What You Should Know About Bupropion XR Side Effects

Every medication comes with potential side effects, and Bupropion XR (brand names Wellbutrin XL, Aplenzin, Forfivo XL) is no exception. But here's the thing: most people tolerate Bupropion XR well, and the most common side effects are mild and tend to improve within the first few weeks of treatment.

This guide covers what to expect, what's serious, and when you should pick up the phone and call your doctor.

What Is Bupropion XR?

Bupropion XR is an extended-release antidepressant that belongs to the norepinephrine-dopamine reuptake inhibitor (NDRI) class. It's FDA-approved to treat major depressive disorder (MDD) and seasonal affective disorder (SAD). Unlike SSRIs, it works primarily on dopamine and norepinephrine rather than serotonin, which gives it a different side effect profile than most other antidepressants.

Common Side Effects

The following side effects are reported most frequently in clinical trials. They're generally mild to moderate and often improve as your body adjusts to the medication:

• Dry mouth — One of the most common effects. Staying hydrated and chewing sugar-free gum can help.
• Nausea — Usually mild and tends to go away within the first week or two.
• Insomnia — Bupropion XR can be activating. This is why doctors recommend taking it in the morning. If sleep problems persist, talk to your doctor.
• Constipation — Increasing fiber and water intake usually helps.
• Headache — Common early in treatment but typically temporary.
• Dizziness — May occur when standing up quickly. Rise slowly from sitting or lying positions.
• Excessive sweating — Some people notice increased perspiration, especially at higher doses.
• Tremor — Mild hand tremors may occur, particularly at doses above 300 mg/day.
• Anxiety or agitation — Since Bupropion XR is stimulating compared to other antidepressants, some people feel jittery initially.
• Weight loss and decreased appetite — Unlike many antidepressants, Bupropion XR is associated with weight loss rather than weight gain. This is a positive for some patients but should be monitored.

Serious Side Effects

These are less common but require immediate medical attention:

Seizures

The most well-known serious risk with Bupropion XR is seizures. The risk is dose-dependent — approximately 0.4% at doses up to 450 mg per day. The risk increases significantly above the maximum recommended dose. You're at higher risk if you have a history of seizures, eating disorders, head trauma, or if you're withdrawing from alcohol or benzodiazepines.

Suicidal Thoughts and Behavior

Bupropion XR carries an FDA boxed warning about increased risk of suicidal thinking and behavior in children, adolescents, and young adults (ages 18–24). This risk is highest during the first few months of treatment or when the dose changes. If you or someone you know experiences worsening depression, new or worsening anxiety, panic attacks, or thoughts of self-harm, contact a doctor immediately or call 988 (Suicide & Crisis Lifeline).

Neuropsychiatric Events

In rare cases, Bupropion XR can cause psychosis, hallucinations, paranoia, or delusions. These are more common in patients with a history of psychiatric illness.

Severe Allergic Reactions

Allergic reactions including anaphylaxis and Stevens-Johnson syndrome have been reported. Seek emergency help if you develop a rash, hives, swelling of the face or throat, or difficulty breathing.

Elevated Blood Pressure

Bupropion XR can raise blood pressure. Your doctor should check your blood pressure before starting treatment and at regular intervals, especially if you already have hypertension.

Angle-Closure Glaucoma

In rare cases, Bupropion XR can trigger angle-closure glaucoma. If you experience eye pain, changes in vision, or swelling around the eyes, seek medical attention right away.

Hepatotoxicity

Rare cases of liver damage have been reported. Contact your doctor if you develop yellowing of the skin or eyes, dark urine, or persistent abdominal pain.

Specific Populations

Young Adults (Under 25)

The boxed warning applies most strongly here. Close monitoring during the first several months of treatment is critical.

Pregnant and Breastfeeding Women

Bupropion XR is classified as Pregnancy Category C, meaning animal studies have shown risk but there are no adequate studies in humans. Discuss the risks and benefits with your doctor. Bupropion does pass into breast milk.

Older Adults

Elderly patients may be more sensitive to Bupropion XR's effects. Dose adjustments may be necessary, particularly for those with reduced kidney or liver function.

Patients with Liver or Kidney Problems

Reduced doses are recommended for patients with hepatic impairment. Patients with kidney problems, including those on dialysis, may also need dose adjustments.

People with Eating Disorders

Bupropion XR is contraindicated in patients with a current or prior diagnosis of bulimia or anorexia nervosa due to a higher incidence of seizures.

How to Manage Common Side Effects

Most side effects can be managed with simple strategies:

• Take it in the morning — This reduces insomnia and sleep disruption.
• Stay hydrated — Helps with dry mouth and constipation.
• Don't skip meals — Low blood sugar can worsen dizziness and headaches.
• Avoid alcohol — Alcohol increases the risk of seizures and can worsen side effects. Learn more about Bupropion XR interactions.
• Give it time — Many side effects improve within 1–2 weeks as your body adjusts.
• Don't change your dose without asking your doctor — Abruptly stopping or rapidly increasing the dose can increase side effect risk.

Final Thoughts

Bupropion XR has a favorable side effect profile compared to many other antidepressants — it's less likely to cause weight gain, sexual dysfunction, or drowsiness. Most people who take it experience only mild side effects that improve over time. But it's important to know the warning signs of serious reactions so you can act quickly if needed.

If you're experiencing side effects that concern you, talk to your doctor before making any changes. And if you're having trouble finding Bupropion XR at your pharmacy, Medfinder can help you locate it in stock near you.