes peak-trough fluctuations, enhancing tolerability
- Non-sedating profile suitable for daytime use without significant cognitive impairment
Common use
Bupropion SR is primarily indicated for the treatment of major depressive disorder (MDD) in adults. It is also FDA-approved as an aid to smoking cessation treatment. Off-label uses may include attention-deficit/hyperactivity disorder (ADHD), bipolar depression (with mood stabilizer), and augmentation strategies in treatment-resistant depression. Clinical evidence supports its efficacy in improving mood, energy, concentration, and overall quality of life in patients with moderate to severe depression.
Dosage and direction
The initial recommended dose for Bupropion SR is 150 mg once daily in the morning. After at least three days, the dose may be increased to 150 mg twice daily, with at least 8 hours between doses. The maximum recommended dose is 400 mg per day, given as 200 mg twice daily. Tablets should be swallowed whole and not crushed, chewed, or divided. Administration with food may reduce gastrointestinal irritation. Dose adjustments are necessary in patients with hepatic or renal impairment. Treatment should be initiated under medical supervision, with regular monitoring of therapeutic response and side effects.
Precautions
Patients should be monitored for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Use with caution in patients with a history of seizure disorder, cranial trauma, or conditions that lower seizure threshold. May increase blood pressure; monitor blood pressure regularly during treatment. Use cautiously in patients with hepatic or renal impairment, with appropriate dose reduction. May cause weight loss; monitor nutritional status in underweight patients. Avoid abrupt discontinuation; taper dose when discontinuing treatment.
Contraindications
Bupropion SR is contraindicated in patients with seizure disorder or history of seizures. Contraindicated in patients with current or prior diagnosis of bulimia or anorexia nervosa due to increased seizure risk. Should not be used concomitantly with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI treatment. Contraindicated in patients undergoing abrupt discontinuation of alcohol or sedatives. Not recommended for patients with known hypersensitivity to bupropion or any component of the formulation.
Possible side effects
Common side effects (≥1%) include dry mouth, nausea, constipation, headache, dizziness, insomnia, tremor, sweating, and tinnitus. Less frequent adverse reactions may include anxiety, agitation, blurred vision, tachycardia, hypertension, rash, and weight loss. Serious but rare side effects include seizures (dose-dependent), allergic reactions, angle-closure glaucoma, and severe skin reactions. Psychiatric side effects may include suicidal ideation (particularly in young adults), hostility, and mood changes. Most side effects are dose-dependent and often diminish with continued treatment.
Drug interaction
MAOIs: Risk of hypertensive crisis; contraindicated within 14 days of MAOI use. CYP2B6 inhibitors (e.g., ticlopidine, clopidogrel): May increase bupropion levels. Drugs that lower seizure threshold: Concurrent use with antipsychotics, antidepressants, tramadol, or theophylline may increase seizure risk. Alcohol: May increase risk of neuropsychiatric events. Levodopa and amantadine: Increased risk of adverse reactions. Beta-blockers: Potential increased effects. CYP2D6 substrates: Bupropion may increase levels of drugs metabolized by CYP2D6 (e.g., antidepressants, antipsychotics, beta-blockers, type 1C antiarrhythmics).
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the time for the next dose. Do not double the dose to make up for a missed dose. If multiple doses are missed, contact healthcare provider for guidance. Maintain regular dosing schedule to ensure stable therapeutic levels. Patients should be educated about the importance of adherence and the risks of abrupt discontinuation.
Overdose
Symptoms of overdose may include seizures, hallucinations, loss of consciousness, sinus tachycardia, ECG changes (prolonged QRS, QT interval), and hyperthermia. Fatal outcomes have been reported, particularly with mixed overdoses involving multiple drugs. Management includes supportive care, ECG monitoring, and control of seizures with benzodiazepines. Gastric lavage may be considered if presented early. There is no specific antidote; hemodialysis is not likely to be effective due to large volume of distribution.
Storage
Store at room temperature (20-25°C or 68-77°F) in a dry place. Protect from light and moisture. Keep in original container with tight closure. Do not store in bathroom or other humid areas. Keep out of reach of children and pets. Do not use if tablets are discolored, broken, or show signs of moisture damage. Properly dispose of expired or unused medication through take-back programs.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or discontinuing any medication. Individual response to treatment may vary. Only a healthcare provider can determine the appropriate treatment based on individual medical history, current medications, and specific health conditions. Do not share medication with others, even if they have similar symptoms.
Reviews
Clinical studies demonstrate Bupropion SR’s efficacy in depression treatment, with response rates of 50-65% and remission rates of 35-40% in major depressive disorder. Patients frequently report improvements in energy, motivation, and concentration, with particular appreciation for the reduced sexual side effects compared to other antidepressants. Smoking cessation studies show approximately double the quit rates compared to placebo. Some patients note initial side effects such as insomnia or dry mouth, which often diminish over time. Healthcare providers value its unique mechanism of action and utility in treatment-resistant cases.