Bupropion—Wellbutrin, Budeprion General Information About Medication
Each child and adolescent is different. No one has exactly the same combination of medical and psychologicalproblems. It is a good idea to talk with the doctor or nurse about the reasons a medicine is being used. It isvery important to keep all appointments and to be in touch by telephone if you have concerns. It is importantto communicate with the doctor, nurse, or therapist.
It is very important that the medicine be taken exactly as the doctor instructs. However, once in a while,
everyone forgets to give a medicine on time. It is a good idea to ask the doctor or nurse what to do if thishappens. Do not stop or change a medicine without asking the doctor or nurse first.
If the medicine seems to stop working, it may be because it is not being taken regularly. The youth may
be “cheeking” or hiding the medicine or forgetting to take it (especially at school). The doses may be too far apart, or a different dose may be needed. Something at school, at home, or in the neighborhood may be up- setting the youth, or he or she may need special help for learning disabilities or tutoring. Please discuss your concerns with the doctor. Do not just increase the dose.
All medicines should be kept in a safe place, out of the reach of children, and should be supervised by an
adult. If someone takes too much of a medicine, call the doctor, the poison control center, or a hospital emer-gency room.
Each medicine has a “generic” or chemical name. Just like laundry detergents or paper towels, some med-
icines are sold by more than one company under different brand names. The same medicine may be availableunder a generic name and several brand names. The generic medications are usually less expensive than thebrand name ones. The generic medications have the same chemical formula, but they may or may not be ex-actly the same strength as the brand-name medications. Also, some brands of pills contain dye that can causeallergic reactions. It is a good idea to talk to the doctor and the pharmacist about whether it is important touse a specific brand of medicine.
All medicines can cause an allergic reaction. Examples are hives, itching, rashes, swelling, and trouble
breathing. Even a tiny amount of a medicine can cause a reaction in patients who are allergic to that medicine. Be sure to talk to the doctor before restarting a medicine that has caused an allergic reaction.
Taking more than one medicine at the same time may cause more side effects or cause one of the medicines
to not work as well. Always ask the doctor, nurse, or pharmacist before adding another medicine, whether pre-scription or over-the-counter. Be sure that each doctor knows about all of the medicines your child is taking. Also tell the doctor about any vitamins, herbal medicines, or supplements your child may be taking. Some ofthese may have side effects alone or when taken with this medication.
Everyone taking medicine should have a physical examination at least once a year.
If you suspect the youth is using drugs or alcohol, please tell the doctor right away.
Pregnancy requires special care in the use of medicine. Please tell the doctor immediately if you suspect
the teenager is pregnant or might become pregnant. Medication Information for Parents and Teachers
Printed information like this applies to children and adolescents in general. If you have questions about
the medicine, or if you notice changes or anything unusual, please ask the doctor or nurse. As scientific re-search advances, knowledge increases and advice changes. Even experts do not always agree. Many medicineshave not been approved by the U.S. Food and Drug Administration (FDA) for use in children. For this reason,use of the medicine for a particular problem or age group often is not listed in the Physicians’ Desk Reference. This does not necessarily mean that the medicine is dangerous or does not work, only that the company thatmakes the medicine has not received permission to advertise the medicine for use in children. Companies of-ten do not apply for this permission because it is expensive to do the tests needed to apply for approval for usein children. Once a medication is approved by the FDA for any purpose, a doctor is allowed to prescribe itaccording to research and clinical experience. Note to Teachers
It is a good idea to talk with the parent(s) about the reason(s) that a medication is being used. If the parent(s)sign consent to release information, it is often helpful to talk with the doctor. If the parent(s) give permission,the doctor may ask you to fill out rating forms about your experience with the student’s behavior, feelings,academic performance, and medication side effects. This information is very useful in selecting and monitor-ing medication treatment. If you have observations that you think are important, do not hesitate to share thesewith the student’s parent(s) and treating clinicians.
It is very important that the medicine be taken exactly as the doctor instructs. However, everyone forgets
to give a medicine on time once in a while. It is a good idea to ask the parent(s) in advance what to do if thishappens. Do not stop or change the time you are giving a medicine at school without parental permission. Ifa medication is to be taken with food, but lunchtime or snack time changes, be sure to notify the parent(s) soappropriate adjustments can be made.
All medicines should be kept in a secure place and should be supervised by an adult. If someone takes too
much of a medicine, follow your school procedure for an urgent medical problem.
Taking medicine is a private matter and is best managed discreetly and confidentially. It is important to be
sensitive to the student’s feelings about taking medicine.
If you suspect that the student is using drugs or alcohol, please tell the parent(s) or a school counselor right
Please tell the parent(s) or school nurse if you suspect medication side effects.
• If the student has dry mouth, it helps to allow chewing of sugar-free gum or extra trips to the water foun-
• The medicine may cause the student to be constipated; allowing the student to drink more fluids and use
the bathroom more often may help. The student may need to use a bathroom with more privacy.
• If the medicine gives the student an upset stomach, it may help to take the medicine after a meal or a snack.
• The student may become dizzy when standing up quickly in the classroom or during physical education;
suggest that the student stand up more slowly.
Modifications of the classroom environment or assignments may be useful in addition to medication. The
student may need to be evaluated for additional help or for an Individualized Education Plan for learning orbehavior.
Any expression of suicidal thoughts or feelings or self-harm by a child or adolescent is a clear signal of
distress and should be taken seriously. These behaviors should not be dismissed as “attention seeking.”
Bupropion—Wellbutrin, Budeprion What Is Bupropion (Wellbutrin, Budeprion)?
Bupropion is called an antidepressant, but it is used to treat behavioral problems, including attention-deficit/hyperactivity disorder (ADHD or ADD) and conduct problems, as well as depression. Bupropion comes inimmediate-release tablets (Wellbutrin and generic), sustained-release long-acting tablets (Wellbutrin SR,Budeprion SR, and generic), and very long-acting extended-release tablets (Wellbutrin XL). Bupropion alsocomes in brand names Zyban and Buproban, which are used to help people stop smoking. How Can This Medicine Help?
Bupropion can decrease symptoms of ADHD, impulsive behavior, depression, and aggression. How Does This Medicine Work?
Bupropion helps by balancing the levels of certain chemicals that are naturally found in the brain, called neu-rotransmitters. Neurotransmitters are the chemicals that the brain makes for the nerve cells to communicatewith each other. Bupropion is sometimes called a dopamine-norepinephrine reuptake inhibitor.How Long Does This Medicine Last?
Immediate-release bupropion must be taken three times a day. The sustained-release form can be taken twicea day, and the extended-release form can be taken only once a day. How Will the Doctor Monitor This Medicine?
The doctor will review your child’s medical history and physical examination before starting bupropion. The doctor may order some tests to be sure your child does not have a hidden medical condition that would make it unsafe to use this medicine. Bupropion should not be used if the child has an eating disorder (anorexia ner- vosa or bulimia) or a brain problem such as seizures (epilepsy), a head injury, or a brain tumor. Extra caution is needed when using this medicine in children and adolescents with liver or kidney problems.
The doctor or nurse may measure your child’s pulse and blood pressure before starting bupropion.
After the medicine is started, the doctor will want to have regular appointments with you and your child
to see how the medicine is working, to see if a dose change is needed, to watch for side effects, to see if bu-propion is still needed, and to see if any other treatment is needed. The doctor or nurse may check your child’sheight, weight, pulse, and blood pressure. What Side Effects Can This Medicine Have?
Any medicine can have side effects, including an allergy to the medicine. Allergy to bupropion is more com-mon if the patient has had allergic reactions to other medicines. Because each patient is different, the doctorwill monitor the youth closely, especially when the medicine is started. The doctor will work with you to
Medication Information for Parents and Teachers
increase the positive effects and decrease the negative effects of the medicine. Please tell the doctor if any ofthe listed side effects appear or if you think that the medicine is causing any other problems. Not all of therare or unusual side effects are listed.
Side effects are most common after starting the medicine or after a dose increase. Many side effects can
be avoided or lessened by starting with a very low dose and increasing it slowly—ask the doctor.
Tell the doctor in a day or two (if possible, before the next dose of medicine):
Stop the medicine and get immediate medical care:
• Irritability—Dose may need to be lowered.
• Dry mouth—Have your child try using sugar-free gum or candy.
• Constipation—Encourage your child to drink more fluids and eat high-fiber foods; if necessary, the doctor
may recommend a fiber medicine such as Benefiber or a stool softener such as Colace or mineral oil.
• Nausea—Taking bupropion with food may help.
Call the doctor within a day or two if your child experiences any of these side effects:
• Motor tics (fast, repeated movements), muscle twitches (jerking movements), or tremor (shaking)
Less Common, but More Serious, Side Effects
Call the doctor immediately:
• Seizures (fits, convulsions), especially if taking more than 400 mg/day or if drinking alcoholic beverages.
This is less common with the longer-acting forms.
• Unusual excitement, decreased need for sleep, rapid speech
Bupropion—Wellbutrin, Budeprion Some Interactions With Other Medicines or Food Please note that the following are only the most likely interactions with food or other medicines.
Carbamazepine (Tegretol) may decrease the positive effect of bupropion. It can be very dangerous to take bupropion at the same time as, or even within several weeks of, taking another type of medicine called a monoamine oxidase inhibitor (MAOI), such as Eldepryl (se- legiline), Nardil (phenelzine), Parnate (tranylcypromine), or Marplan (isocarboxazid). The combina- tion may cause very high fever, high blood pressure, and extreme excitement and agitation. What Could Happen if This Medicine Is Stopped Suddenly?
No known medical withdrawal effects occur if bupropion is stopped suddenly. Some people may get a head-ache as the medicine wears off. If the medicine is stopped, the original problems may come back. Talk to thedoctor before stopping the medicine. How Long Will This Medicine Be Needed?
Bupropion may take up to 4 weeks to reach its full effect. Your child may need to take the medicine for at leastseveral months so that the emotional or behavioral problem does not come back. What Else Should I Know About This Medicine?
It is very important not to chew the sustained-release tablet or to double up doses if one is missed.
Store the medicine away from heat and wetness.
In youth who have bipolar disorder (manic depression) or who are at risk for bipolar disorder, any antide-
pressant medicine may increase the risk of hypomania or mania (excitement, agitation, increased activity, de-creased sleep).
Bupropion is sometimes confused with buspirone. Be sure to check the prescription.
Sometimes the different forms of bupropion are confused. Be sure you know whether the doctor has pre-
scribed the immediate-release, sustained-release, or extended-release form, and check that the pharmacy hasdispensed the correct form of medicine. Be sure that the number of “mg” (dose) and the number of times themedicine is taken each day are clear and consistent.
In 2004, an advisory committee to the FDA decided that there might be an increased risk of suicidal behaviorfor some youth taking medicines called antidepressants. In the research studies that the committee reviewed,about 3%–4% of youth with depression who took an antidepressant medicine—and 1%–2% of youth withdepression who took a placebo (pill without active medicine)—talked about suicidal thoughts (thinking aboutkilling themselves or wishing they were dead) or did something to harm themselves. This means that almosttwice as many youth who were taking an antidepressant to treat their depression talked about suicide or had
Medication Information for Parents and Teachers
suicidal behavior compared with youth with depression who were taking inactive medicine. There were nocompleted suicides in any of these research studies, which included more than 4,000 children and adolescents. For youth being treated for anxiety, there was no difference in suicidal talking or behavior between those tak-ing antidepressant medication and those taking placebo.
The FDA told drug companies to add a black box warning label to all antidepressant medicines. Because of
this label, a doctor (or advanced practice nurse) prescribing one of these medicines has to warn youth and theirfamilies that there might be more suicidal thoughts and actions in youth taking these medicines.
On the other hand, in places where more youth are taking the newer antidepressant medicines, the num-
ber of adolescents who commit suicide has gotten smaller. Also, thinking about or attempting suicide is morecommon in surveys of teenagers in the community than it is in depressed youth treated in research studieswith antidepressant medicine.
If a youth is being treated with this medicine and is doing well, then no changes are needed as a result of
this warning. Increased suicidal talk or action is most likely to happen in the first few months of treatmentwith a medicine. If your child has recently started this medicine, or is about to start, then you and your doctor(or advanced practice nurse) should watch for any changes in behavior. People who are depressed often havesuicidal thoughts or actions. It is hard to know whether suicidal thoughts or actions in depressed people arecaused by the depression itself or by the medicine. Also, as their depression is getting better, some people talkmore about the suicidal thoughts they had before but did not talk about. As young people get better from de-pression, they might be at higher risk of doing something about suicidal thoughts that they have had for sometime, because they have more energy.
1. Be honest with your child about possible risks and benefits of medicine.
2. Talk to your child about whether he or she is having any suicidal thoughts, and tell your child to come to
you if he or she is having such thoughts.
3. You, your child, and your child’s doctor or nurse should develop a safety plan. Pick adults whom your child
can tell if he or she is thinking about suicide.
4. Be sure to tell your child’s doctor, nurse, or therapist if you suspect that your child is using alcohol or drugs
or if something has happened that might make your child feel worse, such as a family separation, breakingup with a boyfriend or girlfriend, someone close dying or attempting suicide, physical or sexual abuse, orfailure in school.
5. Be sure that there are no guns in the home and that all medicines (including over-the-counter medicines
like Tylenol) are closely supervised by an adult and kept in a safe place.
6. Watch for new or worse thoughts of suicide, self-harm, depression, anxiety (nerves), feeling very agitated
or restless, being angry or aggressive, having more trouble sleeping, or anything else that you see for the first time, seems worse, or worries your child or you. If these appear, contact a mental health professional right away. Do not just stop or change the dose of the medicine on your own. If the problems are serious, and you cannot reach one of your clinicians, call a 24-hour psychiatry emergency telephone number or take your child to an emergency room.
Youth taking antidepressant medicine should be watched carefully by their parent(s), clinician(s) (doctor,
nurse, therapist), and other concerned adults for the first weeks of treatment. It is a good idea to have a visitor telephone call with the doctor, nurse, or therapist weekly for the first month, every 2 weeks for the secondmonth, and after that at least once a month to check for feelings of depression or sadness, thoughts of killingor harming himself or herself, and any problems with the medication. If you have questions, be sure to ask thedoctor, nurse, or therapist.
For more information, see http://www.parentsmedguide.org (in English and Spanish). Bupropion—Wellbutrin, Budeprion
Use this space to take notes or to write down questions you want to ask the doctor. Copyright 2007 American Psychiatric Publishing, Inc. The purchaser of this book is licensed to dis- tribute copies of these forms in limited amounts. Please see copyright page for further information. The au- thors have worked to ensure that all information in this book concerning drug dosages, schedules, routes of administration, and side effects is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community and accepted child psychiatric practice. The information on this medication sheet does not cover all the possible uses, precautions, side ef- fects, or interactions of this drug. For a complete listing of side effects, see the manufacturer’s package insert, which can be obtained from your physician or pharmacist. As medical research and practice advance, thera- peutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family.
From Dulcan MK (editor): Helping Parents, Youth, and Teachers Understand Medications for Behavioral and Emo-tional Problems: A Resource Book of Medication Information Handouts, Third Edition. Washington, DC, American Psychiatric Publishing, 2007
Keep in a cool place: exposure of medicines to hightemperatures in general practice during a British heatwaveExposure of medicines to high temperatures in storage or in transit could reduce their efficacy, and most licencesspecify storage at 258C or less. To assess whether this criterion was being met, maximum temperatures in a generalpractice drug cupboard and in drug bags placed in car boots