Wellbutrin pill. Wellbutrin: Uses, Side Effects, and Essential Information for Patients

27.06.202317.07.2023 by alexxlab

What are the primary uses of Wellbutrin. How does Wellbutrin work in treating depression. What are the potential side effects of Wellbutrin. How should patients take Wellbutrin safely. What precautions should be taken when using Wellbutrin.

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Understanding Wellbutrin: An Overview of the Antidepressant

Wellbutrin, also known by its generic name bupropion, is a widely prescribed antidepressant medication used to treat various mental health conditions. This powerful drug belongs to a class of medications called norepinephrine-dopamine reuptake inhibitors (NDRIs), which work by altering the balance of certain neurotransmitters in the brain.

Bupropion is primarily used to treat depression, but it has also shown efficacy in managing other mental health disorders and as an aid for smoking cessation. Its unique mechanism of action sets it apart from other antidepressants, making it a valuable option for patients who may not respond well to more common selective serotonin reuptake inhibitors (SSRIs).

The Therapeutic Uses of Wellbutrin: Beyond Depression

While Wellbutrin is primarily known for its antidepressant properties, its applications extend beyond treating major depressive disorder. Here are some of the key therapeutic uses of Wellbutrin:

Treatment of major depressive disorder
Management of seasonal affective disorder (SAD)
Aid in smoking cessation
Off-label use for attention deficit hyperactivity disorder (ADHD)
Potential benefits for bipolar depression
Adjunctive therapy for anxiety disorders

How does Wellbutrin differ from other antidepressants in its mechanism of action? Unlike SSRIs, which primarily target serotonin, Wellbutrin works by inhibiting the reuptake of norepinephrine and dopamine. This unique approach can be particularly beneficial for patients who experience fatigue, lack of motivation, or cognitive difficulties as part of their depressive symptoms.

Navigating the Side Effects: What Patients Should Know

As with any medication, Wellbutrin can cause side effects. It’s crucial for patients to be aware of these potential adverse reactions and to communicate any concerns with their healthcare provider. Common side effects of Wellbutrin include:

Dry mouth
Nausea
Insomnia or sleep disturbances
Agitation or anxiety
Headache
Constipation
Increased sweating
Weight loss

While many of these side effects are mild and may subside as the body adjusts to the medication, some patients may experience more severe reactions. What are the serious side effects that require immediate medical attention? Patients should be vigilant for signs of:

Seizures
Severe allergic reactions
Unusual changes in mood or behavior
Suicidal thoughts or behaviors
Hallucinations or psychosis
Severe skin reactions

It’s important to note that the risk of seizures is dose-dependent, which is why healthcare providers carefully manage the dosage and titration of Wellbutrin.

Proper Administration: How to Take Wellbutrin Safely

Taking Wellbutrin correctly is essential for maximizing its therapeutic benefits while minimizing the risk of adverse effects. Here are key points patients should remember:

Follow the prescribed dosage carefully
Take doses at least 6 hours apart to reduce seizure risk
Do not crush, cut, or chew extended-release tablets
Take with or without food, but be consistent
Avoid taking doses close to bedtime to prevent insomnia
Never adjust the dose without consulting a healthcare provider

How long does it take for Wellbutrin to start working? Patients should be aware that the full therapeutic effects of Wellbutrin may not be evident for 4 to 6 weeks after starting treatment. It’s crucial to continue taking the medication as prescribed, even if improvements are not immediately noticeable.

Dosage Considerations and Titration

The appropriate dosage of Wellbutrin varies depending on the condition being treated and the individual patient’s response. Typically, healthcare providers start with a lower dose and gradually increase it to minimize side effects and reduce the risk of seizures. This process, known as titration, allows the body to adjust to the medication slowly.

For depression treatment, the usual starting dose is 150 mg once daily, which may be increased to 300 mg per day, taken as 150 mg twice daily. In some cases, the dose may be further increased to a maximum of 450 mg per day, divided into three doses. However, single doses should not exceed 150 mg to minimize seizure risk.

Drug Interactions: Combining Wellbutrin with Other Medications

Wellbutrin can interact with various medications and substances, potentially altering its effectiveness or increasing the risk of side effects. What are some critical drug interactions patients should be aware of? Here’s a list of medications and substances that may interact with Wellbutrin:

Monoamine oxidase inhibitors (MAOIs)
Other antidepressants, particularly SSRIs
Antipsychotics
Beta-blockers
Certain antiarrhythmic drugs
Alcohol
Stimulants, including those used to treat ADHD
Steroids
Certain antibiotics and antifungal medications

Patients should always provide their healthcare provider with a comprehensive list of all medications, supplements, and herbal products they are taking to avoid potential interactions.

The Impact of Alcohol on Wellbutrin Treatment

Combining Wellbutrin with alcohol can be particularly problematic. How does alcohol affect the safety and efficacy of Wellbutrin? Alcohol consumption while taking Wellbutrin can:

Increase the risk of seizures
Exacerbate side effects such as dizziness and drowsiness
Potentially worsen symptoms of depression or anxiety
Interfere with the medication’s therapeutic effects

For these reasons, healthcare providers typically advise patients to avoid alcohol consumption while taking Wellbutrin or to consult with their doctor about safe alcohol use during treatment.

Special Populations: Considerations for Specific Patient Groups

Certain patient populations may require special considerations when using Wellbutrin. These groups include:

Pregnant and Breastfeeding Women

The safety of Wellbutrin during pregnancy and breastfeeding is not fully established. While some studies suggest that the risk to the fetus is low, others have indicated potential risks. Pregnant women or those planning to become pregnant should discuss the risks and benefits of Wellbutrin use with their healthcare provider.

Elderly Patients

Older adults may be more sensitive to the side effects of Wellbutrin, particularly dizziness and confusion. Healthcare providers may start with lower doses and increase them more slowly in this population.

Patients with Pre-existing Medical Conditions

Individuals with certain medical conditions may need closer monitoring or dosage adjustments when taking Wellbutrin. These conditions include:

History of seizures or epilepsy
Eating disorders
Liver or kidney disease
Cardiovascular disease
Bipolar disorder

Monitoring and Follow-up: Ensuring Safe and Effective Treatment

Regular monitoring is essential for patients taking Wellbutrin to ensure the medication’s safety and effectiveness. What should patients expect in terms of follow-up care? Healthcare providers typically recommend:

Regular check-ups to assess the medication’s effectiveness
Monitoring of mood changes and potential side effects
Periodic blood tests to check liver function and other parameters
Adjustments to the treatment plan as needed

Patients should be encouraged to keep a mood journal or track their symptoms to provide accurate feedback to their healthcare provider. This information can be invaluable in assessing the medication’s effectiveness and making necessary adjustments to the treatment plan.

Recognizing and Responding to Warning Signs

While Wellbutrin is generally safe and effective when used as prescribed, patients and their caregivers should be aware of potential warning signs that may indicate a need for immediate medical attention. These signs include:

Sudden onset of severe headache or confusion
Rapid heartbeat or chest pain
Severe skin rash or hives
Unusual changes in mood or behavior
Thoughts of self-harm or suicide

If any of these symptoms occur, patients should seek medical help immediately. It’s crucial to emphasize that while the risk of serious side effects is low, prompt action can prevent potential complications.

Long-term Use and Discontinuation: Planning for the Future

For many patients, Wellbutrin treatment may be a long-term commitment. How should patients approach long-term use of Wellbutrin? Here are some key considerations:

Regular reassessment of the need for continued treatment
Monitoring for any changes in effectiveness over time
Awareness of potential long-term side effects
Consideration of lifestyle changes that may support mental health

When the time comes to discontinue Wellbutrin, it’s crucial to do so under medical supervision. Abrupt discontinuation can lead to withdrawal symptoms or a recurrence of depressive symptoms. Healthcare providers typically recommend a gradual tapering of the medication to minimize these risks.

The Discontinuation Process

What should patients expect when discontinuing Wellbutrin? The process typically involves:

A gradual reduction in dosage over several weeks or months
Close monitoring for any re-emergence of depressive symptoms
Support in developing coping strategies for managing without medication
Consideration of alternative treatments or therapies if needed

Patients should be prepared for potential discontinuation symptoms, which may include irritability, anxiety, or mood swings. These symptoms are usually temporary and can be managed with proper support and guidance from a healthcare provider.

Complementary Therapies: Enhancing the Effectiveness of Wellbutrin

While Wellbutrin can be highly effective on its own, many patients find that combining medication with other therapeutic approaches can enhance their overall treatment outcomes. What complementary therapies can be used alongside Wellbutrin? Consider the following options:

Cognitive-behavioral therapy (CBT)
Mindfulness meditation
Regular exercise
Nutritional counseling
Support groups
Stress management techniques

These complementary approaches can help address the underlying factors contributing to depression or other mental health issues, potentially leading to more comprehensive and lasting improvements in mood and overall well-being.

The Role of Lifestyle Changes

In addition to complementary therapies, certain lifestyle changes can support the effectiveness of Wellbutrin treatment. Patients may benefit from:

Establishing a regular sleep schedule
Engaging in regular physical activity
Maintaining a balanced, nutritious diet
Limiting alcohol and caffeine intake
Developing strong social support networks
Practicing stress-reduction techniques

By incorporating these lifestyle changes, patients may experience enhanced mood stability and a reduced risk of depressive episodes, complementing the therapeutic effects of Wellbutrin.

Patient Education: Empowering Informed Decision-Making

Educating patients about Wellbutrin is crucial for ensuring safe and effective treatment. What key points should be emphasized in patient education? Healthcare providers should focus on:

The importance of adherence to the prescribed treatment regimen
Potential side effects and when to seek medical attention
The gradual nature of improvement and the need for patience
The risks associated with abrupt discontinuation
The importance of open communication with healthcare providers
Strategies for managing common side effects

By providing comprehensive education, healthcare providers can empower patients to take an active role in their treatment, leading to better outcomes and improved quality of life.

Resources for Patients and Caregivers

To support ongoing patient education, healthcare providers can recommend reliable resources for additional information and support. These may include:

Reputable mental health organizations and websites
Patient support groups and online forums
Educational materials provided by pharmaceutical companies
Mental health apps and digital tools
Books and publications on depression management and treatment

Encouraging patients to utilize these resources can help reinforce their understanding of Wellbutrin and its role in their overall mental health treatment plan.

Wellbutrin Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Bupropion is an antidepressant used to treat a variety of conditions, including depression, other mental/mood disorders, and smoking cessation. Antidepressants can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience new or worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication, even if treatment is not for a mental/mood condition.

Tell the doctor right away if you notice new or worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

If you are using bupropion to quit smoking, stop taking bupropion and contact your doctor right away if you experience any of the symptoms listed above. Tell your doctor right away if you have any of these symptoms after stopping treatment.

Warnings:

Uses

Bupropion is used to treat depression. It can improve your mood and feelings of well-being. It may work by helping to restore the balance of certain natural chemicals (neurotransmitters) in your brain.

How to use Wellbutrin 75 Mg Tablet

Read the Patient Information Leaflet and Medication Guide available from your pharmacist before you start using bupropion and each time you get a refill. Consult your doctor or pharmacist if you have any questions.

Take this medication by mouth with or without food as directed by your doctor, usually three times daily. If stomach upset occurs, you may take this drug with food. It is important to take your doses at least 6 hours apart or as directed by your doctor to decrease your risk of having a seizure.

The manufacturer directs not to crush, cut, or chew the tablet before taking it. However, many similar drugs (immediate-release tablets) can be crushed, cut, or chewed. Follow your doctor’s directions on how to take this medication.

Do not take more or less medication or take it more often than prescribed. Taking more than the recommended dose of bupropion may increase your risk of having a seizure.

The dosage is based on your medical condition and response to treatment. Your dose may be slowly increased to limit side effects such as sleeplessness, and to decrease the risk of seizures. To avoid trouble sleeping, do not take this medication too close to bedtime. Let your doctor know if sleeplessness becomes a problem.

Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day.

Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.

It may take 4 or more weeks before you notice the full benefit of this drug. Continue to take this medication as directed by your doctor even after you feel better. Talk to your doctor if your condition does not improve or if it worsens.

Side Effects

Precautions

Before taking bupropion, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: seizures or conditions that increase your risk of seizures (including brain/head injury, brain tumors, arteriovenous malformation, eating disorders such as bulimia/anorexia nervosa), alcohol/drug dependence (including benzodiazepines, opioid pain medicines, cocaine and stimulants), diabetes, heart disease (such as congestive heart failure, high blood pressure, recent heart attack), kidney problems, liver problems (such as cirrhosis), personal or family history of psychiatric disorder (such as bipolar/manic-depressive disorder), personal or family history of suicide thoughts/attempts, personal or family history of glaucoma (angle-closure type).

This medication should not be used if you are suddenly stopping regular use of sedatives (including benzodiazepines such as lorazepam), drugs used to treat seizures, or alcohol. Doing so may increase your risk of seizures.

This drug may make you dizzy or affect your coordination. Alcohol or marijuana (cannabis) can make you more dizzy or affect your coordination. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Alcohol can also increase your risk of seizures. Talk to your doctor if you are using marijuana (cannabis).

Older adults may be more sensitive to the side effects of this drug, especially dizziness and memory loss. Dizziness can increase the risk of falling.

During pregnancy, this medication should be used only when clearly needed. Since untreated mental/mood problems (such as depression, seasonal affective disorder, bipolar disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.

This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: codeine, pimozide, tamoxifen, thioridazine.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

This medication may interfere with certain medical/lab tests (such as brain scan for Parkinson’s disease, urine screening for amphetamines), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

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Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures, hallucinations, fast or slow heart rate, loss of consciousness.

Do not share this medication with others.

Psychiatric/medical checkups or tests such as blood pressure monitoring may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

If you miss a dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Bupropion tablets may have a strange odor. This is normal and the medication is still okay to use. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Wellbutrin Dosage Guide – Drugs.com

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Generic name: BUPROPION HYDROCHLORIDE 75mg
Dosage form: tablet, film coated
Drug class: Miscellaneous antidepressants

Medically reviewed by Drugs. com. Last updated on Apr 17, 2023.

General Instructions for Use

To minimize the risk of seizure, increase the dose gradually [see Warnings and Precautions (5.3)]. Increases in dose should not exceed 100 mg per day in a 3‑day period. WELLBUTRIN Tablets should be swallowed whole and not crushed, divided, or chewed. WELLBUTRIN may be taken with or without food.

The recommended starting dose is 200 mg per day, given as 100 mg twice daily. After 3 days of dosing, the dose may be increased to 300 mg per day, given as 100 mg 3 times daily, with at least 6 hours between successive doses. Dosing above 300 mg per day may be accomplished using the 75- or 100-mg tablets.

A maximum of 450 mg per day, given in divided doses of not more than 150 mg each, may be considered for patients who show no clinical improvement after several weeks of treatment at 300 mg per day. Administer the 100‑mg tablet 4 times daily to not exceed the limit of 150 mg in a single dose.

It is generally agreed that acute episodes of depression require several months or longer of antidepressant drug treatment beyond the response in the acute episode. It is unknown whether the dose of WELLBUTRIN needed for maintenance treatment is identical to the dose that provided an initial response. Periodically reassess the need for maintenance treatment and the appropriate dose for such treatment.

Dose Adjustment in Patients with Hepatic Impairment

In patients with moderate to severe hepatic impairment (Child-Pugh score: 7 to 15), the maximum dose of WELLBUTRIN is 75 mg per day. In patients with mild hepatic impairment (Child-Pugh score: 5 to 6), consider reducing the dose and/or frequency of dosing [see Use in Specific Populations (8.7), Clinical Pharmacology (12.3)].

Dose Adjustment in Patients with Renal Impairment

Consider reducing the dose and/or frequency of WELLBUTRIN in patients with renal impairment (Glomerular Filtration Rate less than 90 mL per min) [see Use in Specific Populations (8.6), Clinical Pharmacology (12.3)].

Switching a Patient to or from a Monoamine Oxidase Inhibitor (MAOI) Antidepressant

At least 14 days should elapse between discontinuation of an MAOI intended to treat depression and initiation of therapy with WELLBUTRIN. Conversely, at least 14 days should be allowed after stopping WELLBUTRIN before starting an MAOI antidepressant [see Contraindications (4), Drug Interactions (7.6)].

Use of WELLBUTRIN with Reversible MAOIs Such as Linezolid or Methylene Blue

Do not start WELLBUTRIN in a patient who is being treated with a reversible MAOI such as linezolid or intravenous methylene blue. Drug interactions can increase the risk of hypertensive reactions. In a patient who requires more urgent treatment of a psychiatric condition, non-pharmacological interventions, including hospitalization, should be considered [see Contraindications (4), Drug Interactions (7.6)].

In some cases, a patient already receiving therapy with WELLBUTRIN may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of hypertensive reactions in a particular patient, WELLBUTRIN should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for 2 weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with WELLBUTRIN may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue.

The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg per kg with WELLBUTRIN is unclear. The clinician should, nevertheless, be aware of the possibility of a drug interaction with such use [see Contraindications (4), Drug Interactions (7.6)].

Frequently asked questions

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Medical Disclaimer

Wellbutrin instructions for use price reviews Kiev, Kharkov 150 mg (60 tablets)

for medical use of the drug

WELLBUTRIN SR

Composition:

90 002 1 tablet contains bupropion hydrochloride 150 mg.

Release form.

Coated tablets, prolonged release.

Pharmacotherapeutic group.

Antidepressants.

Reading.

Treatment of major depression.

Wellbutrin: how to take the drug

Dosage and administration.

The drug begins to act no earlier than 14 days after the start of therapy. As with other antidepressants, the full effect of the drug is observed only after a few weeks of treatment.

Wellbutrin tablets should be swallowed whole and not divided, crushed or chewed as this may increase the risk of side effects, including convulsions.

The maximum single dose should not exceed 150 mg. Use Wellbutrin tablets in 2 doses per day with an interval between doses of at least 8 hours.

Wellbutrin – contraindications, side effects

Contraindications.

Wellbutrin is contraindicated in patients with hypersensitivity to bupropion or to any of the components of the drug.

Wellbutrin is contraindicated in patients with seizures.

Wellbutrin is contraindicated in patients who are currently abruptly discontinued from alcohol or sedatives.

Wellbutrin tablets contain bupropion and therefore should not be given to patients receiving any other drug containing bupropion because the incidence of seizures is dose dependent.

Wellbutrin is contraindicated in patients with current or history of bulimia nervosa or anorexia nervosa, because in this group of patients there was a greater incidence of seizures when prescribing the rapid release form of bupropion.

Co-administration of Wellbutrin and monoamine oxidase inhibitors is contraindicated. Between the abolition of irreversible MAO inhibitors and the start of treatment with Wellbutrin, at least 14 days should elapse.

Adverse reactions.

From the immune system: hypersensitivity reactions such as urticaria, more severe hypersensitivity reactions including angioedema, dyspnea/bronchospasm or anaphylactic shock.

From the side of metabolism and digestive disorders: anorexia, weight loss, impaired blood glucose levels.

Mental disorders: insomnia, sleep disturbance, agitation, anxiety, depression, dysphoria, disorientation, aggressiveness, hostility, irritability, restlessness, hallucinations, unusual dreams, depersonalization, delusions, paranoid thinking, suicidal thoughts and suicidal behavior, psychosis , euphoria, mania, hypomania, changes in mental state.

From the side of the central nervous system: headache, tremor, dizziness, taste disturbances, memory disturbances, anxiety, myoclonus, dystonia, migraine, attention disorders, vertigo, akathisia, dysarthria, convulsions, EEG disturbances, dystonia, ataxia, parkinsonism, disorder of coordination of movements, memory impairment, paresthesia, fainting, coma, delirium, sensory disturbances, dyskinesia.

On the part of the organs of vision: visual disturbance, diplopia, mydriasis, increased eye pressure.

From the hearing organs: ringing in the ears.

From the side of the heart: tachycardia, cardiac arrhythmias, ECG changes, myocardial infarction, increased blood pressure, edema, palpitations.

Vascular: increased blood pressure (in some cases significant), redness, vasodilation, postural hypotension.

From the digestive tract: dry mouth, gastrointestinal disorders, including nausea and vomiting, abdominal pain, constipation, dyspepsia, toothache, gum irritation, intestinal perforation.

From the hepatobiliary system: increased levels of liver enzymes, jaundice, hepatitis.

From the side of the skin and subcutaneous tissue: rash, itching, sweating, polymorphic erythema and Stevens-Johnson syndrome, exacerbation of psoriasis, alopecia.

From the respiratory system: pulmonary embolism, bronchitis.

From the musculoskeletal system and connective tissues: muscle twitching, arthritis, rhabdomyolysis.

From the side of the kidneys, urinary and reproductive system: infections of the urinary system: decreased libido, increased frequency of urination and / or delay, erectile dysfunction, menstrual disorders, gynecomastia, testicular edema, glucosuria, nocturia.

General disorders: fever, chest pain, asthenia.

On the part of the blood system: leukocytosis, leukopenia, thrombocytopenia.

Bupropion gave criminal complications – Kommersant

“Kommersant” became aware of a new criminal case related to the drug bupropion – we recall that the police and customs of the Russian Federation call it a “derivative of a narcotic substance”, and psychiatrists consider it a legal antidepressant. Astrakhan customs opened a large-scale drug smuggling case against Olga Kalinovskaya, suffering from a psychiatric illness, who received pills in the mail. The woman claims that she did not even order the medicine – the package was allegedly a New Year’s gift from a friend who advised her on treatment. Experts point out that bupropion is not banned in Russia, but this does not interfere with judging for its purchase.

Photo: Sergey Mikheev, Kommersant / buy photo

Olga Kalinovskaya lived in Ukraine since 2008, where she was diagnosed with a depressive personality disorder. In 2012, an acquaintance of hers, a teacher who works with special children, suggested that the woman might also have attention deficit hyperactivity disorder (ADHD). She advised me to contact a friend from Norway who lives with ADHD himself and consults other patients remotely. He confirmed the diagnosis of Olga Kalinovskaya and recommended bupropion for treatment; she several times ordered the drug to Ukraine from an Indian pharmaceutical company without any problems.

Abroad Bupropion is completely legal and prescribed by doctors as an antidepressant or to help quit smoking. Foreign pharmaceutical companies produce bupropion tablets under different names: Zyban, Elontril, Wellbutrin. Until 2016, it was also sold in Russia, and the Ministry of Health even included it in the standards for the provision of medical care. But then the manufacturer left the Russian market and withdrew the license from the State Register of Medicines. By law, such drugs without a license can be bought and sold as dietary supplements.

In 2017, Olga Kalinovskaya returned to Volgograd with her husband and child to take care of her elderly mother. The woman passed a psychiatric commission, but Russian doctors did not confirm ADHD. She was given a different diagnosis (she asked not to disclose it to the media) and prescribed treatment. Ivan Martynikhin, a member of the executive committee of the Russian Society of Psychiatrists, told Kommersant that ADHD is poorly diagnosed in Russia: “Doctors do not know that it persists in adults. I see patients who come in with a depressive disorder, and ADHD is at the root.”

At the same time, the psychiatrist emphasized that one should not engage in self-examination: “Only in half of the patients who came to see me and complained of ADHD, the syndrome was actually confirmed.”

At the end of December 2019, Kalinovskaya received a notification about the delivery of an unknown package from India. She was detained at the post office – it turned out that the package contained 300 bupropion tablets. According to Mrs. Kalinovskaya, this was a complete surprise for her. Later, the woman found out that the same patient-consultant from Norway had sent the drug. “He didn’t warn me, he sent me pills for his money. He explained that he knew about my problem and just wanted to help,” said Olga Kalinovskaya. As a result, the Astrakhan customs opened a criminal case against Ms. Kalinovskaya under Part 3 of Art. 229.1 of the Criminal Code of the Russian Federation (drug smuggling on an especially large scale, the maximum penalty is up to 20 years in prison). Customs experts considered that the tablets contained “derivatives” of the illegal drug ephedron.

As Kommersant already said, at the beginning of 2019, Russian law enforcement agencies began to arrest citizens ordering drugs with bupropion in foreign online stores. The fact is that in Russian legislation since 2012 there is the concept of “derivatives of narcotic drugs” – this is the name of substances created by slightly changing the chemical formula of the drug. “Derivatives” are not listed as banned substances, but are still considered drugs. This wording appeared as part of the fight against new types of drugs, primarily “spice” – manufacturers quickly changed parts of the formula, which made it possible for some time to sell the drug without the threat of punishment. However, lawyers and narcologists already then criticized the idea of “derivatives” for legal uncertainty: they warned that sooner or later legal pharmaceuticals would fall under the ban.

There are already about ten criminal cases of bupropion smuggling, at least two people are in jail.

At the same time, the Russian Society of Psychiatrists (ROP) in August 2019 published an official conclusion that bupropion is not a drug and does not lead to dependence. Ivan Martynikhin, a member of the executive committee of the ROP, said that patients applied to the society with a request to include bupropion in clinical recommendations. The psychiatrist told Kommersant that the drug has practically no analogues and “kills two birds with one stone: bupropion is good in the treatment of depression and affects the cause – attention deficit hyperactivity disorder.” Ivan Martynikhin noted that bupropion does not have severe side effects, which is important for patients with bipolar depression. Moreover, the drug can be prescribed in addition to the main drugs to correct side effects.

Legal consultant on drug-related cases, expert of the Institute of Human Rights Arseniy Levinson draws attention to the fact that not a single Russian legal act prohibits bupropion from circulation in the Russian Federation, nowhere is it officially indicated that it is considered a drug. “If a person does not read the news, then there is no way for him to know that bupropion is recognized by the police as a derivative of ephedron,” says Mr. Levinson. “Obviously, such a person cannot commit smuggling, a crime involving direct intent. In other words, the person must know that he is committing a crime and desire it. How could Olga Kalinovskaya know that the medicine she freely bought in Ukraine suddenly turned out to be a drug in Russia?” According to him, “the authorities stubbornly ignore” the problem of criminal liability for “derivatives”. Mr. Levinson participates in the work of the Duma working group on improving anti-drug legislation; summer 2019years he spoke there about the situation with bupropion. “The representative of the Ministry of Internal Affairs said that they are aware of the problem, that the police are humanely sorry for those who are persecuted for purchasing medicine for medical reasons, but nothing needs to be changed,” said Arseniy Levinson.

“As a result, I face 20 years in prison for inaccuracies in the legislation,” says Olga Kalinovskaya.

Recall that the first criminal case on the smuggling of bupropion was initiated in April 2019 by the Ural customs against Daria Belyaeva, who ordered an antidepressant from Poland. As Irina Ruchko, the girl’s lawyer, told Kommersant, in January 2020 the case was returned for additional investigation for the third time – with the wording that the investigation “did not specify the circumstances of socially dangerous acts.” According to her, now the investigator intends to send several requests: “At least, to the medical institution where Daria was treated – to find out what drugs she was prescribed in connection with the disease. And to the Ministry of Health – to find out the attitude of the department towards bupropion.

The lawyer said that the investigator himself became the object of a departmental check: “Initially, the defense was acquainted with the decision on the appointment of an examination on bupropion, where the expert was asked five questions. And then the same decision appeared in the case file, only with three questions. In simple terms, this means that the investigator replaced one decision with another.” The lawyer sent a petition, after which the Investigative Committee checked the actions of the investigator. “The results are not yet known to me, but I very much doubt that a criminal case will be initiated,” she said.

During the investigation, Darya Belyaeva was ordered an additional psychiatric examination – the girl was declared insane. “If the court concludes that she is guilty, then she will be sent to compulsory outpatient treatment,” the lawyer explained. “That is, in any case, she is not threatened with a colony now. But this situation puts pressure on her – after all, she already had a serious illness. Of course, it is not easy for her to bear it. “Let’s hope that the case will be dismissed without trial on rehabilitative grounds,” says Arseniy Levinson. “It is absolutely obvious that there is no public danger in the actions of a patient who acquires a medicine legal all over the world for medical use.