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Wellbutrin strengths: Pain Management Uses, Dosage, Side Effects, Interactions, Warning

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Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Wellbutrin SR and Wellbutrin XL are two prescription medications that can treat symptoms of depression. Both drugs contain the active ingredient, bupropion hydrochloride. Wellbutrin SR and Wellbutrin XL are part of a class of medications called norepinephrine-dopamine reuptake inhibitors (NDRIs). They are also referred to as aminoketone antidepressants.

Wellbutrin SR and Wellbutrin XL have the same mechanism of action. They work by blocking the reuptake of norepinephrine and dopamine in the brain. The increased activity of these neurotransmitters is what helps alleviate symptoms of depression.

What are the main differences between Wellbutrin SR and Wellbutrin XL?

Wellbutrin SR (Wellbutrin SR coupons | Wellbutrin SR details) is the brand name for bupropion sustained-release tablets. It was FDA approved in 1996 for the treatment of major depressive disorder. Wellbutrin SR is usually taken as 150 mg twice daily for a total daily dose of 300 mg.

Wellbutrin XL (Wellbutrin XL coupons | Wellbutrin XL details) is the brand name for bupropion extended-release tablets. It was FDA approved in 2003 for major depressive disorder and seasonal affective disorder. Wellbutrin XL is absorbed in the body more slowly. Compared to immediate-release and sustained-release bupropion, the XL form releases the drug over a longer period of time. For this reason, Wellbutrin XL is taken as a once-daily tablet.

Main differences between Wellbutrin SR and Wellbutrin XL
Drug class Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
Aminoketone antidepressant
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
Aminoketone antidepressant
Brand/generic status Brand and generic versions available Brand and generic versions available
What is the generic name? Bupropion HCl, sustained-release Bupropion HCl, extended-release
What form(s) does the drug come in? Oral tablet, sustained-release Oral tablet, extended-release
What is the standard dosage? Starting dose: 150 mg per day
Target dose: 150 mg twice daily
Starting dose: 150 mg once daily
Target dose: 300 mg once daily
How long is the typical treatment? 3 to 6 weeks or longer depending on symptoms 3 to 6 weeks or longer depending on symptoms
Who typically uses the medication? Adults 18 years and older Adults 18 years and older

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Conditions treated by Wellbutrin SR and Wellbutrin XL

Both Wellbutrin SR and Wellbutrin XL are indicated to treat symptoms of major depression (otherwise known as major depressive disorder). However, Wellbutrin XL is also approved to prevent seasonal affective disorder. Seasonal affective disorder is a mood disorder that affects some people during seasonal changes. For example, someone who normally doesn’t experience depression throughout the year may feel depressed during the winter. Wellbutrin XL can be started in the fall season to prevent mood changes in the winter.

Bupropion can be used in off-label ways to treat ADHD (attention-deficit hyperactivity disorder), depressive episodes of bipolar disorder, and sexual dysfunction caused by other antidepressants like SSRIs (selective serotonin reuptake inhibitors) and tricyclic antidepressants. Other off-label indications include social phobia and PTSD (post-traumatic stress disorder). Bupropion is sometimes used in combination with naltrexone to treat obesity and weight-related conditions.

Bupropion can help with smoking cessation. Bupropion for smoking cessation is manufactured under a different brand called Zyban. Zyban and Wellbutrin cannot be substituted for one another due to differences in dosing.

Major depressive disorder (MDD) Yes Yes
Seasonal affective disorder (SAD) prevention Off-label Yes
ADHD Off-label Off-label
Bipolar disorder Off-label Off-label
Obesity Off-label Off-label
Sexual dysfunction Off-label Off-label
PTSD Off-label Off-label
Social phobia Off-label Off-label

Is Wellbutrin SR or Wellbutrin XL more effective?

Wellbutrin SR and Wellbutrin XL are both effective for treating depression. Their uses and differences in dosing hold the most weight when choosing between the two. In a clinical study comparing bupropion SR and bupropion XL, those taking the once-daily bupropion XL experienced lower rates of depression and relapse. Clinical trials found that there was more consistent use with the once-daily pill, most likely due to the ease of use. Those taking the twice-daily bupropion SR may have had more trouble taking both doses consistently.

In a systematic review of bupropion, the XL formulation was found to be favored over placebo for preventing seasonal affective disorder. Controlled trials within the review showed a significant decrease in depressive symptoms in those affected with seasonal affective disorder.

Both forms of Wellbutrin are useful for treating some of the same conditions. As prescription medications, Wellbutrin SR and Wellbutrin XL can only be prescribed after a doctor’s visit. Based on your medical history, you may be prescribed a different antidepressant.

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Coverage and cost comparison of Wellbutrin SR vs. Wellbutrin XL

Wellbutrin SR is available as a generic oral tablet. It is usually covered by Medicare and most insurance plans. Brand name Wellbutrin SR can cost an average price of around $516 for a 60-day supply of 150 mg tablets. If you use a SingleCare discount card for generic bupropion, the cost can be reduced to a more affordable price. Purchasing Wellbutrin SR with a discount card can lower the cost to as low as $9 at participating pharmacies.

Get the SingleCare prescription discount card

The generic version of Wellbutrin XL is typically covered by Medicare and other insurance plans. Brand name Wellbutrin XL can have an out-of-pocket cost of over $1000. Using a generic bupropion coupon, the price is only $9-$31. Check to see if your pharmacy accepts SingleCare cards for prescription discounts.

Typically covered by insurance? Yes; the generic is covered Yes; the generic is covered
Typically covered by Medicare? Yes; the generic is covered Yes; the generic is covered
Standard dosage 150 mg tablets (60 count) 150 mg tablets (30 count)
Typical Medicare copay $0-$47 $0-$51
SingleCare cost $9 $9-$31

Common side effects of Wellbutrin SR vs.

Wellbutrin XL

The most common side effects of Wellbutrin SR and Wellbutrin XL include headache, dry mouth, and nausea. Other side effects involve the CNS (central nervous system) and include dizziness, insomnia, and anxiety.

Wellbutrin can also cause gastrointestinal side effects such as stomach upset and constipation. Other common side effects may include heart palpitations, tremors, tinnitus (ringing in the ears), muscle pain, and rash. Weight loss and weight gain are other possible side effects associated with Wellbutrin.

Serious side effects with Wellbutrin are rare and often associated with overdose. Serious side effects include hallucinations, arrhythmia (heart rhythm problems), low blood pressure, and seizures.

Side Effect Applicable? Frequency Applicable? Frequency
Headache Yes 26% Yes 23%
Dry mouth Yes 3% Yes 7%
Nausea Yes 13% Yes 8%
Insomnia Yes 11% Yes 6%
Dizziness Yes 7% Yes 5%
Sore throat Yes 3% Yes 2%
Constipation Yes 10% Yes 7%
Anxiety Yes 5% Yes 3%
Stomach ache Yes 3% Yes 2%
Tinnitus Yes 6% Yes 2%
Tremor Yes 6% Yes 1%
Palpitations Yes 2% Yes 2%
Muscle aches Yes 2% Yes 3%
Sweating Yes 6% Yes 2%
Rash Yes 5% Yes 1%

This may not be a complete list. Consult your doctor or pharmacist for other side effects.
Source: DailyMed (Wellbutrin SR), DailyMed (Wellbutrin XL)

Drug interactions of Wellbutrin SR and Wellbutrin XL

Bupropion is processed in the liver by the CYP2B6 enzyme to form an active metabolite called hydroxybupropion. Drugs that block (inhibit) or stimulate (induce) this enzyme can alter the effects of bupropion. CYP2B6 inhibitors can increase the level of bupropion in the blood which can increase the risk of adverse effects. CYP2B6 inducers can lower blood levels of bupropion and decrease its effectiveness.

Bupropion can also affect the CYP2D6 enzyme and alter the effects of other drugs that are processed by it. Other drugs like monoamine oxidase inhibitors (MAOIs) can increase the risk of hypersensitivity reactions and adverse events. Drugs that lower the seizure threshold can increase the risk of seizures in those taking bupropion.

This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.

Warnings of Wellbutrin SR and Wellbutrin XL

Wellbutrin SR and Wellbutrin XL may increase the risk of suicidal thinking and behavior. Like other antidepressants, these medications should be monitored for new or worsening suicidal behavior.

Wellbutrin SR and Wellbutrin XL both have seizure risks, especially at high doses. Those with a history of seizure disorders should consult a doctor before taking Wellbutrin. Taking Wellbutrin can increase the incidence of seizures.

Wellbutrin has other precautions such as increases in blood pressure. Therefore, it’s important to watch blood pressure changes. Those who take blood pressure medications may need to adjust their treatment with their doctor.

The use of bupropion has been known to cause psychiatric reactions such as mania, hallucinations, paranoia, delusions, and changes in mood. Follow up with a doctor if you experience these effects.

Frequently asked questions about Wellbutrin SR vs. Wellbutrin XL

What is Wellbutrin SR?

Wellbutrin SR contains a sustained-release formulation of bupropion. It is a norepinephrine-dopamine reuptake inhibitor (NDRI) that balances neurotransmitters in the brain. It is prescribed twice daily to treat symptoms of depression.

What is Wellbutrin XL?

Wellbutrin XL contains extended-release bupropion. It is released more slowly in the body compared to Wellbutrin SR. Wellbutrin XL is approved to treat depression and prevent seasonal affective disorder. It is prescribed once daily.

Are Wellbutrin SR and Wellbutrin XL the same?

No. Wellbutrin SR and Wellbutrin XL are not the same drug. Wellbutrin XL is the extended-release form of bupropion that lasts longer in the body. They have differences in dosing and approved uses.

Is Wellbutrin SR or Wellbutrin XL better?

Wellbutrin SR and Wellbutrin XL both work to relieve symptoms of depression. Wellbutrin XL may be preferred for its once-daily dosing. It may also be better for treating depression during seasonal changes (seasonal affective disorder).

Can I use Wellbutrin SR or Wellbutrin XL while pregnant?

Wellbutrin SR or Wellbutrin XL should only be used during pregnancy if the potential benefits outweigh the risks. These medications should be discussed with a healthcare provider before using during pregnancy or breastfeeding.

Can I use Wellbutrin SR or Wellbutrin XL with alcohol?

Wellbutrin SR or Wellbutrin XL should not be taken with alcohol. Drinking alcohol can lead to an increased risk of adverse side effects. Alcohol should be avoided with these medications.

Does Wellbutrin affect memory?

Decreased memory is a possible side effect of taking Wellbutrin. However, it may not be as common as other side effects such as dizziness, headache, and dry mouth.

Why does Wellbutrin make me feel high?

Wellbutrin increases the activity of norepinephrine and dopamine in the brain. These neurotransmitters are considered “feel-good” chemicals. This feeling usually occurs after taking a high dose of bupropion.

What does Wellbutrin do to the brain?

Wellbutrin inhibits the reuptake of norepinephrine and dopamine. As a result, the drug enhances the activity of these neurotransmitters. Wellbutrin can be used to treat mental health conditions affected by these chemicals in the brain.

Does Wellbutrin treat anxiety?

Wellbutrin is not approved to treat anxiety. In fact, Wellbutrin may cause anxiety as a side effect. Wellbutrin is primarily used to treat symptoms of depression.

Bupropion (Oral Route) Proper Use

Proper Use

Drug information provided by: IBM Micromedex

Take this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

Swallow the tablet whole. Do not break, crush, or chew it.

You may take this medicine with or without food. But if you have nausea, take the medicine with food.

A part of the extended-release tablet may pass into your stool. This is normal and is nothing to worry about.

Use of Zyban® tablets:


  • You may continue to smoke for about 1 week after you start the medicine.

  • Set a target date to quit smoking during your second week of treatment.

  • If you are still having trouble with quitting after using the medicine for at least 7 weeks, talk to your doctor.

  • If you use a nicotine product (eg, patch) together with Zyban®, do not smoke. Smoking may increase the chance for serious side effects.

If you have trouble sleeping (insomnia), do not take this medicine too close to bedtime.

If you use this medicine to prevent depression with seasonal affective disorder, take it during the autumn season before your symptoms start. Continue using the medicine through the winter season and until early spring.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.


  • For oral dosage form (extended-release tablets):


    • For depression:


      • Adults—


        • Aplenzin®: At first, 174 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 522 mg per day.

        • Forfivo XL®: 450 mg once a day.

        • Wellbutrin XL®: At first, 150 mg once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 450 mg per day.

      • Children—Use and dose must be determined by your doctor.

    • For seasonal affective disorder:


      • Adults—


        • Aplenzin®: At first, 174 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 522 mg per day.

        • Wellbutrin XL®: At first, 150 mg once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 300 mg once a day.

      • Children—Use and dose must be determined by your doctor.

  • For oral dosage form (sustained-release tablets):


    • For depression:


      • Adults—At first, 150 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 200 mg two times per day, taken at least 8 hours apart.

      • Children—Use and dose must be determined by your doctor.

    • To quit smoking:


      • Adults—At first, 150 milligrams (mg) once a day for the first 3 days. Your doctor may adjust your dose as needed. However, the dose is usually not more than 300 mg per day.

      • Children—Use and dose must be determined by your doctor.

  • For oral dosage form (tablets):


    • For depression:


      • Adults—At first, 100 milligrams (mg) two times per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 150 mg three times per day, taken at least 6 hours apart.

      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you are taking the Wellbutrin XL® extended-release tablet and you miss a dose, skip the missed dose and go back to your regular dosing schedule.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Portions of this document last updated: Feb. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.


.

Wellbutrin Dosage Guide – Drugs.com

Medically reviewed by Drugs.com. Last updated on April 16, 2020.

Generic name: BUPROPION HYDROCHLORIDE 75mg
Dosage form: tablet, film coated

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

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Bupropion Dosage Guide with Precautions

Medically reviewed by Drugs.com. Last updated on Jan 27, 2020.

Applies to the following strengths: hydrobromide 174 mg/24 hours; hydrobromide 348 mg/24 hours; hydrobromide 522 mg/24 hours; 150 mg/12 hours; 75 mg; 100 mg; 100 mg/12 hours; 150 mg/24 hours; 300 mg/24 hours; 200 mg/12 hours; 450 mg/24 hours

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Depression

BUPROPION HYDROCHLORIDE:
Immediate-release tablets:
-Initial dose: 100 mg orally twice a day, increase if necessary after 3 days to 100 mg orally three times a day.
-Maintenance dose: 100 mg orally three times a day
-Maximum dose: 450 mg/day in up to 4 divided doses; single doses should not exceed 150 mg

Sustained-release tablets:
-Initial dose: 150 mg orally once a day in the morning, increase if necessary after 3 days to 150 mg orally twice a day.
-Maintenance dose: 150 mg orally twice a day
-Maximum dose: 400 mg/day; maximum single dose should not exceed 200 mg

Extended-release tablets:
-Initial dose: 150 mg orally once a day in the morning, increase if necessary after 4 days to 300 mg orally once a day.
-Maintenance dose: 300 mg orally once a day
-Maximum dose: 450 mg/day

BUPROPION HYDROBROMIDE:
Extended-release tablets:
-Initial dose: 174 mg orally once a day in the morning, increase if necessary after 4 days to 348 mg orally once a day.
-Maintenance dose: 348 mg orally once a day

Comments:
-Doses of immediate-release oral tablets should be given at least 6 hours apart.
-Doses of sustained-release oral tablets should be given at least 8 hours apart.
-Doses of extended-release oral tablets should be given at least 24 hours apart.
-Dose increases of the immediate-release tablet should not exceed 100 mg per day in a 3-day period.
-So as not to exceed the maximum single dose of 150 mg for immediate-release tablets, a dose of 100 mg orally four times a day (using the 100 mg tablet) may be administered.
-Patients who are taking 300 mg/day for at least 2 weeks (OR are currently taking 450 mg/day) of any formulation may be switched to the extended-release 450 mg dose.
-Bupropion hydrobromide 174 mg oral tablet is equivalent to bupropion hydrochloride 150 mg.
-Patients should be periodically reviewed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Use: Treatment of major depressive disorder

Usual Adult Dose for Seasonal Affective Disorder

BUPROPION HYDROCHLORIDE:
Extended-release tablets:
-Initial dose: 150 mg orally once a day in the morning, increased if necessary after 7 days to 300 mg orally once a day
-Maintenance dose: 150 to 300 mg orally once a day
-Maximum dose: 300 mg/day

BUPROPION HYDROBROMIDE:
Extended-release tablets:
-Initial dose: 174 mg orally once a day, increased if necessary after 7 days to 348 mg orally once a day
-Maintenance dose: 348 mg orally once a day
-Maximum dose: 348 mg/day

Comments:
-Treatment should be initiated in the autumn prior to the onset of depressive symptoms, continued through the winter season, and discontinued in early spring.
-If bupropion hydrochloride 300 mg orally per day is not tolerated, it should be reduced to 150 mg once a day before discontinuing treatment.
-Patients taking bupropion hydrochloride 300 mg orally per day during the autumn-winter season should have their dose tapered to 150 mg once a day for 2 weeks prior to discontinuation.
-When discontinuing bupropion hydrobromide in patients treated with 348 mg orally once a day, the dose should be reduced to 174 mg once a day prior to discontinuation.
-The timing of initiation and treatment duration for seasonal affective disorder should be individualized according to the patient’s historical pattern of seasonal major depressive episodes.

Use: Prevention of seasonal major depressive episodes in patients with a diagnosis of seasonal affective disorder (SAD)

Usual Adult Dose for Smoking Cessation

BUPROPION HYDROCHLORIDE:
Sustained-release tablets:
-Initial dose: 150 mg orally once a day for 3 days, increased to 150 mg orally twice a day
-Maintenance dose: 150 mg orally twice a day
-Maximum dose: 300 mg/day; maximum single dose should not exceed 150 mg
-Duration of therapy: 7 to 12 weeks

Comments:
-Begin dosing one week before quit day; the target stop date should be set within the first 2 weeks of treatment, preferably in the second week.
-There should be an interval of at least 8 hours between doses.
-May be used with a nicotine transdermal system.
-If there is no effect after 12 weeks, treatment should be discontinued; longer treatment should be guided by the relative benefits and risks for the individual patient.

Use: Aid to smoking cessation treatment

Renal Dose Adjustments

Renal dysfunction (Glomerular filtration rate [GFR] less than 90 mL/min): Consider reducing the dose and/or frequency

Extended-release 450 mg tablets: Not recommended.

Liver Dose Adjustments

BUPROPION HYDROCHLORIDE:
Immediate-release tablets:
-Mild liver dysfunction (Child-Pugh 5 to 6): Consider reducing the dose and/or frequency of dosing.
-Moderate to severe liver dysfunction (Child-Pugh 7 to 15): The maximum dose is 75 mg orally once a day.

Sustained and Extended-release tablets:
-Mild liver dysfunction (Child-Pugh score 5 to 6): Consider reducing the dose and/or frequency of dosing.
-Moderate to severe liver dysfunction (Child-Pugh score 7 to 15): 100 mg orally once a day OR 150 mg orally every other day. The manufacturer product information should be consulted for further guidance.

Extended-release 450 mg tablets: Not recommended.

BUPROPION HYDROBROMIDE:
Extended-release tablets:
-Mild liver dysfunction (Child-Pugh score 5 to 6): Consider reducing the dose and/or frequency of dosing.
-Severe liver dysfunction (Child-Pugh score 7 to 15): 174 mg orally every other day

Dose Adjustments

-Dose adjustments should be made gradually to minimize the risk of seizure.
-Consider reducing the dose and/or frequency in elderly patients.
-Dose adjustments may be necessary when bupropion is coadministered with CYP450 2B6 inhibitors.
-Dosage increases of bupropion may be necessary when coadministered with ritonavir, lopinavir, or efavirenz.
-If bupropion is used concomitantly with a CYP450 inducer, it may be necessary to increase the dose of bupropion.

Precautions

The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for extended-release tablet formulations. It includes a medication guide. For additional information: www.accessdata.fda.gov/scripts/cder/rems/index.cfm

US BOXED WARNINGS:
NEUROPSYCHIATRIC REACTIONS DURING SMOKING CESSATION:
-Serious neuropsychiatric reactions have occurred in patients taking bupropion for smoking cessation. The majority of these reactions occurred during bupropion treatment, but some occurred in the context of discontinuing treatment. In many cases, a causal relationship to bupropion treatment is not certain, because depressed mood may be a symptom of nicotine withdrawal. However, some of these symptoms have occurred in patients taking bupropion who continued to smoke.
-The risks of bupropion should be weighed against the benefit of its use. Bupropion has been demonstrated to increase the likelihood of abstinence from smoking for as long as 6 months compared with treatment with placebo. The health benefits of quitting smoking are immediate and substantial.
-Although not all products containing the active ingredient of bupropion are approved as a smoking cessation aid, all patients taking bupropion should be observed for neuropsychiatric reactions and instructed to contact a healthcare provider if such reactions occur.

SUICIDALITY AND ANTIDEPRESSANT DRUGS:
-Although the brands Buproban (R) and Zyban (R) are not indicated for the treatment of depression, they contain the same active ingredient as the antidepressant medications Wellbutrin(R), Wellbutrin SR(R) and Wellbutrin XL(R). Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials. These trials did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in subjects over age 24; there was a reduction in risk with antidepressant use in subjects aged 65 and older.
-In patients of all ages who are started on antidepressant therapy, monitor closely for worsening, and for emergence of suicidal thoughts and behaviors.
-Advise families and caregivers of the need for close observations and communication with the prescriber.
Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-All oral formulations should be swallowed whole and not crushed, divided, or chewed.
-Doses may be taken with or without food.

General:
-Give the same total daily dose when possible when switching from immediate-release or sustained-release oral bupropion hydrochloride tablets to extended-release oral bupropion hydrochloride.
-Equivalent daily doses of bupropion hydrobromide and bupropion hydrochloride:
—Bupropion hydrobromide 522 mg is equivalent to 450 mg bupropion hydrochloride.
—Bupropion hydrobromide 348 mg is equivalent to 300 mg bupropion hydrochloride.
—Bupropion hydrobromide 174 mg is equivalent to 150 mg bupropion hydrochloride.
-Periodically review the dose and need for maintenance treatment.
-The full antidepressant effect of this drug may not be evident for 4 weeks or longer.
-Monitoring for potential treatment-emergent elevations of blood pressure is recommended if combination therapy with nicotine transdermal system is used.
-Prophylactic treatment for seasonal affective disorder is not recommended in patients with infrequent episodes or whose seasonal depressive episodes are not associated with significant impairment.
-Patients are more likely to quit smoking and remain abstinent if they are seen frequently and receive support from their physicians or other healthcare professionals. Physicians should also review the patient’s overall smoking cessation program.

Monitoring:
-Cardiovascular: Hypertension
-Hepatic: Liver function
-Neurologic: Seizures
-Psychiatric: Suicidal ideation and behavior; re-emergence or worsening of symptoms of depression

Patient advice:
-If you, your family member, or caregiver notice symptoms such as agitation, hostility, depression, thoughts about suicide or dying, or changes in thinking or behavior that are out of character, contact your health provider right away.
-If you are using this medicine to help you quit smoking, only use it as part of a smoking cessation program.
-Do not drive or operate heavy machinery until you know how this drug affects you.

Frequently asked questions

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Effectiveness, dosage, and side effects

Doctors will usually prescribe stimulant drugs, such as Ritalin, Concerta, or Vyvanse, for treating attention deficit hyperactivity disorder, or ADHD. However, not everyone can tolerate these stimulant medications.

Nonstimulant treatments, such as Wellbutrin, are common alternatives that doctors can prescribe to people with ADHD. Wellbutrin is an antidepressant that researchers have tested for the treatment of ADHD in adults.

In this article, we discuss the effectiveness, side effects, warnings, and doses of Wellbutrin for treating ADHD in adults.

Share on PinterestDoctors may prescribe Wellbutrin for depression, seasonal affective disorder, and ADHD.

Wellbutrin is one brand of the generic drug bupropion. People use bupropion for treating depression and seasonal affective disorder, and as an aid for quitting smoking.

Some doctors also prescribe Wellbutrin for antidepressant-induced sexual dysfunction, obesity, attention deficit hyperactivity disorder (ADHD), and depressive episodes in people with bipolar disorder.

Wellbutrin acts on norepinephrine and dopamine in the brain, which are two chemicals associated with mood.

Wellbutrin is available in three formulations:

  • immediate release
  • sustained release
  • extended release

Extended release formulations release the medication throughout a 12-hour or 24-hour period.

The different formulations also have different “peak serum concentration” times when the level of medication in the blood is highest.

Immediate release Sustained release Extended release
Peak serum concentration 2 hours 3 hours 5 hours

Wellbutrin is available in the following strengths in milligrams (mg).

People may experience side effects when taking Wellbutrin. Researchers estimate that side effects may occur in at least 1 in 10 people taking the drug.

Side effects of Wellbutrin can include:

ADHD is a psychological condition that affects both children and adults. People with ADHD may find it difficult to concentrate or pay attention. Other symptoms include impulsivity and hyperactivity.

These symptoms can interfere with a person’s daily functioning or a child’s development.

Doctors often prescribe stimulant medications and recommend therapy for people living with ADHD. However, not everyone responds well or tolerates stimulant medications.

People with other psychiatric conditions or tic disorders cannot use some stimulant medications.

Stimulant medications are controlled substances with a potential for abuse, so they may not be suitable for some people.

As an alternative to stimulants, doctors can prescribe Wellbutrin to treat symptoms of ADHD in adults. Doctors do not know the safety and efficacy of Wellbutrin in children.

Share on PinterestPrevious research suggests that taking Wellbutrin can help treat symptoms of ADHD.

In 2017, researchers reviewed six clinical studies that evaluated the effects and side effects of Wellbutrin compared with a placebo in adults with ADHD.

Each study used a long-acting formulation of Wellbutrin and doses ranging from 150 mg to 450 mg per day.

The results of this study showed a possible benefit of using Wellbutrin to treat symptoms of ADHD in adults. The researchers found evidence that Wellbutrin decreased the severity of ADHD symptoms.

Wellbutrin also increased the proportion of participants who experienced a significant improvement in ADHD symptoms. People who took Wellbutrin were 50% more likely to improve compared to people who received a placebo (no treatment).

The studies included in the analysis were only 6 to 10 weeks long, so researchers still do not know the long term effects of Wellbutrin. And the studies only looked at ADHD in adults, so they do not know whether Wellbutrin will have the same effect in children.

Researchers need to do more studies to investigate the safety and efficacy of Wellbutrin for treating symptoms of ADHD. They also need time to investigate the long term effects.

The Food and Drug Administration (FDA) have not approved Wellbutrin for treating ADHD. When doctors prescribe it “off-label” for this purpose, they must refer to clinical studies to find the right dosage.

A doctor may begin by prescribing 150 mg per day and slowly increasing the dose until it is effective, up to a maximum of 450 mg per day.

Share on PinterestTaking antidepressants can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

Wellbutrin is an antidepressant, and antidepressants can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

Doctors need to monitor people taking Wellbutrin for suicidal thoughts and behaviors during the first few months of them taking the drug, and whenever the doctor increases the dose.

Wellbutrin can also cause seizures. The risk of seizures is greater in people taking higher doses of the medication.

If any person experiences a seizure while taking Wellbutrin, they should seek treatment, and their doctor will change their medication.

Some people also experience high blood pressure when taking Wellbutrin, so a doctor will regularly check a person’s blood pressure.

The risk of high blood pressure is greater when people use Wellbutrin alongside some other medications, such as monoamine oxidase inhibitors (MAOIs).

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

The FDA have not approved Wellbutrin for the treatment of ADHD. However, some doctors may prescribe it to adults if they cannot take standard treatments, such as stimulants.

While researchers are unsure about the safety of using Wellbutrin for ADHD symptoms in children, it appears to be relatively effective in some adults.

Researchers need to carry out further studies to determine the best dose of Wellbutrin for treating ADHD and who can benefit most from this treatment.

Wellbutrin can cause both mild and severe side effects. Anyone taking Wellbutrin who experiences a seizure or thoughts of suicide should see a doctor as soon as possible.

FDA approves Wellbutrin XL(TM) | EurekAlert! Science News

Research Triangle Park, NC (August 28, 2003) — GlaxoSmithKline announced today that the U.S. Food and Drug Administration has approved Wellbutrin XL™ (bupropion hydrochloride extended-release tablets) for the treatment of major depressive disorder in patients 18 and older. The new once-daily medication will offer patients an effective and convenient option to treat their depression, with a low risk of sexual side effects and weight gain. Sexual function and weight change are important considerations in selecting antidepressant therapy, as they may be a side effect of the medication or a symptom of the depression itself. GlaxoSmithKline expects Wellbutrin XL to be available in pharmacies by mid-September.

“Approximately 14 million adults in the U.S. suffer from depression, and while the number of available treatments has increased in the past decade, some antidepressant medications have left patients coping with other problems, such as side effects, which may include sexual dysfunction and weight change,” said Anita Clayton, M.D., Professor of Psychiatry at the University of Virginia Health System. “Wellbutrin XL is a long-awaited treatment option because it offers a low risk of sexual side effects and weight gain – with the convenience of once-daily dosing.”

Wellbutrin XL tablets have a two-layered coating designed to release drug slowly in the body. GlaxoSmithKline licensed this once-daily formulation of bupropion hydrochloride from Biovail Corporation in October 2001. Wellbutrin XL will be available in two strengths, 150 mg and 300 mg, to allow for dosing flexibility. The usual target dose is 300 mg given once daily – initiated at 150 mg/day and then increased to 300 mg/day as early as day four, if adequately tolerated. The maximum total daily dose of Wellbutrin XL is 450 mg.

“Wellbutrin XL builds on a strong foundation. Through the first half of 2003, our twice-daily formulation, Wellbutrin SR®, has remained the number one prescribed antidepressant among U.S. psychiatrists,” said Chris Viehbacher, President, US Pharmaceuticals, GlaxoSmithKline. “Yet we know that for many doctors twice-daily dosing is a major prescribing barrier. We are confident that the convenient once-daily dosing of Wellbutrin XL will be a welcome improvement for patients coping with depressive illness and for the physicians who are treating them.”

HOW WELLBUTRIN XL WORKS


Wellbutrin XL is the first and only once-daily norepinephrine and dopamine reuptake inhibitor (NDRI) for the treatment of depression in adults. The active ingredient in Wellbutrin XL – bupropion hydrochloride – is believed to act upon norepinephrine and dopamine, two chemicals in the brain known to help regulate different aspects of mood, cognition, and behavior. Imbalances in these brain chemicals are associated with depressed mood and other symptoms of depression. Bupropion has no clinically significant impact on serotonin, a third brain chemical involved in mood regulation.

“In my clinical practice of treating patients with depression, sexual problems and weight change may be related to the depression itself, or these problems may arise as side effects of the antidepressant treatment,” said James F. Pradko, M.Sc., M.D. a practicing physician and the director of the Bay Pointe Depression Clinic in Detroit MI. “In either case, sexual function and weight issues relating to depression should be addressed and can have an impact on a patient’s treatment and well-being.

CLINICAL HIGHLIGHTS


The approval of Wellbutrin XL was based on bioequivalence to Wellbutrin® Tablets (the immediate-release formulation of bupropion). Wellbutrin XL has also been proven bioequivalent to Wellbutrin SR® Tablets (the sustained-release formulation of bupropion).

The efficacy of bupropion in the treatment of a major depressive episode was established using the immediate-release formulation in two four-week controlled trials of inpatients and one six-week controlled trial of outpatients who met criteria for major depression. The efficacy of bupropion in maintaining an antidepressant response for up to 44 weeks was established with the sustained-release formulation in a placebo-controlled trial. Bupropion has also been shown to be effective in preventing relapse of depression. In other clinical studies, the active ingredient in Wellbutrin XL has proven comparable to Zoloft®* in treating moderate to severe recurrent major depression.


SAFETY INFORMATION


Wellbutrin XL has been proven bioequivalent to both Wellbutrin® Tablets and Wellbutrin SR® tablets. Given that there are multiple formulations of bupropion, familiarity with the different names and dosing schedules is important to avoid dosing errors.

Placebo-controlled trials of Wellbutrin SR show it to be generally well tolerated. Adverse events reported in at least 10 percent of patients treated with Wellbutrin SR 300 mg/day or 400 mg/day and at a rate at least twice that of placebo were dry mouth, nausea, insomnia, dizziness, weight loss, and pharyngitis. Similar adverse events would be expected with Wellbutrin XL.

Wellbutrin XL is contraindicated in patients who have or have had a seizure disorder, patients being treated with Zyban® (bupropion hydrochloride) Sustained-Release Tablets or Wellbutrin SR® or any other medications that contain bupropion, patients who have or had bulimia or anorexia nervosa, patients undergoing abrupt discontinuation of alcohol or sedatives (including benzodiazepines), and patients taking monoamine oxidase (MAO) inhibitors.

In treating depression, physicians should be aware that Wellbutrin XL™ is associated with a risk of seizures which is dose-related. While Wellbutrin XL has not been formally evaluated in clinical trials, its incidence of seizure may be similar to that of the immediate-release and the sustained-release formulations of bupropion, since it has demonstrated bioequivalence to both. At doses of up to 300 mg/day of the sustained-release formulation (Wellbutrin SR®), the incidence of seizure is approximately 0.1 percent. At doses of 300 mg/day to 450 mg/day of the immediate-release (Wellbutrin), the incidence of seizure is approximately 0.4 percent. To reduce the risk of seizures, refer to the Warnings section of the Prescribing Information for patient selection considerations, including concomitant medications and dosing recommendations.

The weight loss potential of Wellbutrin XL should be considered if weight loss is a major presenting sign of the depressive illness.

When treating patients with severe hepatic cirrhosis, extreme caution should be exercised and a reduced dosage and/or frequency is required to avoid accumulation.

ABOUT GLAXOSMITHKLINE


GlaxoSmithKline, one of the world’s leading research-based pharmaceutical and healthcare companies, is committed to improving the quality of human life by enabling people to do more, feel better and live longer. GlaxoSmithKline has U.S. operations in Philadelphia and Research Triangle Park, N.C.

###

For full prescribing information or product photo, please contact Holly Russell at 919-483-2839.

* Zoloft (sertraline HCl) is a registered trademark of Pfizer Inc.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Bupropion (Wellbutrin)

How does this medicine work?

Bupropion (bu-pro-pee-on) is an antidepressant. It regulates the mood by increasing specific brain chemicals. It may be used for:

  • depression
  • attention deficit and hyperactivity disorders
  • anxiety
  • quitting smoking

It may also be used to treat other conditions as determined by your doctor.

Bupropion may take up to 12 weeks to build up in the body and produce its fullest effect.

How should I give it?

Bupropion comes in pill form. Your child should take this medicine exactly as prescribed. Give it at regular times every day to keep a steady level in the bloodstream.

Do not stop this medicine without checking with your doctor or nurse practitioner. It should be stopped over a period of time.

___ If your child is taking a short-acting pill, and cannot swallow pills:

  • Crush it in a tablet crusher or between 2 spoons, inside a plastic bag, or in folded paper.
  • Mix the powder with a very small amount (about 1 teaspoon) of soft food, such as applesauce, chocolate syrup, ice cream, jelly, or yogurt. Make sure your child takes all of the mixture.

___ If the medicine is an extended-release (SR or XL) product, it should be swallowed whole. Tablets should not be cut in half, crushed or chewed.

Are there any precautions about food or other medicines?

Follow the directions for using this medicine provided by your doctor.

Give this medicine with food if it upsets your child’s stomach.

Warning! There are certain medicines that interact with bupropion. Please check with the doctor or pharmacist before giving any other prescription or non-prescription medicine, vitamins, or herbs.

Avoid alcohol-containing foods or beverages while taking this medicine.

What should I do if a dose is missed?

Take the missed dose as soon as you remember, but do not give doses closer than 8 hours apart for extended-release and 6 hours for short-acting. This can cause seizures or convulsion (muscles stiffening and shaking). If it is too close to the next dose, skip the missed dose and continue with the regular schedule. Never give a double dose. If your child misses two doses, call the clinic.

If your child vomits within 30 minutes after a dose, please call the clinic for instructions.

What are the side effects?

Common

  • drowsiness
  • lightheadedness, dizziness
  • headache
  • constipation
  • dry mouth
  • nausea (upset stomach)
  • vomiting (throwing up)

Occasional

  • tiredness or weakness
  • muscle twitching
  • possible weight loss
  • blurred vision
  • trouble sleeping

The person taking this medicine should not drive, operate machinery, or do anything else that could be dangerous until it is known if he or she has any side effects to this medicine.

When should I call the clinic?

  • suicidal thinking
  • significant worsening of depression
  • dizziness, lightheadedness, or fainting
  • severe headache
  • irregular (fast or pounding) heartbeat
  • rash or hives
  • confusion or hallucinations (hearing or seeing things that do not exist)
  • seizures or convulsions (uncontrollable muscle stiffening and shaking)
  • vomiting (if due to this medicine)
  • trouble breathing – call 911

What else do I need to know?

This medicine should not be used in children with a history of eating disorders or seizures.

While taking the extended-release form of this medicine, part of the tablet may pass in a bowel movement. This is normal.

You and your child should know the names of all the medicines he or she is taking. Share this information with anyone involved in your child’s care. Please bring the medicine container when your child comes to the clinic or emergency department.

Check the label and expiration date before giving each dose. Ask your pharmacist what to do with outdated or unused medicines. If there is no “take-back” program empty them into the trash.

Store all medicines in their original container and away from direct sunlight or heat. Do not store in humid places such as the bathroom. Keep them out of children’s reach, locked up if possible.

Always make sure you have enough medicine on hand. Each time you refill your prescription, check to see how many refills are left. If no refills are left, the pharmacist will need 2 or 3 days to contact the clinic to renew the prescription.

If too much or the wrong kind of medicine is taken, call the Poison Control Center at 1-800-222-1222. If your child is unconscious or has a seizure, call 911.

Questions?

This is not specific to your child but provides general information. If you have any questions, please call your clinic or pharmacy.

Last reviewed 8/2015 ©Copyright

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Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Aplenzin; Forfivo XL; Wellbutrin SR; Wellbutrin XL; Zyban [DSC]

Trade names: Canada

MYLAN-BuPROPion XL; PMS-BuPROPion SR; RATIO-BuPROPion SR [DSC]; SANDOZ BuPROPion; TARO-Bupropion XL; TEVA-Bupropion XL; Wellbutrin SR; Wellbutrin XL; Zyban

Warning

  • Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people.This risk may be higher in people who have attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor right away if you have suicidal thoughts or attempted suicides.

What is this drug used for?

  • The drug is used to treat depression.
  • Used to treat Seasonal Affective Disorder (SAD).
  • Used for smoking cessation.
  • This medicinal product can be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

  • If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
  • If you have ever had a seizure.
  • If you abuse alcohol and suddenly stop using it.
  • If you are taking certain other drugs, such as anticonvulsants or tranquilizers, and you suddenly stop using them.
  • If you have ever had an eating disorder such as anorexia or bulimia.
  • If you have any of the following health conditions: kidney disease or liver disease.
  • If you have taken a drug for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
  • If you are taking any of the following drugs: linezolid or methylene blue.
  • If you are taking another drug that contains the same drug.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any medication or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

For all patients taking this drug:

  • Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
  • Avoid driving or doing other tasks or work requiring attention or sharp eyesight until you know how this drug is affecting you.
  • This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
  • Do not stop taking this drug abruptly without talking to your doctor. This can increase the risk of side effects. If necessary, this drug should be stopped gradually as directed by your doctor.
  • High blood pressure has happened with this drug.Monitor your blood pressure as directed by your doctor.
  • This drug may increase the risk of seizures. The risk may be increased in people with certain health problems, in those using certain other drugs, or in alcohol abuse. Talk to your doctor to find out if you are at increased risk of seizures while taking this drug.
  • Avoid drinking alcohol while taking this drug.
  • Consult your doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow you down.
  • It may take several weeks to achieve full effect.
  • This drug is not approved for use in children. Consult your doctor.
  • If you are 65 years of age or older, use this drug with caution. You may have more side effects.
  • Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

If you smoke:

  • Not all drugs are approved for smoking cessation purposes. Check with your doctor to make sure you are getting the right drug.
  • New or worsening mental, mood, or behavioral disorders have been reported with bupropion for smoking cessation.These disorders include thoughts of committing suicide or homicide, depression, violent behavior, rage, anxiety, and anger. These disorders were observed in people who had mental and mood disorders in the past, and those who did not have such disorders. Consult your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects.Call your healthcare professional or get medical attention right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

  • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
  • Signs of high blood pressure, such as very severe headache, or dizziness, or loss of consciousness, or blurred vision.
  • Feeling confused, unable to concentrate, or changes in behavior.
  • Hallucinations (a person sees or hears something that is not in reality).
  • If convulsions become more frequent or severe after starting the medication.
  • Pain or pressure in the chest.
  • Increased or abnormal heart rhythm.
  • Inflammation.
  • Shortness of breath.
  • Hearing change.
  • Ringing in the ears.
  • Frequent urination.
  • Swelling of the gland.
  • Violation of motor functions.
  • The risk of eye problems may be increased in some patients with this drug. Your doctor may order you to see an ophthalmologist to see if you are at increased risk of developing these eye problems. Call your doctor right away if you have eye pain, change in vision, swelling, or redness around the eye.
  • Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis). This can lead to serious and permanent health problems and sometimes death. Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), redness or irritation of the eyes, and ulceration in the mouth, throat, nose, or eyes.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

All forms of issue:

  • Dizziness or headache.
  • Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
  • Shiver.
  • Nervous tension and agitation.
  • Strange or unusual dreams.
  • Gas.
  • Dry mouth.
  • Sleep disorders.
  • Joint or muscle pain.
  • Nose or throat irritation.
  • Excessive sweating.
  • Unexplained weight fluctuations.

Extended release tablets:

  • Some brands of tablet coating can sometimes be seen in the stool.For these brands, this is normal and not a cause for concern. If you have any questions, please consult your doctor.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088.You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

For all uses of this product:

  • Do not take this medicine more often than prescribed. This can increase your risk of developing seizures.Make sure you know at what intervals you need to apply the drug.
  • Take in the morning if you are taking this drug once a day.
  • Take this medication with or without food.
  • If you cannot sleep, do not take this drug before bed. Consult your doctor.
  • Swallow whole. Do not chew, break, or crush.
  • Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.
  • If you have difficulty swallowing, consult your doctor.

To quit smoking:

  • You can take this drug for 1 week before you stop smoking.
  • Nicotine replacement and psychosocial treatment can be done at the same time for better results.
  • If you have not been able to quit smoking after 12 weeks of taking this drug, talk to your doctor.
  • When you are trying to quit smoking, you may have symptoms of nicotine withdrawal, even when using drugs similar to this drug to help quit smoking.There are many signs of nicotine withdrawal. People who try to quit smoking have occasional depression and suicidal thoughts. Check with your doctor.

What should I do if a dose of a drug is missed?

  • Skip the forgotten dose and return to your normal schedule.
  • Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

  • Store at room temperature, protected from light.Store in a dry place. Do not store in the bathroom.
  • Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
  • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

  • If your health does not improve or even worsens, see your doctor.
  • You should not give your medicine to anyone and take other people’s medicines.
  • Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
  • A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it every time you replenish your supply. If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
  • If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

Bupropion: Pediatric Medication | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Aplenzin; Forfivo XL; Wellbutrin SR; Wellbutrin XL; Zyban [DSC]

Trade names: Canada

MYLAN-BuPROPion XL; PMS-BuPROPion SR; RATIO-BuPROPion SR [DSC]; SANDOZ BuPROPion; TARO-Bupropion XL; TEVA-Bupropion XL; Wellbutrin SR; Wellbutrin XL; Zyban

Warning

  • Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people.This risk may be higher in people who have attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor right away if you have suicidal thoughts or attempted suicides.

What is this drug used for?

  • The drug is used to treat depression.
  • Used to treat Seasonal Affective Disorder (SAD).
  • This drug can be given to children for other indications. Consult your doctor.

To quit smoking:

  • If your child has taken this form of this drug, ask your doctor about the benefits and risks.Talk to your doctor if you have questions or concerns about your child’s use of this drug.

What do I need to tell my doctor BEFORE my child takes this drug?

  • If your child is allergic to this drug, any of its ingredients, other drugs, foods, or substances. Tell your doctor about the allergy and how your child has it.
  • If your child has ever had a seizure.
  • If your child abuses alcohol and suddenly stops drinking.
  • If your child is taking certain other drugs or natural drugs that slow the rate of reaction (such as anticonvulsants or tranquilizers) and your child abruptly stops taking them.
  • If your child has ever had an eating disorder such as anorexia or bulimia.
  • If your child has any of the following: kidney disease or liver disease.
  • If your child has been taking drugs for depression or some other medical condition in the past 14 days. These include isocarboxazid, phenelzine, and tranylcypromine. An episode of very high blood pressure may occur.
  • If your child is receiving any of the following: linezolid or methylene blue.
  • If the child is taking another drug that contains the same drug.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Talk to your doctor or pharmacist about all medications your child is taking (prescription and over-the-counter, natural products, and vitamins) and any health concerns. You need to make sure that this drug is safe for your child’s illness and in combination with other drugs he is already taking. You should not start, stop, or change the dosage of any drug your child is taking without talking to your doctor.

What do I need to know or do while my child is taking this drug?

For all patients taking this drug:

  • Tell all health care providers for your child that your child is taking this drug. These are your child’s doctors, nurses, pharmacists and dentists.
  • Have your child avoid tasks or activities that require attention until you see how this drug is working for your child.This includes cycling, playing sports, or using items such as scissors, lawn mowers, electric scooters, toy cars, or motorized vehicles.
  • This drug may interfere with some laboratory tests. Tell all healthcare professionals and laboratory staff providing your child’s healthcare that your child is taking this drug.
  • Do not suddenly stop giving this drug to your child without talking to your doctor.This can increase your child’s risk of side effects. If your child needs this drug, stop taking this drug gradually, as directed by the doctor.
  • High blood pressure has happened with this drug. Monitor your child’s blood pressure as directed by your doctor.
  • This drug may increase the risk of seizures. The risk may be increased in people with certain health problems, in those using certain other drugs, or in alcohol abuse.Talk to your doctor to see if your child is at increased risk of seizures while taking this drug.
  • Alcohol may interact with this drug. Make sure your child does not drink alcohol.
  • Consult with your child’s doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow down your child’s actions.
  • It may take several weeks to achieve full effect.
  • This drug is not approved for use in children. Consult your doctor.

If your daughter is pregnant or breastfeeding:

  • Consult a doctor if your daughter is pregnant, pregnant, or breastfeeding. The benefits and risks for your daughter and her child will need to be discussed.

If your child smokes:

  • Not all drugs are approved for smoking cessation purposes.Check with your doctor to make sure you are getting the right drug.
  • New or worsening mental, mood, or behavioral disorders have been reported with bupropion for smoking cessation. These disorders include thoughts of committing suicide or homicide, depression, violent behavior, rage, anxiety, and anger. These disorders were observed in people who had mental and mood disorders in the past, and those who did not have such disorders. Consult your doctor.

What side effects should I report to my child’s healthcare provider right away?

WARNING / CAUTION: Although rare, this drug can cause very serious and sometimes deadly side effects in some people. Call your child’s doctor right away or get medical attention if your child has any of the following signs or symptoms that could be associated with a very bad side effect:

  • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
  • Signs of high blood pressure, such as very severe headache, or dizziness, or loss of consciousness, or blurred vision.
  • Feeling confused, unable to concentrate, or changes in behavior.
  • Hallucinations (a person sees or hears something that is not in reality).
  • If convulsions become more frequent or severe after starting the medication.
  • Pain or pressure in the chest.
  • Increased or abnormal heart rhythm.
  • Inflammation.
  • Shortness of breath.
  • Hearing change.
  • Ringing in the ears.
  • Frequent urination.
  • Swelling of the gland.
  • Violation of motor functions.
  • The risk of eye problems may be increased in some patients with this drug. Your child’s doctor may order your child to be examined by an ophthalmologist to see if they are at increased risk of developing these eye problems. Call your doctor right away if your child has eye pain, change in vision, swelling, or redness around the eye.
  • Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis). This can lead to serious and permanent health problems and sometimes death. Get medical help right away if your child has symptoms such as redness, skin swelling with blistering or scaling (with or without a fever), redness or irritation of the eyes, painful sores on the lining of the mouth, throat, nose, or eyes . ..

What are some other side effects of this drug?

Any drug can have side effects. However, many people have little or no side effects. Call your child’s doctor or get medical help if any of these or other side effects bothers your child or does not go away:

All forms of issue:

  • Dizziness or headache.
  • Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
  • Shiver.
  • Nervous tension and agitation.
  • Strange or unusual dreams.
  • Gas.
  • Dry mouth.
  • Sleep disorders.
  • Joint or muscle pain.
  • Nose or throat irritation.
  • Excessive sweating.
  • Unexplained weight fluctuations.

Extended release tablets:

  • When using certain brands of drugs, you or your child may notice the tablet shell in the child’s stool.For these brands, this is normal and not a cause for concern. If you have any questions, please consult your doctor.

This list of potential side effects is not exhaustive. If you have any questions about side effects, talk to your child’s doctor. Talk to your child’s doctor about side effects.

You can report side effects to the National Health Office.

What is the best way to give this drug?

Give this drug to your child as directed by the doctor.Read all the information provided to you. Follow all instructions strictly.

  • Give this drug at the same time of the day.
  • Do not give this drug more often than prescribed. This can increase your risk of developing seizures. Make sure you know at what intervals your child should be given this drug.
  • Give this drug in the morning if it is used once a day.
  • Give this drug with or without food.
  • If a child cannot sleep, do not give this drug shortly before bedtime. Consult your doctor.
  • Watch that the child swallows the tablet whole. Instruct your child not to chew, crush, or crush the pill.
  • Continue giving this drug as directed by your child’s doctor or other healthcare professional, even if your child is well.
  • If your child has difficulty swallowing, consult a doctor.

What if my child misses a dose of a drug?

  • Your child should not take the missed dose, give him / her the next dose on time.
  • Do not give a double dose at the same time or additional doses.

How do I store and / or discard this drug?

  • Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
  • Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
  • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

  • If your child’s symptoms or health problems do not improve, or if they get worse, see your child’s doctor.
  • Do not share your child’s medicine with others or give anyone’s medicine to your child.
  • Some medicines may have different patient information sheets. If you have questions about this drug, talk with your child’s doctor, nurse, pharmacist, or other healthcare professional.
  • If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

90,000 Atypical antidepressant. A Russian woman faces jail for ordering an unauthorized drug

  • Daria Napeeva
  • BBC

Photo author, Getty Images

A criminal case was opened in Yekaterinburg against a girl who ordered a package of antidepressants foreign online pharmacy.Now she faces up to 20 years in prison for the acquisition and smuggling of drugs on a large scale.

24-year-old Daria Belyaeva was detained on April 8 at the exit from the post office. As the Ural Customs Administration reported, the package she received “contained 30 tablets containing the narcotic drug ephedrone” with a total weight of 10.6 grams.

This substance, as stated in the department, is used by drug addicts to stimulate the adrenergic system (receptors that produce adrenaline and norepinephrine).

Ephedrone (methcathinone) is a strong stimulant of the central nervous system, produced by handicrafts and banned in most countries, including Russia. Among drug users, he is also known as “mulka” and “jeff”.

As attorney Irina Ruchko told the BBC Russian Service, Daria Belyaeva is registered with a psychiatrist with a diagnosis of schizotypal personality disorder. Now the girl is under recognizance not to leave. The antidepressant she ordered by mail from Poland is called bupropion.

Does not apply to prohibited

This medicine cannot be sold in Russian pharmacies, since it does not have a pharmacological registration, but it does not apply to prohibited drugs.

“The prescribed drugs did not help, the attending physician said that there is a drug bupropion that can help. Daria read about it on the Internet, made inquiries, concluded that this substance is not prohibited for circulation in Russia, ordered it on the official website in Europe, where the drug is manufactured and released for circulation.She could not and should not have known that this substance may contain some ephedrone derivatives in its composition, “- says the defender.

” According to Daria, several people had previously ordered this drug in the same way and successfully received it. There were no complaints from the customs authorities against them “, – said the lawyer Irina Ruchko.

Daria Belyaeva herself confirmed to the BBC that she decided to try bupropion, because the antidepressants that she took on the prescription of doctors did not help her to the full. least.

“Conventional SSRIs [selective serotonin reuptake inhibitors], with which everyone is mainly treated, do not help me as needed – they do not relieve severe fatigue, lethargy, apathy and 13-hour sleep. There are also tricyclic antidepressants, but they are quite old, They have a lot of severe “side effects” in the somatic plan. I have experienced those on myself and I don’t want to anymore, “said Daria Belyaeva,” I decided to try [bupropion], because I have been very, very bad for quite a long time, and I just want to improve his condition “.

Legal uncertainty

Bupropion is not on the lists of substances restricted for circulation in Russia. However, as stated in the conclusion drawn up by an expert of the customs department, it is a derivative of ephedrone, included in the list of prohibited substances.

Bupropion and ephedrone have a similar structure and both belong to the class of phenethylamines, but ephedrone cannot be obtained from bupropion itself, Alexander Polezhaev, PhD in Chemistry, senior researcher at INEOS RAS told the BBC.

Photo author, Getty Images

Photo caption,

Bupropion molecule

The examination, made at the request of the FCS, says that bupropion is a derivative of ephedrone – the experts make such a conclusion, referring to the note, which lists psychotropic substances subject to control in Russia was supplemented in 2012.

The concept of “derivatives of narcotic drugs and psychotropic substances” established in it is based on the mechanism of the so-called “formal replacement” of hydrogen atoms, halogens or hydroxyl groups in the chemical structure of a known narcotic substance, in which the total number of carbon atoms in the resulting substance should not exceed them quantity in the “original substance”.

Professional chemists criticize this approach because it does not take into account the significant changes in the biochemical and psychoactive properties of substances, which, as a rule, are observed during the “formal replacement” of one or more atoms.

“Formal substitution” does not guarantee the similarity of the biochemical properties of the parent substance and its derivative, explains Dmitry Gladyshev, head of the independent examination bureau “Versia”. If you follow the government’s definition, it turns out that, for example, fluoroacetic acid (CH2FCOOH) is a derivative of acetic acid (CH3COOH), since it has one hydrogen atom formally replaced by one fluorine atom. But in fact, the first is a highly toxic poison, and the second is an almost harmless substance widely used in the food industry and cooking.

According to Gladyshev, one should look not at how many hydrogen atoms and which ones are replaced in a controlled substance, but at what psychoactive and physicochemical properties the substance has and whether it reproduces the effect of a known drug.

Photo author, Getty Images

Photo caption,

Ephedrone molecule

“There are a lot of legal grounds for saying that this substance [bupropion] is not controlled at all on the territory of the Russian Federation, and by and large, if the person did not know that this substance possesses psychoactive properties and did not specifically take it for narcotisation and for obtaining psychoactive effects, he cannot have any intention to turn over such substances.And there should be no questions to him “, – Gladyshev believes.

What kind of antidepressant is this

Bupropion is an atypical antidepressant. Unlike the often prescribed SSRI antidepressants, whose action is based on the reuptake of serotonin, bupropion affects dopamine and norepinephrine.The drug has been on the market for over 30 years, and in the US it is the fourth most frequently prescribed antidepressant – in 2016 it was prescribed more than 23 million times.

In Russia, bupropion, produced by the British company GlaxoSmithKline, was registered in 2010 under the trade the name Wellbutrin.According to information from the state register of medicines, after six years, its registration was canceled. As follows from the documents of the Ministry of Health, such a decision was made on the basis of a statement by the Russian pharmaceutical company AKRIKHIN JSC. The BBC did not respond to inquiries.

In world practice, bupropion is used for various forms of depression, bipolar disorder, attention deficit disorder, nicotine addiction, as well as for enhancing the action of other antidepressants and correcting drug-induced sexual dysfunctions.

“It is well tolerated, does not increase, but even reduces weight, does not impair sexual function, has a stimulating effect, which is important for many patients with depression,” says psychiatrist, narcologist Dmitry Frolov.

According to psychiatrist Pavel Alfimov, bupropion is usually prescribed when the patient has symptoms such as hypersomnia (excessive sleep duration) and hyperphagia (overeating), in addition, the drug works well for anxiety and atypical depression.In a number of countries, bupropion is prescribed not even by psychiatrists, but by general practitioners, Alfimov notes.

Both experts told the BBC that bupropion has proven to be reasonably safe and non-addictive. “Its addictive potential is rather casuistry. It does not cause such physical addiction as, for example, phenazepam, xanax or alcohol and cigarettes,” says Alfimov.

Psychiatrists have also confirmed that bupropion can be prescribed for patients with schizotypal personality disorder, like Daria Belyaeva’s, to treat comorbid depressive symptoms, which are quite common.”In schizotypal disorder, there can be depression, it can be severe and persistent. There are a lot of people for whom SSRIs are poorly suited, for such people bupropion is the drug of choice,” says Alfimov.

The doctor claims that he often meets patients who take or have used bupropion, despite the fact that it is not in Russian pharmacies, some were prescribed it abroad. Patients also told Dmitry Frolov about the successful experience of self-medication with bupropion and the problems associated with buying it.

As noted by Alfimov, despite the pronounced stimulating effect, bupropion is not suitable for recreational consumption: “When using bupropion, you can almost never meet the effect of euphoria, buzz … Of course, citizens experiment, but this is completely useless.”

Photo author, easyfarma. cl

Caption,

Daria Belyaeva bought bupropion under the trade name Elontril

“This is not a drug, it is a medicine that has been well studied.Currently, tens of millions of people receive it, and they are not drug users, not stimulant addicts. These are people with depression, people who are trying to quit smoking, those who are trying to lose weight and cure sexual dysfunction. This is not a panacea, but there are people for whom it can improve the quality of life, “concludes Alfimov.

” I often feel the need to prescribe such a drug, especially considering that psychostimulants that are used to treat apathy and drowsiness in depression, ADHD, we are prohibited.But alas, Russian drug policy sometimes openly interferes with the treatment of mental disorders, “says Frolov.

The doctor suggests that the manufacturer GlaxoSmithKline could refuse to renew the drug’s registration in Russia, having decided” not to get involved in possible problems with the harsh Russian drug policy. ”

According to Alfimov, the absence of bupropion on the Russian market may be due to commercial reasons – the drug is quite cheap, and to enter the market, the manufacturer needs to invest serious resources, which only large corporations can afford.

How the pill that does not heal became the most famous antidepressant | Technologies

The story began in 2006, when a generic drug, created in the image and likeness of wellbutrin, was approved by the FDA. The medicine is available in two dosages – 150 mg and 300 mg. Large dose – for patients with more severe depression, for whom the small dose does not work. Almost immediately, officials began to receive reports that the 300-milligram dose caused side effects and surprisingly low efficacy.Complaints were received from hundreds of patients. The FDA did not pay much attention to the complaints and issued a statement that can be translated into normal language something like this: “Patients with severe disorders tend to see problems where there are none.

And the reason was that the FDA did not conduct its own research on the effect of the drug. The FDA asked the manufacturing company to determine if the generic and the original drug are identical. According to the FDA now, Teva began research, but then simply abandoned them because it did not find enough volunteers.

A little explanation needs to be made here. Many consumers mistakenly believe that a branded drug and an associated generic are essentially the same thing. But generics do not have to be identical to the reference drug. They must be “biologically equivalent”. What does it mean? They must release into the body approximately the same substances in approximately the same concentration. Bioequivalence is determined experimentally, with the participation of volunteers – the degree and rate of absorption of the main substance, its distribution in the body, etc.d.

The FDA did not start independently investigating a generic drug until 2010, four years after it allowed the drug to be marketed. The study ended in August 2012. It turned out that the 300 gram tablet is really ineffective. The public learned about these results only now, in October.

The agency issued a press release explaining what happened like this: we did a study with 150 milligram pills, and then we thought that since they worked great, then everything should be fine with 300 milligram pills.”There have been no direct studies of the effects of the 300 mg tablets,” the management said bluntly, “just extrapolation of the results.” The agency then announced that this approach would no longer be used and that “new rules” are being prepared for the industry on how to conduct bioequivalence studies between the drug and its generic counterpart. Thus, the FDA pretended that what was happening was within the framework of some “old rules”. Although any medical student understands: this, in principle, does not correspond to any rules.

The FDA has always supported generics. Buying generics instead of branded drugs has helped consumers and governments save billions of dollars. But instead of independently checking how well the companies are doing, the FDA has outsourced the checks to those very companies. This is no longer a mistake, this is a trend.

90,000 Why a Russian woman faces 20 years in prison for a pack of antidepressants: Society: Russia: Lenta.ru

A resident of Yekaterinburg, Daria Belyaeva, is suspected of drug smuggling for buying a Polish antidepressant on the Internet.The girl herself suffers from a mental disorder, and the active substance of the drug – bupropion – is not indicated in the list of narcotic drugs, psychotropic substances and their precursors, it is not in the list of potent and poisonous substances. In Russia, the license for it was revoked in 2016, but it is not prohibited – it simply cannot be bought in pharmacies. However, the Russian woman faces 10 to 20 years in prison. At the request of Lenta.ru, the artist and psychoactivist Sasha Starost talked with Belyaeva and talked about why such situations can become a system.

“I have been ill since adolescence, but I came to a psychiatrist only seven years ago, already with derealization and depersonalization, terrible anxiety, jumping mood and severe apathy. Diagnoses were constantly changing, but in 2015 they settled on schizotypal disorder. Now we are treating symptoms in the form of depression, derealization-depersonalization, a jumping emotional state and, of course, apathy, ”says 24-year-old Daria.

She is a psychiatric patient with a diagnosis of schizotypal personality disorder since 2012, and since that time she has been constantly taking a combination of drugs, including antidepressants, antipsychotics and tranquilizers.As often happens with schizotypals, her depression was not relieved by standard antidepressants that work as selective serotonin reuptake inhibitors, so she consulted with her doctor and decided to buy the original European drug Elontril, which could eliminate dopamine receptor malfunction.

On April 23, the public PSY.WEB on VKontakte published the news that a criminal case was initiated against her, which could threaten her for up to 20 years. She is accused of drug smuggling on a large scale for purchasing an atypical antidepressant with the active substance bupropion on the international pharmacological portal Euromedex.She was detained by customs officers right at the post office, where she came to receive the parcel.

Photo: Kirill Kukhmar / TASS

Law enforcement agencies claim that the drug is a derivative of the illegal drug ephedrone and “is used by drug addicts to obtain a euphoric effect.”

In the international classifier of diseases, schizotypal disorder is classified as personality disorder and is defined when the symptoms do not correspond in strength to classical schizophrenic manifestations, but have a common nature with other schizo-spectrum disorders.Like other disorders in this cluster, it is characterized by features of thinking, speech, behavior and affect – that is, mood.

Although the average layman is likely completely unfamiliar with the medical definition, the disorder has a long and confusing history. More recently, this condition was denoted by the vague term “sluggish schizophrenia”, which, however, is done in some government agencies to this day.

The so-called “schizophrenic defect”, which is manifested by a gradual degradation of the cognitive and volitional sphere in schizotypal disorder, does not arise, but this does not mean at all that fluctuations of affect or apathetic states are not characteristic of it.

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Be spok

Doctors have thought about the uselessness of antidepressants

Psychiatry is the most elusive branch of modern medicine, in which for successful treatment and rehabilitation requires the most individual approach. The selection of the right medications is akin to fortune-telling on Tarot cards, and the same symptoms, depending on the diagnosis, medical history and patient’s life, can manifest themselves in completely different ways and, accordingly, succumb or not succumb to standard therapy.

“Depression in the circle of depressive, bipolar or schizo-disorders in most cases will require a completely different approach – that is why people suffering from such disorders go through many ways to cure, and this is not uncommon,” says psychiatrist and activist Viktor Lebedev, creator of the public “Delo Pinel “.

According to him, serotonin reuptake inhibitors, or classic antidepressants such as Sertraline, Fluoxetine, Paroxetine, are the first line drugs, according to modern guidelines for the treatment of depression and depressive conditions.This means that patients should start therapy with them if there are no direct contraindications.

“They are really effective, and in many cases they do it. Thanks to the action of this group of antidepressants, the amount of serotonin, one of the neurotransmitters, which, among other things, is responsible for mood and balanced brain function, increases. But not everything is so simple, and first-line drugs do not always work, and in this case we switch to second-line drugs, for example, tricyclic and non-tricyclic antidepressants, ”he says.

Bupropion, also known as Welbutrin, Elontril or Zyban, is just a second-line drug, and its fate in Russia is no less complicated than the fate of Dasha’s diagnosis.

This drug is recommended for the treatment of depression, but it also has another side quality: in the West, it is periodically used in the treatment of nicotine addiction. The peculiarity of Bupropion is that, unlike classical antidepressants, it affects not only the serotonin system, but also the dopamine system, and therefore works especially productively in apathetic states.This is Dasha’s case.

“According to the guidelines, it is not a starting drug, it should be used exactly when first-line antidepressants do not work,” says Lebedev.

Bupropion has advantages, he says. If classical antidepressants mainly contribute to the accumulation of serotonin in the synaptic cleft, in the place where one neuron transmits a signal to another, then this drug can increase the content of both norepinephrine and dopamine, another neurotransmitter.Due to this, it has a stimulating effect, but only in the medical sense of the word. That is, it allows you to cope with the apathetic component of depression, when a person has severe drowsiness, lethargy, and decreased tone. “Sometimes this becomes the main problem of our patients, and despite the adequately selected dose of SSRIs, these symptoms cannot be removed. Bupropion does an excellent job with them, ”says the psychiatrist.

Apathy is difficult to treat and is particularly common in the spectrum of schizo disorders.Extreme manifestations of apathy and violations of the volitional sphere can elementarily lead to disability and complete loss from society.

Until 2016, the drug was on the free market in Russia, and then its license was revoked. However, this had nothing to do with drug side effects: the drug manufacturers simply stopped importing it into our country, and the need for registration disappeared by itself.

Bupropion is still recommended by doctors, is listed in the standards of medical care and is easily googled, including in combination with the word “buy”.

The Rosminzdrav website in the State Register of Medicines indicates that Bupropion is not on the list of illegal drugs and is not a precursor of any known drug.

According to Lebedev, there are no studies that would prove that the drug is addictive or is a narcotic substance.

“This is a completely safe medication, at least not more dangerous than other antidepressants, or tranquilizers, which are sold relatively freely in our country, and, by the way, are very addictive,” says the psychiatrist.

Yes, and the Euromedex website is not at all a secret opium brothel from the depths of the darknet: hundreds of people order original European drugs and their generics on the website.

The problem is how the control over drugs and their accounting is organized in modern Russia: drug control has been fighting synthetic drugs, salts and spice for several years now, which have gained frenzied popularity in Russia. Smoking blends, which until 2009 were openly sold as incense in esoteric stores, turned out to be a powerful drug that causes severe addiction.

Spice and salt made their way to the Olympus of drug use in no time and became one of the most popular street drugs. As soon as they came to the attention of law enforcement agencies, a process began that eventually made Daria’s situation possible.

Drug manufacturers created new formulas, and the drug police consistently banned them. To combat the constantly adjusting drug market, in 2012 the concept of “derivative” was created.

It is this derivative of the stimulating drug ephedrone that is now called Bupropion.The difference between a derivative and a precursor or a drug itself is that a precursor is something you can make a drug from if you want and have a home laboratory.

A derivative is a substance that is obtained by modifying the components of the original formula. In the drug market, the change in the formula is used in order to bring the drug back into the legal zone, making it invisible. Nevertheless, even minor changes in the formula of a substance affect its quality and effect.

On the one hand, this explains the unpredictability of salts and spice, on the other hand, the impossibility of getting narcotic intoxication from an antidepressant.

Photo: press service of the Ural Customs Directorate

Each formula can have up to a trillion derivatives, and in Russia all of them are prosecuted. This means that not only ephedrone itself, but also any other substances that may be obtained by changing its formula, are recognized as a drug within the country.For the acquisition or distribution of these substances, any of us can go to jail.

According to Arseniy Levinson, an expert at the Institute of Human Rights and a consultant at the Hand-help portal, such a situation is unacceptable. According to him, a mechanism was created in which the list simply states that the narcotic substance and all its derivatives are prohibited.

“This is a totally wrong regulation that we have been criticizing since 2012. Not a single layman would guess to read the formula of a substance and understand that when hydrogen atoms are replaced, something happens to it, and it turns into a drug, therefore it cannot be acquired.This is not an easy task, even for professionals. This approach creates legal uncertainty, in which a person is not aware of the consequences of his actions, and, accordingly, cannot commit crimes, because the crime is committed intentionally. The average citizen does not have enough knowledge to draw conclusions about a substance, ”he says.

Levinson adds that scores of people are already imprisoned for believing they were dealing with legal substances by acquiring drug derivatives.

“The police justified their actions by the fact that their hands were tied and they were unable to cope with the changing drug market. But this is not the case, all buyers of synthetic drug derivatives were attracted quite calmly. The current legislation allows millions of chemical compounds to be considered derivatives. Once we asked for the derivatives of one of the substances indicated in the list, and we were told that it was impossible to do this, because the result would be a number with 12 zeros. Each of these formulas can lead to criminal liability, and it is not known who they will come to with such an accusation next time, ”the expert sums up.

In 2015, the state decided to create a register of derivatives, the head of the drug police was appointed in charge of it.

But this initiative has not received any completion. The register has been created, but it has not been maintained or updated for four years. Probably because it is technically impossible.

Drug control generally does not favor ordinary consumers, making them its main targets. Every fourth prisoner in Russia is imprisoned under Article 228, and the overwhelming majority of them are drug addicts, not traffic organizers.Human rights organizations have repeatedly drawn attention to the fact that the bodies act in a completely formal way, sometimes simply closing cases for accountability.

But Daria’s case still remains unique and causes particular concern. As far as it was possible to find out, drugs had never been declared as derivatives before.

Human rights activist Levinson also does not remember such stories, but he can definitely answer the question about the legality of such a practice.

“The opinion of the customs specialist recognized that the drug Elontril with the active ingredient” bupropion “is a derivative of the drug ephedrone.However, drugs cannot be recognized as drug derivatives. According to paragraph 6 of the Note to the List of Narcotic Drugs, approved by Government Decree No. 681 of 1996, derivatives may include substances with a certain modified chemical formula, “which are not included in independent positions in the state register of drugs or in this list”, – emphasizes is he.

Levinson adds that if you look at this norm formally, without taking into account other provisions of the Criminal Code, the Administrative Offenses Code, the basics of anti-drug legislation, legislation on the circulation of medicines and health protection, it can be concluded that a drug excluded from the state register may be recognized as a derivative of a narcotic drug, but this is not the case: a drug, even if it is not registered in Russia, cannot be a derivative of a narcotic drug.In relation to medicines, the legislation provides for the specifics of circulation. And anti-drug legislation can only be applied to narcotic (psychotropic) drugs. Therefore, the investigation must establish whether the seized tablets are a drug and whether it is a narcotic drug.

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00:01 – January 16, 2019

According to clauses 8 and 9 of Article 4 of Federal Law No. 61 of 2010 “On the Circulation of Medicines”, narcotic (psychotropic) medicines may include only those that contain substances included in the list of narcotic drugs.Meanwhile, Bupropion is not included in the list of drugs, but belongs to derivatives. This means that the seized medicinal product cannot be the subject of contraband, that is, a narcotic medicinal product illegally transported across the customs border.

Levinson notes that controlling all psychoactive substances as drugs is an unproductive way, and there are already mechanisms that regulate the circulation of such drugs. The tranquilizers and other sedatives mentioned by Viktor Lebedev, for example, are sold by prescription in Russia.

Fortunately, it is not easy to get a sentence for phenazepam so far. But it is not known how long this will last.

The only offense actually committed by Daria Belyaeva is the initiation of the import of unregistered medicinal products into the territory of Russia. This is an administrative article that is punishable by a fine.

According to Levinson, the case of Daria Belyaeva should be terminated for lack of corpus delicti and intent, and the accused should be assisted in rehabilitation and compensation for the damage caused.If this does not happen, the police will have the opportunity to manipulate the concept of a derivative in the most unpredictable way.

This situation will automatically affect the most vulnerable groups of Russian citizens – patients with chronic mental and somatic disorders.

Where drugs potentially intersect with drug derivatives, a space of absolute powerlessness is created, born of the double stigma of drug use and mental illness.The need to protect their rights will automatically put many patients in a situation of compulsory disclosure of the diagnosis, which, among other difficulties, will have a direct impact on their standard of living and social adaptation.

The social stigma of the mentally ill is a part of the reality of modern Russia, with which I, as an activist and patient with schizoaffective disorder, are very familiar. And the prospect of adding to it the stigma of a prisoner causes nothing but alarm.

90,000 8 quotes from the Prime Minister of India on how to modernize one of the poorest countries in the world

In May of this year, Narendra Modi won the largest democratic election in human history and became Prime Minister of India.Since then, he has become one of the most interesting politicians on the planet. He has been criticized for nationalism and populism, but at the same time he has been compared to prominent reformers of the past. Apparat studied Modi’s views and figured out how he is going to modernize one of the poorest countries in the world with smart cities, space travel and viral social media campaigns.

Narendra Modi

Prime Minister of India

Narendra Modi has a reputation as a “slumdog millionaire” who knows what a common Indian needs: as a child, he sold tea at a provincial town train station.Under his leadership, the state of Gujarat has shown one of the highest rates of economic growth among all regions of the country. Now with the remote cell phone spy app, many are counting on Modi to turn India into a world power. At the same time, Mondi and his Bharatiya Janata Party (BJP) have been criticized for nationalism and populism. Mondi is also considered one of the perpetrators of the anti-Muslim pogroms in Gujarat at the beginning of this century, which killed more than a thousand people. A talented speaker, Modi prefers to communicate with people through social networks – only Barack Obama is ahead of him in terms of the number of followers on Facebook.

A bet on alternative energy sources

Narendra Modi is just starting to work, but he is already being compared with such radical reformers as former Singaporean Prime Minister Lee Kuan Yew or former British Prime Minister Margaret Thatcher. Today, nearly 600 million Indian citizens are still engaged in agriculture, and 400 million people lack access to electricity and live in darkness. Agricultural modernization and electrification are two important topics on Modi’s agenda.At the same time, the Prime Minister believes that the stake should be placed on alternative energy sources: the government has already allocated money for the construction of several giant solar stations. The country’s development strategy, according to Modi, is encoded in the Indian flag.

Green indicates,

, that we must start the second “green revolution” (the first was carried out in developing countries in the middle of the XX century and led to a significant increase in the amount of agricultural production.- Approx. ed.) – to increase productivity in agriculture, increase added value and develop new technologies. White is a “white revolution”, that is, increasing the efficiency of dairy farming and creating conditions for the breeding of healthy cattle. Saffron is energy. We need a “saffron revolution,” which is about developing renewable energy sources, to prepare for the rise in energy consumption in India.

India is no longer a country of snake charmers, but a high-tech power

The contribution of information technology to the Indian economy is difficult to overestimate – in 2012, the IT sector accounted for 7.5% of the country’s GDP.India actively cooperates with foreign technology companies, since the salary of Indian programmers with sufficiently high qualifications is noticeably lower than that of their foreign colleagues. But experts expect India to become a supplier of cheap computer equipment as well. For example, recently the Indian company Jivi released an affordable smartphone for $ 30, and in 2012 the whole world was discussing the release of the Aakash tablet at a price of $ 50.

Earlier, many were convinced that India

is the land of snake charmers and black magic.But our young generation surprised the world with their skills in cell phone spy software in the field of information technology. We are not snake charmers, but office mouse charmers. Our youth are changing the IT sector with the click of a mouse.

India must build smart cities of the future

In 2015, the Indian government plans to spend 1.2 billion dollars on the creation of smart cities. We are talking about spending on the development of technological infrastructure, the construction of satellite cities and the modernization of existing megacities.According to Modi, rapid urbanization will be beneficial for many Indian professionals: programmers, big data analysts, architects.

In the past, cities were built on the banks of rivers, and now they appear along the largest freeways. As for the cities of the future, they will be built where there is access to fiber-optic networks and next-generation infrastructure. Urbanization should not be seen as a problem, but as an opportunity. To create new jobs and change the country for the better, we need to build 100 smart cities.

India should become a full-fledged player in the space technology market

Almost a third of India’s population lives below the poverty line, but the country continues to actively develop the space industry. Recently, the Mangalyan satellite was successfully launched into Mars orbit. Modi had nothing to do with the project (this is the merit of the previous Prime Minister Manmohan Singh), but shortly after the launch of the satellite announced that he wanted to make India a full-fledged player in the space technology market.

Indian satellite has successfully reached Mars. History was being made today. We decided to go into the unknown and achieved the almost impossible. Many skeptics did not believe in our success. A mission to Mars cost us less than making a Hollywood movie. This success was achieved with little money. This is all thanks to the dedication and dedication of our cell spy scientists.

India must liberalize its economy

In the Indian press, Modi has been nicknamed “the friend of entrepreneurs”.During his reign, the state of Gujarat has outpaced most other regions of the country in terms of economic growth. However, as experts note, despite its rapid development, Gujarat has not improved in many important indicators – infant mortality and literacy. But the people of India see Modi as a business man who can boost India’s economy. The Prime Minister relies on supporting business and attracting foreign investment.

The time has come to create conditions for the professional development of our youth, which will provide them with work in the future.If we want to compete with China, we must focus on three things – skill, scale and speed. We need to be more qualified, on a large http://cellphonespyappon.com/ scale and with more dynamics.

Demography is one of the main strengths of India

Today, half of Indians are under 24 years old. By 2025, the number of unemployed citizens will drop to 48,9005,9002%, most of whom are children. The working-age population will increase by 230 million.Demography can become one of the key advantages of the country on the world stage, which Modi constantly reminds of.

India is developing dynamically. We have three advantages that no one else has. It is our responsibility to identify these strengths. First of all, this is democracy, our greatest strength, something that we should be proud of. The second advantage is the demographic situation. 35% of the population are children and adolescents. The third advantage is demand. The eyes of the whole world are directed towards India.

Viral campaigns on social networks will make India cleaner

Modi does not like traditional media very much, but loves new ones, especially Facebook and Twitter, where only Barack Obama is ahead of him in polarity. After taking office as prime minister, he limited government members to newspapers and forced them to use social media as much as possible. Journalists believe that as a result, an unusual form of censorship is being established in the country. But Modi is trying to use tweets for more than just controlling the news agenda.Inspired by the viral charity event Ice Bucket Chalenge, the head of the country tried to apply viral mechanics to solve one of the most pressing problems in India – unsanitary conditions.

I launched a viral social media campaign. I asked nine people to post a photo of them cleaning the streets. Each of them must invite nine more people. If we can get to Mars, can’t we clean up our areas? I feel pain when I see that 60% of people relieve themselves on the street.The creation of toilets is very important. But for now, we can at least get out.

Digital government must make Indian officials work efficient

The number of Internet users in India is growing rapidly: today 243 million people have access to the Internet. According to Modi, this cannot be ignored. On his initiative, the MyGov website was launched, where citizens are given the opportunity to put forward legislative initiatives and speak out on several key projects of the countries.

We must focus our efforts on creating digital government. Management should be based on new technologies, only then will it be effective.

Cover work: Daniel Firman

Source: http://podmikroskopom.ru

Clinical Study Non-Small Cell Lung Cancer: Armodafinil, Bupropion, Minocycline, Curcumin, Telephone Questionnaire – Clinical Trials Registry

Detailed Description

Investigational Drugs: It is not known which study drug or combination of study drugs is better at reducing side effects.effects that patients may experience during chemoradiation therapy. For this reason, the researchers selected 4 study drugs that may help reduce side effects. tested separately and in combination with each other. Armodafinil is intended to prevent excessive sleepiness. Bupropion is an antidepressant with anti-inflammatory properties that can help reduce multiple symptoms. Curcumin is the active ingredient in the spice, turmeric. It can interfere with the production of cytokines (which cause inflammation) that can reduce multiple symptoms.Minocycline is an antibiotic that has been shown to interrupt the production of cytokines, which can help reduce multiple symptoms. Study Commissions: If you agree to participate in this study, you will be assigned at random (as in the dice list) to join 1 of 16 groups. You may be ordered not to receive study drug, 1 study drug, or a combination of 2, 3, or all 4 study drugs. During this study, you may receive one or more placebos.The placebo looks like the investigational drugs. but does not contain active ingredients. You may be in a group not receiving any investigational drugs, but all patients are under standard care by their healthcare provider. Neither you nor the research staff you see at the clinic will know if you are receiving any investigational drug and / or placebo (s). However, if necessary for your safety, research personnel will be able to find out which investigational drug you are taking.Study Drug Administration: You will be taking study drug / placebo every day for 10 weeks. study combination drugs or placebo orally daily as directed by the investigator. You will be given brochures with more information on how to take the study drug / placebo. You will be given a daily diary to record when you take the study drug / placebo. Study drug / placebo blisters / sticks should be brought to the clinic at each study visit.You should also bring your diary with every visit. Completing a Symptom Questionnaire: Throughout the study, you will be asked to complete a symptom questionnaire. asked about the symptoms of therapy you may be experiencing and how they might interfere with your daily activities. The research staff will meet you during your routine clinic to come or call your home at a convenient time for you. fill out the questionnaire on paper and in pen or by entering your answers into an electronic Tablet computer.Over the phone, staff will ask you questions and record your answers. on paper or enter them into a computer. The symptom questionnaire will take up to 5 minutes. complete. – Within 1-10 weeks, you will complete a symptom questionnaire 2 times a week. – For 11-16 weeks, you will complete a symptom questionnaire once a week. Study visits: Before starting chemoradiotherapy: – You will complete 4 questionnaires about pain and other symptoms, your mood and quality of life. It will take about 15 minutes to complete all 4 questionnaires.- You will have a blood clotting test called PT-INR to make sure your blood clots are normal. – If you are a woman who can become pregnant, you will have a urine pregnancy test. The research staff will give you a pregnancy test kit at your scheduled visit, review and record the test results before your research prescriptions are performed by the Pharmaceuticals. After 4 weeks of chemoradiation therapy: – You will fill out 1 questionnaire about the quality of your life. it will take about 2-3 minutes to complete.- You will have a blood clotting test called PT-INR to make sure your blood clots are normal. During the last week of chemoradiation therapy (approximately 7th week): -You fill out 3 questionnaires about your symptoms, mood and quality of life. filling out the questionnaire will take about 10 minutes. After about 7 weeks, the research staff will call you 2 times a week to check on you for up to a week. 10. This phone call should only last a few minutes. If you have experienced multiple sides due to chemoradiotherapy, this phone call may take longer.At about 12 weeks (on a typical clinical visit): – You will complete 3 questionnaires about your symptoms, mood and quality of life. – If you smoked at the beginning of the study, you will fill out the questionnaire. asks if you quit smoking at any point during the study. It will take a few minutes. – You will have a blood clotting test called PT-INR to make sure your blood clots are normal. – You will be asked to complete another questionnaire that asks how satisfied you are with the investigational drugs.It will take a few minutes. Duration of Study: You will be on the study for about 16 weeks, you will take the study drugs for 10 weeks, and you will complete the symptom survey for up to 16 weeks. You will be excluded from the study if you experience any intolerable side effects. This is an exploratory study. Armodafinil is FDA approved and is commercially available for the treatment of excessive sleepiness. Bupropion is FDA approved and is commercially available for the treatment of depression. Minocycline is FDA approved and is commercially available for the treatment of bacterial infections.Curcumin is not FDA approved. Curcumin is currently only used in research. The various possible combinations of these drugs are used in this study is of an exploratory nature. This study will enroll up to 32 patients, all of whom will be enrolled in MD Anderson. …

Intervention

Intervention type:

Drug, remedy, medication

Intervention name:

Armodafinil

Description:

Initial dose of 150 mg once daily (50 mg and 100 mg oral tablets) for 10 weeks.

Intervention type:

Drug, remedy, medication

Intervention name:

Bupropion

Description:

The initial dose is 100 mg twice a day (200 mg) for 10 weeks.

Intervention type:

Drug, remedy, medication

Intervention name:

Minocycline

Description:

The initial dose is 100 mg twice a day (200 mg) for 10 weeks.

Intervention type:

Drug, remedy, medication

Intervention name:

Curcumin

Description:

Initial dose in sticks of 4 g once a day (4 g) for 10 weeks.

Intervention type:

Behavioral

Intervention name:

Telephone questionnaire

Description:

1-10 weeks, 2 surveys per week; and weeks 11-16, 1 call per week.

Another name:

Interview

Eligibility

Criteria:

Inclusion criteria: 1. Patients with a pathologically confirmed diagnosis of inoperable non-small cell lung. carcinoma (NSCLC) and agreed to concurrent chemoradiation therapy with Dr. Anderson Cancer Center (MDACC).2. Patients from 18 to 65 years old. 3. Patients who will receive platinum / taxane based chemoradiotherapy and total radiation dose> or = 50 Gy, as assessed by the treating physician 4. Patients who speak only English (due to the novelty of the study and its complexity, we are only English-speaking patient protocol) 5. Patients must agree to discontinue any current use of herbal supplements and refrain from taking any herbal supplements during protocol 6. Patients must be willing and able to review, understand and provide written consent.before starting therapy 7. Patients already taking any of the symptom medications of this study (including modafinil) should be prepared to discontinue the medication for a washout period of 30 days before they are randomized to symptom treatment and begin symptom study Criterion exceptions: 1. Patients who are taking medications or have conditions that potentially prevent their use. any investigational drugs or interventions as determined by your healthcare professional.2. Patients taking CHANTIX (smoking cessation medicine) 3. Patients participating in other clinical trials for symptom management or treatment. 4. Obstruction of the bile ducts or cholelithiasis. 5. A history of a clinically significant skin reaction to drugs or a history of a clinically significant hypersensitivity reaction, including multiple allergies or drug reactions. 6. Preexisting psychosis or bipolar disorder. 7. Preexisting renal impairment: serum creatinine screening limit> 1.5 mg / dL.will be performed by an oncologist to meet the radiographic criteria. 8. Preexisting liver dysfunction: screening for total bilirubin> 25.7 µmol / L (1.5 µmol / L). mg / dl) will be performed by an oncologist to qualify for chemoradiation therapy (CXRT). Screening for 2x the upper limit of normal hepatotoxicity (aspartate aminotransferase (AST), alkaline phosphatase (ALP), and alanine aminotransferase (ALT)) will be performed by an oncologist to meet radiographic criteria. 9.Preexisting Tourette’s Syndrome. 10. Convulsive disorder. 11. Anorexia / bulimia in the last two months. 12. Application of monoamine oxidase inhibitors (MAO) within 14 days. 13. Patients who abruptly stop ethanol or sedatives (including benzodiazepines) 14. Patients receiving bupropion in other dosage forms if they do not agree to undergo treatment. washout period 15. Allergy to turmeric or any of its components, including curcumin, to yellow foods. coloration, or a member of the Zingiberaceae family (gingerbreads) 16.Stomach or duodenal ulcers or gastric acidity disorders. 17. Hypersensitivity to any tetracyclines. 18. Patients who must be confirmed as non-pregnant (serum negative for hCG). Screening for this will be done by an oncologist during an X-ray. 19. Patients with a history of heart disease, including angina pectoris and cardiac ischemia, left ventricular hypertrophy, myocardial infarction, and mitral valve prolapse. 20. Patients taking antifungal, antiretroviral drugs and macrolides with strong CYP3A4.potent inhibitors including indinavir, nelfinavir, ritonavir, clarithromycin, itraconazole, ketoconazole, and nefazodone. 21. Patients taking anticoagulants (eg warfarin / heparin). 22. Patients with an international normalized ratio (INR)> 1.5.

Floor:

Everything

Minimum age:

18 years

Maximum age:

65 years

Healthy volunteers:

Not

Armament group

Label:

Questionnaires and phone calls

A type:

different

Description:

1-10 weeks, 2 surveys per week; and weeks 11-16, 1 call per week.

Label:

Curcumin only

A type:

Active comparator

Label:

Armodafinil only

A type:

Active comparator

Label:

Minocycline only

A type:

Active comparator

Label:

Bupropion only

A type:

Active comparator

Label:

Curcumin + Armodafinil

A type:

Active comparator

Label:

Curcumin + Minocycline

A type:

Active comparator

Label:

Curcumin + Bupropion

A type:

Active comparator

Label:

Armodafinil + minocycline

A type:

Active comparator

Label:

Armodafinil + bupropion

A type:

Active comparator

Label:

Minocycline + Bupropion

A type:

Active comparator

Label:

Curcumin + Armodafinil + Minocycline

A type:

Active comparator

Label:

Curcumin + Armodafinil + Bupropion

A type:

Active comparator

Label:

Curcumin + Minocycline + Bupropion

A type:

Active comparator

Label:

Armodafinil + Minocycline + Bupropion

A type:

Active comparator

Label:

Curcumin + Armodafinil + Minocycline + Bupropion

A type:

Active comparator

.