Bupropion has a well-established safety profile, but there are specific risks and contraindications worth knowing — both before starting and during treatment.
Bupropion is not appropriate for:
- People with a history of seizures — Bupropion can lower the seizure threshold, particularly at higher doses.
- People with a history of eating disorders including anorexia or bulimia. Bupropion's appetite-suppressing effects can be problematic for women with disordered eating histories.
- People with a history of significant alcohol or drug dependence — particularly current use. Bupropion has potential for misuse and can interact poorly with substances. Worth a thorough conversation with your clinician.
- People with severe kidney or liver impairment.
- People taking certain other medications particularly MAOIs (a class of older antidepressants), and certain other antidepressants. Combining can be dangerous.
Other risks to be aware of:
- Seizure risk increases with higher doses or rapid dose changes. This is one reason Bupropion is typically titrated gradually rather than started at full dose. Don't take more than prescribed.
- Increased blood pressure — Bupropion can raise blood pressure, particularly in people who already have elevated blood pressure. Your clinician will monitor this.
- Mood changes, including the rare possibility of new or worsening suicidal thoughts — particularly in the first weeks of treatment. This risk is associated with antidepressants generally and is worth taking seriously, even if Bupropion is being prescribed primarily for weight management rather than mood.
- Interactions with caffeine Bupropion can amplify caffeine's stimulating effects. Most women adjust to this, but worth being aware of, especially in the first weeks.
- Driving or operating machinery — Bupropion can cause drowsiness or impaired alertness in some people, particularly when starting. Don't drive or operate machinery until you know how the medication affects you.
Pregnancy and breastfeeding considerations:
- Bupropion is generally not recommended during pregnancy unless the benefits clearly outweigh the risks. See Q2 above.
- If you become pregnant unexpectedly while taking Bupropion, message your clinician immediately — don't stop abruptly, as Bupropion is typically tapered when discontinuing.
- Tell your clinician if you're breastfeeding.
What to do:
- Tell your clinician about your complete medical history during the intake including any seizure history, eating disorder history, alcohol or substance use history, and all medications and supplements you're taking.
- Don't take more than prescribed. Bupropion's safety profile is dose-sensitive, particularly around seizure risk.
- Don't combine with alcohol beyond very moderate amounts. Combining can increase seizure risk and interfere with the medication.
- Don't stop suddenly if you've been on Bupropion for more than a few weeks. Your clinician will recommend appropriate tapering if you're discontinuing.
- Message your clinician about any concerning symptoms particularly mood changes, increased anxiety, sleep disruption, or unusual physical symptoms.
- Seek immediate care for seizures, severe allergic reactions, suicidal thoughts, or severe blood pressure symptoms.
If you're experiencing thoughts of self-harm or suicide while taking Bupropion, contact the 988 Suicide & Crisis Lifeline (call or text 988) or go to your nearest emergency room.