Wellbutrin SR
Generic name:
Brand names: Wellbutrin XL, Wellbutrin SR, Wellbutrin
Why is Wellbutrin SR prescribed?
Wellbutrin is prescribed to help relieve major depression. Symptoms include a severely depressed mood (for 2 weeks or more) and loss of interest or pleasure in usual activities accompanied by sleep and appetite disturbances, agitation or lack of energy, feelings of guilt or worthlessness, decreased sex drive, inability to concentrate, and sometimes, suicidal thoughts or behavior.
Wellbutrin is thought to work by altering levels of the brain chemicals norepinephrine and dopamine. It is not chemically related to other antidepressants such as tricyclics (Elavil), MAO inhibitors (Nardil, Parnate), or serotonin re-uptake inhibitors (Paxil and Prozac).
Most important fact about Wellbutrin SR
Wellbutrin is associated with an increased risk of seizures. This risk is greater at higher doses (approximately 4 in 1,000 patients at dosages of 300 to 450 milligrams a day). Certain factors increase the risk of seizure, including:
A history of head trauma or previous seizure
Central nervous system tumor
Severe liver disease such as cirrhosis
A history of eating disorders, including anorexia and bulimia
Excessive use of alcohol, or abrupt withdrawal from alcohol or sedatives
Taking medications that lower the seizure threshold (see "Possible food and drug interactions when taking Wellbutrin SR")
To minimize the risk of seizures, dose increases should be done gradually, and the total daily dose of Wellbutrin should not exceed 450 milligrams. Additionally, the doctor should be aware of all your medical conditions, and you should not take any other medications (both prescription and over-the-counter) unless the doctor approves.
How should you take Wellbutrin SR?
Take Wellbutrin exactly as prescribed by your doctor. The usual dosing regimen is 3 equal doses spaced evenly throughout the day. Allow at least 6 hours between doses. Your doctor will probably start you at a low dosage and gradually increase it; this helps minimize side effects.
You should take Wellbutrin SR, the sustained-release form, in 2 doses, at least 8 hours apart. Wellbutrin XL extended-release tablets should be taken once a day in the morning. Swallow Wellbutrin SR and Wellbutrin XL tablets whole; do not chew, divide, or crush them.
If Wellbutrin works for you, your doctor will probably have you continue taking it for at least several months.
--If you miss a dose...
Take it as soon as you remember. If it is within 4 hours of your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
--Storage instructions...
Store at room temperature. Protect from light and moisture.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Wellbutrin.
- Side effects of Wellbutrin may include:
Agitation, constipation, dizziness, dry mouth, excessive sweating, headache, nausea, vomiting, skin rash, sleep disturbances, tremor
- Side effects of Wellbutrin SR may include:
Agitation, constipation, dizziness, dry mouth, insomnia, nausea, rash, sweating, weight loss
- Side effects of Wellbutrin XL may include:
Abdominal pain, agitation, anxiety, constipation, diarrhea, dizziness, dry mouth, heart palpitations, increased urination, insomnia, muscle soreness, nausea, rash, ringing in the ears, sore throat, sweating
Why should Wellbutrin SR not be prescribed?
Do not take Wellbutrin if you are sensitive to or have ever had an allergic reaction to it.
Since Wellbutrin causes seizures in some people, do not take it if you have any type of seizure disorder or if you are taking another medication containing bupropion, such as Zyban, the used to help quit smoking. If you have a seizure while taking Wellbutrin, stop taking the drug and never take it again.
Do not take Wellbutrin while abruptly giving up alcohol or sedatives, including tranquilizers such as Librium, Valium, and Xanax. Rapid withdrawal increases the risk of seizures.
If you have had any kind of heart trouble or liver or kidney disease, be sure your doctor knows about it before you start taking Wellbutrin SR. It must be used with extreme caution if you have severe cirrhosis of the liver. A reduced dosage may be needed if you have any sort of liver or kidney problem.
You should not take Wellbutrin if you currently have, or formerly had, an eating disorder. For some reason, people with a history of anorexia nervosa or bulimia seem to be more likely to experience Wellbutrin-related seizures. Do not take Wellbutrin if, within the past 14 days, you have taken a monoamine oxidase inhibitor (MAO inhibitor) drug, such as the antidepressants Marplan, Nardil or Parnate. This particular drug combination could cause you to experience a sudden, dangerous rise in blood pressure.
Special warnings about Wellbutrin SR
In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Wellbutrin or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Wellbutrin has not been studied in children or adolescents and is not approved for treating anyone less than 18 years old.
Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Wellbutrin and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.
Be sure to let the doctor know if you have heart trouble, liver problems, or kidney disease before you start taking Wellbutrin. Use Wellbutrin SR with extreme caution if you have cirrhosis of the liver.
Stop taking Wellbutrin and call your doctor immediately if you have difficulty breathing or swallowing; notice swelling in your face, lips, tongue, or throat; develop swollen arms and legs; or break out with itchy eruptions. These are warning signs of a potential severe allergic reaction.
Wellbutrin may affect your coordination or judgment and impair your ability to drive or operate dangerous machinery. Avoid activities that require full alertness until you know how the drug affects you.
Like all antidepressants, Wellbutrin could trigger a manic episode in people with bipolar disorder.
Although Wellbutrin occasionally causes weight gain, a more common effect is weight loss: Some 28 percent of people who take Wellbutrin SR lose 5 pounds or more. If depression has already caused you to lose weight, and if further weight loss would be detrimental to your health, Wellbutrin may not be the best antidepressant for you.
Possible food and drug interactions when taking Wellbutrin SR
Do not drink alcohol while you are taking Wellbutrin; an interaction between alcohol and Wellbutrin could increase the possibility of a seizure.
Wellbutrin should not be combined with drugs that lower the seizure threshold, including:
Antidepressants classified as MAO inhibitors, such as Nardil and Parnate
Other antidepressants such as Elavil, Norpramin, Pamelor, Paxil, Prozac, Tofranil, and Zoloft
Antipsychotic drugs such as Haldol, Risperdal, Mellaril, and chlorpromazine
Cocaine
Diabetes medications such as Glucotrol and Prandin
Insulin
Opiates such as heroin and morphine
Sedatives, including benzodiazepines such as Xanax and Valium
Steroid medications such as prednisone
Stimulants, including over-the-counter diet drugs
Theophylline (Theo-24, Uniphyl)
If Wellbutrin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Wellbutrin with the following:
Beta blockers (used for high blood pressure and heart conditions) such as Inderal, Lopressor, and Tenormin
Carbamazepine (Tegretol)
Cimetidine (Tagamet)
Cyclophosphamide (Cytoxan)
Heart-stabilizing drugs such as Rythmol and Tambocor
Levodopa (Larodopa)
Nicotine patches such as Habitrol, NicoDerm CQ, and Nicotrol patch
Orphenadrine (Norgesic)
Phenobarbital
Phenytoin (Dilantin)
Special information if you are pregnant or breastfeeding
If you are pregnant or plan to become pregnant, notify your doctor immediately. Wellbutrin should be taken during pregnancy only if clearly needed.
Wellbutrin does pass into breast milk and may cause serious reactions in a nursing baby; therefore, if you are a new mother, you may need to discontinue breastfeeding while you are taking Wellbutrin SR.
Recommended dosage
No single dose of Wellbutrin should exceed 150 milligrams.
ADULTS
Wellbutrin
At the beginning, your dose will probably be 200 milligrams per day, taken as 100 milligrams 2 times a day. After at least 3 days at this dose, your doctor may increase the dosage to 300 milligrams per day, taken as 100 milligrams 3 times a day, with at least 6 hours between doses. This is the usual adult dose. The maximum recommended dosage is 450 milligrams per day taken in doses of no more than 150 milligrams each.
Wellbutrin SR
The usual starting dose is 150 milligrams in the morning. After 3 days, if you do well, your doctor will have you take another 150 milligrams at least 8 hours after the first dose. It may be 4 weeks before you feel the benefit and you will take the drug for several months. The maximum recommended dose is 400 milligrams a day, taken in doses of 200 milligrams each.
If you have severe cirrhosis of the liver, your dosage should be no more than 75 milligrams once a day. With less serious liver and kidney problems, the dosage will be reduced as needed.
Wellbutrin XL
The usual starting dose is 150 milligrams taken once a day in the morning. If this dose is well tolerated after a minimum of 3 days, the doctor may increase the dose to 300 milligrams, also taken once a day in the morning. If no improvement is seen after several weeks of treatment, the doctor may increase the dose to a maximum of 450 milligrams once a day.
If you have severe liver damage, use Wellbutrin SR with extreme caution. Your dose should not exceed 150 milligrams every other day. People with mild to moderate liver damage or kidney impairment will be prescribed a lower dose as well.
CHILDREN
The safety and effectiveness in children under 18 years old have not been established.
Overdosage
There have been rare reports of death after an overdose of Wellbutrin. If you suspect an overdose, seek medical attention immediately.
- Symptoms of Wellbutrin overdose may include:
Hallucinations, heart failure, loss of consciousness, rapid heartbeat, seizures
- Symptoms of Wellbutrin SR overdose may include:
Blurred vision, confusion, jitteriness, lethargy, light-headedness, nausea, seizures, vomiting
- An overdose that involves other drugs in combination with Wellbutrin may also cause these symptoms:
Breathing difficulties coma fever rigid muscles stupor
Eskalith-CR
Generic Name: lithium (LITH ee um)
Brand Names: Eskalith, Eskalith-CR, Lithobid, Lithonate, Lithotabs
What is Eskalith-CR (lithium)?
Lithium affects the flow of sodium through nerve and muscle cells in the body. Sodium affects excitation or mania.
Lithium is used to treat the manic episodes of manic depression. Manic symptoms include hyperactivity, rushed speech, poor judgment, reduced need for sleep, aggression, and anger. Lithium also helps to prevent or lessen the intensity of manic episodes.
Lithium may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about Eskalith-CR (lithium)?
Do not use this medication without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Call your doctor at once if you have any early signs of lithium toxicity, such as nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Drink extra fluids to keep from getting dehydrated while you are taking lithium. Tell your doctor if you have been sweating excessively, or if you are sick with fever, vomiting, or diarrhea.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
Lithium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
What should I discuss with my healthcare provider before taking Eskalith-CR (lithium)?
Do not use this medication if you are allergic to lithium.
Before taking lithium, tell your doctor if you are allergic to any drugs, or if you have:
- heart disease;
- kidney disease;
- underactive thyroid;
- a severe or debilitating medical condition; or
- if you are dehydrated or have low levels of sodium in your blood (hyponatremia).
If you have any of these conditions, you may need a dose adjustment or special tests to safely take lithium.
FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use lithium without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Lithium can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
Older adults may be more sensitive to the effects of this medication.
Do not give lithium to a child younger than 12 years old.
How should I take Eskalith-CR (lithium)?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Your doctor may occasionally change your dose to make sure you get the best results from this medication.
Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.
Measure the liquid form of lithium with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Taking lithium can make it easier for you to become dehydrated, especially if you have any vomiting or diarrhea, if you are outdoors in the sun, or if you exercise vigorously or sweat more than usual. Dehydration can increase some of the side effects of lithium.
Drink extra fluids each day to keep from getting dehydrated while you are taking lithium. Tell your doctor if you have been sweating excessively, or if you are sick with fever, vomiting, or diarrhea for more than a few hours.
To be sure this medication is not causing harmful effects, your kidney function will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.
If you need to have any type of surgery, tell the surgeon ahead of time that you are taking lithium.
Store lithium at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears.
What should I avoid while taking Eskalith-CR (lithium)?
Lithium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
Do not change the amount of salt that you consume in your diet. Changing your intake of salt could alter the amount of lithium in your blood.
Eskalith-CR (lithium) side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking lithium and call your doctor at once if you have any of these serious side effects:
- extreme thirst, urinating more or less than usual;
- weakness, fever, feeling restless or confused, eye pain and vision problems;
- restless muscle movements in your eyes, tongue, jaw, or neck;
- pain, cold feeling, or discoloration in your fingers or toes;
- feeling light-headed, fainting, slow heart rate;
- hallucinations, seizure (blackout or convulsions);
- fever with muscle stiffness, sweating, fast or uneven heartbeats; or
- early signs of lithium toxicity, such as nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears.
Less serious side effects may include:
- mild tremor of the hands;
- weakness, lack of coordination;
- mild nausea, vomiting, loss of appetite, stomach pain or upset;
- thinning or drying of the hair; or
- itching skin.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effects.
What other drugs will affect Eskalith-CR (lithium)?
Before taking lithium, tell your doctor if you are taking any other medications, especially any of the following:
- acetazolamide (Diamox);
- aminophylline (Truphylline) or theophylline (Elixophyllin, Respbid, Theo-Bid, Theo-Dur, Uniphyl);
- sodium bicarbonate (Alka-Seltzer, Bicitra, Polycitra, or baking soda home remedy antacid);
- carbamazepine (Carbatrol, Tegretol);
- fluoxetine (Prozac);
- metronidazole (Flagyl);
- sodium potassium iodide thyroid medication (Pima);
- an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik);
- a calcium channel blocker such as diltiazem (Tiazac, Cartia, Cardizem) or verapamil (Calan, Covera, Isoptin, Verelan);
- a diuretic (water pill) such as amiloride (Midamor, Moduretic), bumetanide (Bumex), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactazide, Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), torsemide (Demadex), and others;
- medicines to treat psychiatric disorders, such as haloperidol (Haldol), aripiprazole (Abilify), chlorpromazine (Thorazine), clozapine (Clozaril, Fazaclo), olanzapine (Zyprexa), quetiapine (Seroquel), pimozide (Orap), risperidone (Risperdal), or ziprasidone (Geodon); or
- celecoxib (Celebrex) or an NSAID (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.
This list is not complete and there may be other drugs that can interact with lithium. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
- Your pharmacist can provide more information about lithium.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed
- Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
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