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Drug Name bupropion hydrochloride (byoo proe' pee on) Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban Pregnancy Category B Drug classes Antidepressa nt Smoking deterrent Oral

Dosages

Smoking cessation o Adult: Modifiedrelease preparation: Initially, 150 mg once daily for 6 days then increased to 150 mg bid. Period of treatment: 7-12 wk. To discontinue treatment if abstinence is not achieved by 7th wk. Max: 300 mg/day. o Elderly: 150 mg/day. Depression o Adult: Initially, 100 mg bid increased to 100 mg tid after 3 days if necessary. Increased further to 150 mg tid if no improvement has been observed after several wk of therapy. Max: 150 mg tid. As a modified-release preparation: 150 mg once daily in the morning, increased to 150 mg bid after 3 days if necessary,

Therapeutic Actions Bupropion HCl is a relatively weak inhibitor of the neuronal uptake of norepinephrine, serotinin and dopamine. The mechanism by which it aids in smoking cessation is presumed to be mediated by its noradrenergic and/or dopaminergic actions. Absorption: Well absorbed from the GI tract but undergoes extensive first pass effect. Distribution: 80% bound to plasma proteins. Crosses the placenta and distributed into breast milk. Excretion: Terminal half-life of immediate-release preparation: about 14 hr. Mainly excreted in the urine as metabolites.

Indications Treatment of depression Aid to smoking cessation treatment (Zyban) Unlabeled uses: Treatment of neuropathic pain, ADHD

Adverse effects Facial edema; nausea, dry mouth, constipation, diarrhea, anorexia; mouth ulcer; thirst; myalgia, arthralgia; insomnia, dream, abnormality, anxiety, disturbed concentration, dizziness, nervousness, tremor, dysphoria; rhinitis, increased cough, pharyngitis, sinusitis; dyspnea, epistaxis, agitation, insomnia, tremor, headache, weight loss, vomiting, skin rash. Potentially Fatal: StevensJohnson syndrome.

Contraindicati ons Epilepsy; eating disorders (e.g. bulimia or anorexia nervosa); hypersensitivi ty.

Nursing considerations Assessment History: Hypersensitivity to bupropion, history of seizure disorder, bulimia or anorexia, head trauma, CNS tumor, treatment with MAOI, renal or hepatic 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 hepatic and renal

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may further increase to 200 mg bid after several wk if needed. Max: 450 mg as a single dose.

function tests in patients with a history of hepatic or renal impairment. Have patient quit smoking within first 2 wk of treatment for smoking cessation; may be used with transdermal nicotine. BLACK BOX WARNING: Monitor response and behavior; suicide is a risk in depressed patients, children, and adolescents. Teaching points Take this drug in equally divided doses three to four times a day as prescribed for depression. Take sustainedrelease forms twice a day, at least 8 hours apart. Do not combine doses or make up missed doses. Take once a day, or divided into two doses at least 8 hours 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

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Nursing Notes and Community

lozenges); headache, insomnia (consult with care provider if these become a problem; do not selfmedicate); nausea, vomiting, weight loss (eat frequent small meals). Report dark urine, lightcolored stools; rapid or irregular heartbeat; hallucinations; severe headache or insomnia; fever, chills, sore throat.

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