Talk:Bupropion

Request

It would be great if someone with access to the full text of PMID 2500425 and PMID 6406457 could have a read. The first, particularly, appears to be a landmark article regarding the incidence of seizures with bupropion treatment and how it relates to dosage, and both could be used to cite the History section. Fvasconcellos (t·c) 15:58, 18 August 2007 (UTC)

J Clin Psych has online archives only beginning from 1996, so someone has to physically go to the library. The review (see seizure part) and prescribing information give a good enough impression of the seizure liability of bupropion. You can refer to the prescribing information.Paul gene 18:31, 18 August 2007 (UTC)

OK, thanks. Fvasconcellos (t·c) 00:33, 19 August 2007 (UTC)

Make the lead part shorter

The unnecessary inclusion of dosage, adverse effects and availability information overloads the lead part. It also repeats the corresponding parts of the article. I suggest removing the following from the lead:

"In the United Kingdom and Australia, it is only licenced to assist in its cessation of smoking function. The regular dose for treatment and maintenance therapy in clinical depression is 300 mg daily, though doses of up to 450 mg daily may be prescribed by a physician. 150 mg is the daily dose used in the treatment of nicotine dependence.

Common adverse effects include dry mouth, nausea, insomnia, tremor, excessive sweating and tinnitus. Rarer but more serious is the potential for seizures as bupropion lowers seizure threshold and thus caution is advised in situations where they are more likely to occur. Bupropion is not considered dependence-forming, nor is there evidence of increased suicidal behaviour occurring with its use."Paul gene 18:35, 18 August 2007 (UTC)

Paul - the reason I put it in is that the lead is supposed to summarise the salient points of the article - i.e. you could have a quick squiz at the lead and see all you needed to know of high importance at a glance. Most articles at FAC have this approach and I fear that if shortened again there will be a cry for a longer one. I've not been on this article long but it is a tricky one to fingure what should go where in places :) cheers, Casliber (talk · contribs) 22:27, 18 August 2007 (UTC)

OK. I'll try to shorten it based on WP:Lead guidelines "The lead should be capable of standing alone as a concise overview of the article, establishing context, summarizing the most important points, explaining why the subject is interesting or notable, and briefly describing its notable controversies, if there are any. The emphasis given to material in the lead should roughly reflect its importance to the topic according to reliable, published sources. The lead should not "tease" the reader by hinting at but not explaining important facts that will appear later in the article. It should contain up to four paragraphs, should be carefully sourced as appropriate, and should be written in a clear, accessible style so as to invite a reading of the full article."Paul gene 12:13, 19 August 2007 (UTC)

I don't have strong opinions on it either way really so we'll see how it flies..cheers, Casliber (talk · contribs) 13:07, 19 August 2007 (UTC)

Indications for Australia

I suggest removing the Australia part from the following sentence in the History: "In the United Kingdom, bupropion was approved as a smoking cessation aid in 2000, but has not been approved for the treatment of depression;[7] a similar situation exists in Australia." Until somebody finds the reference.Paul gene 18:37, 18 August 2007 (UTC)

I am sorry I didn't get the ref right off but it was late and I was tired. Also I am busy off-keyboard for alot of today. I left it there as there needs to be some global summary of how it is used elsewhere - thus mention of use of other countries will need to be reffed and included prior to FAC being successful - otherwise the article is USA-centric. I'll put a fact tag on it until thencheers, Casliber (talk · contribs) 22:30, 18 August 2007 (UTC)

Comprehensiveness

In order to be fully comprehensive a number of things need to go in:

• Australia & Europe - licencing indications included and reffed.

• Mention of concern about associated psychosis and evidence addressing same.

(Others...?)cheers, Casliber (talk · contribs) 22:42, 18 August 2007 (UTC)

I've added a brief reference to its introduction in Australia for smoking cessation, and rephrased the sentence slightly. Not sure if more should be added or not.

I also added information on the associated psychoses to the 'side effects' section. That pretty much came straight from the manufacturer's information. Dr. Cash 23:41, 18 August 2007 (UTC)

Great -I'll hunt around later in some other stuff I have but gotta run now..cheers, Casliber (talk · contribs) 23:53, 18 August 2007 (UTC)

Is this any help? Fvasconcellos (t·c) 01:06, 19 August 2007 (UTC)

• here is a good item to ref for Europe...and recent news too - :)cheers, Casliber (talk · contribs) 07:57, 19 August 2007 (UTC)

Sorted! OK well done everybody...would be great if we could get some stuff on licencing in some European countries (sorry to be a pain..). I think we've got the content right, now the prose....cheers, Casliber (talk · contribs) 07:52, 19 August 2007 (UTC)

WP:MEDMOS

I've boldly shifted the sections around for better compliance with WP:MEDMOS. As a guideline, MEDMOS is not set in stone, but I do think the article flows better now. If anyone wishes to revert and discuss, please do! Fvasconcellos (t·c) 01:06, 19 August 2007 (UTC)

I moved the 'abuse liability' section down to the bottom, as I feel that there are other sections, like 'mechanism of action' and 'pharmacokinetics', are more important. I also moved the 'overdose' information out of its own section and back into the 'dosage and forms' section, as it really falls under that section. There's no reason for it to be separate. Plus, having several sections in between 'dosage' and 'overdose' really doesn't make sense at all. Yes, I am aware that there is an 'overdose' section in the medical MOS, but I feel that that is an error; (a) there's no section there called 'dosage' or 'dose', just overdose; (b) I think that the order of the sections that they are suggesting for drug articles could be improved. I'll look at this more later, but I would suggest revising the manual of style, at a minimum, to change 'overdose' to 'dose' or 'dosage'. Dr. Cash 07:25, 19 August 2007 (UTC)

Agree with both above. cheers, Casliber (talk · contribs) 07:49, 19 August 2007 (UTC)

Well, there has been some discussion re. not allowing dosage information to be included at all, as it is easily subject to uninformed good-faith edits; MEDMOS currently discourages adding such information altogether. I agree that may be excessive, but this should probably be taken up at the guideline Talk page. Fvasconcellos (t·c) 13:34, 19 August 2007 (UTC)

Trade names

Would anyone object to the "Trade names" section being renamed "Availability" so we can expand a bit with licensing/history information from other countries? Fvasconcellos (t·c) 13:49, 19 August 2007 (UTC)

Hmm, on having second thoughts of the dosage/overdose issue which I reverted, I started thinking about the dose issue per WP:MEDMOS. One of the possibilities I thought of myself was renaming the section to something like 'availability' (merging 'dosage and forms' and 'trade names'), so as to primarily cover the different forms and brands covered and such. Then, the 'overdose' information could be moved into its own section. Dr. Cash 19:53, 19 August 2007 (UTC)

I've just moved this content, merged with 'trade names', and re-created the 'overdose' section. Still uncertain specifically where to put 'overdose' -- for now, I put it after 'adverse effects', but I'm open to suggestions here. Dr. Cash 20:08, 19 August 2007 (UTC)

Looks good. I'll move some of the "History" content into "Availability" and see if I can get some more international information. Fvasconcellos (t·c) 20:09, 19 August 2007 (UTC)

It might also be useful to include some info on relative pricing of the two labels the generic is sold under, generic for Wellbutrin and generic for Zyban. I have found the pricing to vary 2.5:1 with the Zyban generic being the cheaper. I think this is a significant aspect of this drug. It seems like "Availability" would be the right section to include this in. —Preceding unsigned comment added by Gnuarm (talk • contribs) 18:37, 28 December 2009 (UTC)

external links

I've removed the following two links from the external links section of the article:

• http://www.quitsmoking-review.com/
• Quit Smoking Pills

They're largely redundant, and talk more about quitting smoking than bupropion itself. Plus, it really borders on linkspam. This article is about the drug bupropion, which does have one effect of lowering the urge to smoke, but it's still not about 'quitting smoking', so these links are irrelevant. Dr. Cash 16:48, 21 August 2007 (UTC)

Agreed. Fvasconcellos (t·c) 16:52, 21 August 2007 (UTC)

Disagree!! although they need not be added back in, bupropion in the U.S. was marketed as Zyban, specifically for the purpose of quitting smoking, the only non-nicotene medication approved by the FDA for this purpose. This was a matter a some confusion for consumers, because GlaxosmithWel. marketed Wellbutrin and Zyban seperately as two brand names for same medication: bupropion for two different purposes, Wellbutrin (in higher dose pills) for depression and Zyban (lower dose pills) for quitting smoking . The main complaint I have is that apparently "Dr.Cash" threw the accusation of "almost linkspam" before researching it! Bupropion sold as Zyban has been out since the '90s at least. Hopefully better links to Bupropion as Zyban will be found, but please don't arbitrarily remove links without actually READING the entire articles!!! Cuvtixo (talk) 01:04, 22 December 2007 (UTC)

I'm sorry, but I have seen these specific two links (saw them back in August as well) and I really don't think they are helpful; that is, I don't think they add anything to the article. Besides, they provide links to objectionable commercial websites (online pharmacies). Fvasconcellos (t·c) 01:15, 22 December 2007 (UTC)

A few questions - hope someone can light some insight

The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted 21:28, 30 August 2007.

---

Bupropion

I think this is what you would call a "Featured Article Status", I am thus nominating it, so that it becomes official. Anyways research wise I like this chemical a lot, so if it is not at "FA level" yet, I will improve it based on the comments received I have done like just 4 edits after the FA review started. I am sorry. --Savedthat 03:17, 14 August 2007 (UTC)

• Comments. Nice start. Pls see WP:MOSBOLD, WP:DASH, WP:UNITS, WP:LEAD and WP:MEDMOS. Did you consider peer review or good article? SandyGeorgia (Talk) 03:24, 14 August 2007 (UTC)

I have seen those rules you mentioned, but I cannot connect the dots, what exactly is this article not following? I have decided to go straight to FA candidate because it has a more stringent review system. Thus, I can start doing additional research immediately on this substance if it does not meet criteria.--Savedthat 04:23, 14 August 2007 (UTC)

The article is head and shoulders above most pharm articles, but ... Bolding is used where it shouldn't be, the lead could be expanded to a compelling, stand-alone summary of the entire article, there is incorrect use of hyphens where endashes are needed, all numbers and units of measurement need non-breaking hardspaces, there's a citation in a section heading, you should explain your use of trade names (see the footnote at Tourette syndrome), and section headings don't conform with WP:MEDMOS. Each citation that is not to a journal-published source should be scrutinized to see if it can be replaced with refereed sources. External links can probably be pruned per WP:EL, WP:RS, WP:NOT; is there anything there that can't be found in the DMOZ link or in the article and its sources? If so, the article may not be comprehensive. Fvasconcellos (talk · contribs) is familiar with pharm articles and FAC; he might be willing to help out. (Speaking of comprehensive, I don't find the words tic or Tourette syndrome in the article.) SandyGeorgia (Talk) 04:18, 14 August 2007 (UTC)

I've been looking for a sample article to guide you, but I'm afraid you're blazing new territory. Antioxidant is the most recent FA, but it's not a class pharmaceutical, so isn't really comparable. Neither is caffeine. Paracetamol is a very old FA, probably doesn't meet current standards, and needs review. So, there isn't really a pharm FA to compare to, but TimVickers (talk · contribs) could help you prepare for WP:GAC. SandyGeorgia (Talk) 04:29, 14 August 2007 (UTC)

Oppose. Poorly written and MOS breaches.

• MOS breachs—hyphens/dashes; why are simple years linked? Read MOS on linking.
• compared with for contrasts.
• "have confirmed efficacy of bupropion"—"the" is missing

And tons more. Tony 10:14, 14 August 2007 (UTC)

• Comment You may want to contact Paul gene (talk · contribs), the article's main contributor. BTW, anyone consider dropping WP:PHARM a line? What are we, chopped liver? :) I jest, I jest. Fvasconcellos (t·c) 14:59, 14 August 2007 (UTC)

Anyway, here we go:

• The "History" section is excellent, way above average for pharm articles. It is asking for references, though; they shouldn't be too hard to find.
• The article is quite heavy on stats; this is not a bad thing, but more prose would make it more readable. There are a lot of parenthetical statements throughout. It would be nice to rewrite some of these; get crazy with em dashes.
• "Pharmacokinetics" is quite technical. I've no problem with it but it is probably above the lay reader. It also took me a couple of seconds to get acquainted with the metabolites table; its syntax could perhaps be improved to make it... prettier? :)
• "Availability in the UK" should be expanded to "Availability" with country-specific subsections as needed; I hate to toot my own horn, but Orlistat does a good job of this. The list of trade names could go in as a subsection of "Availability" as well; making it two- or three-column, if possible, would help readability.
• "only if you are able to get a letter from a smoking cessation clinic to your GP"... Second-person writing is a no-no.
• IMHO there's nothing in "Additional information" which couldn't be rearranged within the rest of the article. "Overdosage" doesn't fit in with "Availability"; it could be a stand-alone section or go with Adverse effects.

There's more to come, but I'm off to lunch now :) Will see what else I can do later. Best, Fvasconcellos (t·c) 15:35, 14 August 2007 (UTC)

Comments:

• The smoking cessation paragraph under indications should be improved using the later cited cochrane review on antidepressants for smoking cessation.
• Should a study showing equal effectiveness as placebo be included in the article?
• The number of prescriptions in one specific year in one specific country does not belong to the lead section I think.
• History: withdrawal from market, was this in the U.S. only or worldwide?
• The suicide risk section should start with objective information about the suicide risk, not with "the FDA requires...".

--WS 18:34, 14 August 2007 (UTC)

Comments - go for it - this one is doable. Main thing is that WP is an encyclopedia not a pharmaceutical info pamphlet- so the prose should be richer. I am happy to help with copyediting. Only thing of substance I can't see so far is that it has a reputation for benig psychotogenic (at least in Australia) so evidnce refuting or supporting that would be importand.cheers, Casliber (talk · contribs) 04:55, 16 August 2007 (UTC)

Comments Overall, I think this is one of the best drug articles I've seen on Wikipedia yet! I think it covers the topic quite well, is well-referenced, and interesting to read. I've made a couple of minor changes to the article. A couple of things still remain. Here's my detailed comments:

I am reviewing this version of the article.

The lead is a bit short. It should be a concise summary of the article. As a summary, it should ideally not contain any references (inline citations would be placed on the material later in the article that is being cited). WP:LEAD can help in this regard.

I like the indications section, as it is written out in reasonably good prose and not just a list, like a lot of other drug articles. This provides an excellent example for others to follow.

The metabolism image in the pharmacokinetics section seems a bit odd, with the drug on the right and the metabolites pointing back to the left. I would think that it should be the other way around. Also, the quality of some of the lines in the sketch seems a bit choppy. What chemical software was used to create it?

The pharmacokinetics section seems a bit crowded with the image and the table right next to each other. Perhaps the table could be moved to the bottom of the section, after all the text?

References are only indicated for one of the three bullet points under 'dosage'. With specific dosage information provided, a reference should be there.

While the colorful table in the 'availability in the UK' section looks nice and all; (a) it is unreferenced and (b) I am uncertain exactly what it is contributing to the article? It seems to go a bit beyond the purpose of an encyclopedia to provide a listing and descriptions of each of the different pills of the drug; you can look up — perhaps a far more accurate version — on the manufacturer's official website. Plus, is the table specific to the UK? Where's the US version? I would recommend removing this section, and possibily moving the text at the beginning to another section of the article, and finding a reference for it.

"Recently, addition of bupropion to a mood-stabilizer in patients with bipolar depressions was shown to have the same effectiveness as placebo." -- This statement should probably be integrated with a different section. It seems out of place in its own brief subsection under 'additional information'. Once it's removed, I'd recommend renaming the main section to 'trade names' and removing the identically-named subsection.

Dr. Cash 06:07, 16 August 2007 (UTC)

• I believe the bolding problem has been fixed. [1] & [2]. Y Done --Savedthat 05:03, 17 August 2007 (UTC)

• The Trade Name section has been made as a subsection of Additional Information. [3]. Y Done --Savedthat 05:03, 17 August 2007 (UTC)

• Copy-editing has been done here [4], thank you Wouterstomp; and here [5], thank you Axl; and here [6] & [7], thank you Fvasconcellos; and here [8], [9], [10], [11], [12], [13],

[14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], & [32], thank you Derek.cashman; and here [33] & [34], thank you Outriggr --Savedthat 05:10, 17 August 2007 (UTC)

• Dash fixes have been done here [35] & [36] & [37], thank you Fvasconcellos; and here [38] & [39], thank you SandyGeorgia; and here [40], thank you Brighterorange Y Done --Savedthat 05:10, 17 August 2007 (UTC)

• Reference Scrutinizing has been done here [41] & [42], thank you Fvasconcellos. Y Done --Savedthat 05:13, 17 August 2007 (UTC)

• Manual of Style (dates and numbers) has been done here [43], thank you SandyGeorgia. Y Done --Savedthat 05:16, 17 August 2007 (UTC)

• WP:RS, WP:EL, WP:NOT pruning has been done here [44], thank you SandyGeorgia. Y Done --Savedthat 05:21, 17 August 2007 (UTC)

• "The lead... should ideally not contain any references" — Dr. Cash (Derek Cashman)

With respect, I don't think that this is correct. Look at Wikipedia:Lead section#Citations in the lead section. This indicates that references in this section are less important (because appropriate references should be present later in the article); "there is not, however, a citation exception specific to leads". Axl 20:34, 17 August 2007 (UTC)

The lead must conform to verifiability and other policies. In particular, material likely to be challenged and quotations should be cited in the lead. --Savedthat 21:19, 17 August 2007 (UTC)

Thanks for correcting me on that. I often think of the lead section in wikipedia as similar to a scientific abstract, which should not contain references. Wiki does take a stand similar to this, but does not explicitly prohibit references in the lead. Dr. Cash 00:01, 18 August 2007 (UTC)

• Savedthat, thank you for noting my contribution above. However, copyediting is not "done"—the article needs quite a bit of work in this area, and I've done maybe half of it so far. I am willing to continue if there are others also engaged in improving this to FA status. –Outriggr § 07:27, 18 August 2007 (UTC)

FYI, I've finished my contribution to the copyediting of this article... there is always room for improvement, but I feel it's in much better shape than it was, with the efforts of a number of us. –Outriggr § 08:53, 19 August 2007 (UTC)

• Round 2 of copy editing has been done here [45], [46], & [47] thank you Outriggr; and here [48], [49],

[50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], & [61], thank you Derek.cashman; and here [62], [63], [64], [65], [66], [67], [68], [69], & [70], thank you Fvasconcellos; and here [71], [72], & [73], thank you Casliber --Savedthat 11:50, 18 August 2007 (UTC)

• Note on Comprehensiveness - before this can pass, some work needs to be done on comprehensiveness. Rather than clog the page here I am leaving items on the talk page - they are a deal-breaker for me anyway so m vote is currently Oppose for the record but we are really nearly there (nice rhyme ain't it?) and I am close to supporting. The end is in sight.cheers, Casliber (talk · contribs) 23:03, 18 August 2007 (UTC)

• I'm close to Supporting. The article has improved a lot, particularly with regard to referencing and thanks to copy editing efforts. There are still a few minor (dashes and WP:MOSNUM) and not so minor (a few under-referenced paragraphs) obstacles, but I think this is a strong candidate. Fvasconcellos (t·c) 01:14, 19 August 2007 (UTC)

• Support. The article has come a long way, and, as Casliber says below, I think we're "over the line". Any remaining concerns of mine are minor, and don't stand in the way of an FA pass. Fvasconcellos (t·c) 03:22, 22 August 2007 (UTC)

• Weak Support: the content is impressive, but there seems to be something missing. Perhaps it is the structure of the content. I'm not greatly troubled by the quality of the prose as others are; it's really a matter of susbtance for me. Maybe it's the nature of the subject matter but the content doesn't seem to interlink between sections 100%. But all said I'm still voting support because it's very comprehensive and well-researched. Manderiko 08:38, 19 August 2007 (UTC)
  • Note The sections have since been rearranged. You may want to have another look and see whether or not it was an improvement. Fvasconcellos (t·c) 21:20, 19 August 2007 (UTC)

• Support - I think we're over the line; in terms of sources I think the best has been done from what reliable sources are available and the prose has much improved. cheers, Casliber (talk · contribs) 04:58, 20 August 2007 (UTC)

• Support - I really like the direction this article has gone over the past couple of days, it has improved a lot. While I may not be as reliable on the copyediting and manual of style perspective as far as FA status goes (I'll defer to other reviewers there), from a scientific standpoint, I think the article is very complete, well referenced, and well written. Dr. Cash 07:11, 20 August 2007 (UTC)

• Comments regarding Neutral Point of View:
  • I'm not a physician or pharmacologist, but I'll comment on what I can. I honestly don't see how this pertains to NPOV. Fvasconcellos (t·c) 01:58, 23 August 2007 (UTC)

• "Bupropion is an atypical antidepressant that acts as a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist."

If it is nicotinic antagonist it will make people smoke more to get the same effect. I read some journal article that states when Bupropion is taken in higher doses it makes people smoke more.

Actually, it is postulated that nicotinic antagonists, such as mecamylamine (and to a lesser extent bupropion), reduce the urge to smoke by preventing nicotine from doing its thing. I can't find any such article; do you mean this small study, which used acute, therapeutic doses? Fvasconcellos (t·c) 01:58, 23 August 2007 (UTC)

Yes thats the study I was referring to...It makes no sense: increasing the dose of Bupropion has an opposite effect in regards with smoking cessation? --1ws1 02:03, 23 August 2007 (UTC)

Fvasconcellos pretty much has it right. To be specific, bupropion is a competitive antagonist of the [acetylcholinergic] nicotinic receptor. What this means is that it binds at the same active site as nicotine and prevents nicotine from interacting there. So in other words, smoking cigarettes or obtaining nicotine in other ways prevents it from having any effect at its normal site, so it effectively neutralizes it. Dr. Cash 05:49, 23 August 2007 (UTC)

Bupropion is a non-competitive antagonist of nicotinic receptors. See the article. Still prevents nicotine from acting, though.Paul gene 03:48, 25 August 2007 (UTC)

• "Bupropion improved ratings of "energy", which had decreased under the influence of the SSRI; also noted were improvements of mood and motivation" & "Bupropion is more effective than SSRIs at improving symptoms of hypersomnia and fatigue in depressed patients."

I have the opposite reaction when I take Bupropion. I sleep for hours straight. Aren't there any studies that say Bupropion makes people drowsy?

Agitation is far more common than drowsiness with bupropion. In clinical studies, there was no difference in the incidence of drowsiness between bupropion and placebo. Fvasconcellos (t·c) 01:58, 23 August 2007 (UTC)

Bupropion shouldn't cause drowsiness in patients; it's properties as a dopamine reuptake inhibitor should give it an effect similar to other stimulating drugs, such as cocaine, methamphetamine, ritalin, etc. If bupropion is making you "sleep for hours straight" and makes you drowsy, I would think that you might be experiencing an interaction with another drug, or bupropion may just not work with you (drugs do have different effects on different people -- see pharmacogenomics). Anyway, it almost sounds more like you're seeking medical advice than responding to the article, so if you're still having drowsiness issues, I would suggest that you consult your physician. Dr. Cash 06:03, 23 August 2007 (UTC)

• Olanzapine (Zyprexa) a dopamine & serotonin antagonist is sometimes prescribed for bipolar depression. Now I am really confused.

If increasing the levels of dopamine & serotonin in the brain via Bupropion & Citalopram (Celexa) can cure depression, reducing the levels of dopamine & serotonin via Zyprexa can cure bipolar depression?

It's not that simple, particularly regarding the word "cure" :) Long story short, olanzapine is prescribed to treat the manic part of bipolar disorder, usually in conjunction with an antidepressant. Fvasconcellos (t·c) 01:58, 23 August 2007 (UTC)

If they take anti-depressants along with anti-psychotics the levels of the dopamine & serotonin will remain the same as before as the medicines are now contradicting themselves! --1ws1 10:08, 24 August 2007 (UTC)

• Bupropion being a dopamine reuptake inhibitor increases the level of dopamine in the brain right? So are there studies for Bupropion to treat Parkinson's disease which is caused by low levels of dopamine?

A single 1984 study found bupropion to be mildly effective in Parkinson's, though side effects limited its utility. I don't have access to the full text, so I don't know whether or not it's even worth a mention. (Good study design, relevance etc.) Fvasconcellos (t·c) 02:02, 23 August 2007 (UTC)

Very poor study, claims to be double-blind but no protocol is described. Very poorly written, almost incomprehensible. I relegated it to a footnote in the article.Paul gene 04:34, 25 August 2007 (UTC)

• Studies on the drug Modafinil (Alertec) have shown it to inhibit the reuptake of dopamine and, more potently, norepinephrine. While the co-administration of a dopamine antagonist is known to decrease the stimulant effect of amphetamine, it does not negate the wakefulness-promoting actions of modafinil.

What was my question again....I forgot... I probably have ADHD....lol--1ws1 01:08, 23 August 2007 (UTC)

I'm not sure this is relevant to the bupropion article, but I believe antipsychotics like Zyprexa are prescribed to treat the manic part of bipolar disorder. A lot of bipolar patients also take an antidepressant.

A friend of mine also reported sedation with bupropion. Can't find anything about it, but I'm not very good at searching for journal articles. --Galaxiaad 01:45, 23 August 2007 (UTC)

There are bound to be idiosyncratic reactions to any drug. I know of a person who gets very irritable and anxious from benzodiazepines.Paul gene 03:48, 25 August 2007 (UTC)

• Support - conforms to wikipedia standards. --1ws1 03:47, 24 August 2007 (UTC)

• Oppose, not there yet, not comprehensive, not necessarily neutral, although it can certainly make it with a bit more attention. Wikipedia has to take care not to be an advertisement for smoking cessation or for GlaxoSmithKline. It doesn't appear that PMID 17685748 has been factored into the article at all. Causality and comorbidy of smoking with psychiatric disorders have to be sorted out relative to claims that the medication aids in smoking cessation. Whether the bupropion is actually treating underlying psychiatric disorders (ADHD, dpression) that lead to increased smoking, and reduces smoking indirectly via treating other underlying disorders, has not been addressed here. There are also case reports of tic exacerbation in patients on bupropion, which has not been mentioned. We shouldn't downplay side effects of medications or overplay their efficacy. Better attention to wikilinking or definitions is also needed; example only—it appears that Wiki has no article defining "placebo-controlled", so things like that need to be defined for laypersons who may not understand the significance (alternately, an article on placebo-controlled studies needs to be created). Please run through again and make sure all technical terms, not familiar to a layperson, are linked or defined. SandyGeorgia (Talk) 12:45, 24 August 2007 (UTC)
  • Wow, that's a very recent study. Regarding "Whether the bupropion is actually treating underlying psychiatric disorders...", we need to be very careful not to wander into OR territory, but I don't have to tell you that :) Is PMID 8428875 a good enough analysis of tic exacerbation? It's a case series and quite dated, but seems appropriate. Perhaps someone more adept at analysing the literature (hint, hint) could help out :) Fvasconcellos (t·c) 13:04, 24 August 2007 (UTC)

The article is not an advertisement for bupropion for smoking cessation. Equal efficacy of nicotine patch is pointed out. The fact that the new medication varenicline is more effective is also noted in the article. Paul gene 04:34, 25 August 2007 (UTC)

The article is not an advertisement for GSK. Personally, I hold a very dim view of GSK, but it has nothing to do with the fascinating pharmacology of bupropion. Please give examples to correct.

PMID 17685748 is included now.Paul gene 04:34, 25 August 2007 (UTC)

Bupropion is specific for smoking cessation and does not simply treat a possible underlying depression. Results of trials of other antidepressants such as SSRIs (four trials of fluoxetine, one of sertraline and one of paroxetine), venlafaxine and moclobemide for smoking cessation were all negative. See the Cochrane Database review reference in the article.Paul gene 04:34, 25 August 2007 (UTC)

Tics have been reported only in children treated with bupropion for ADHD. Bupropion should not be used in children according to the recent FDA guidelines. And I do not believe anybody uses it in the USA. So the issue of tics is moot.Paul gene 04:34, 25 August 2007 (UTC)

I've struck my Oppose since both of the items I was concerned about have been added, but the commentary above is surprising. Perhaps I'm misunderstanding since the way you interspersed your comments is confusing, but are you really saying that 1) bupropion isn't used in the US, 2) bupropion isn't used off-label in children, and 3) tic exacerbations are moot in a med used often to treat ADHD, considering the high comorbidity between ADHD and tics? <scratching my head ... as long as the article is accurate ... but these certainly are not moot points. Wiki pharm articles have to be comprehensive, and that means common off-label uses have to be considered.> SandyGeorgia (Talk) 23:00, 26 August 2007 (UTC)

O-ops, stupid mistake. Let me re-write incorporating the answer to your objections. Tics have been reported only in children treated with bupropion for ADHD, not in adults. Bupropion should not be used in children. Since 2004, it is not simply an off-label use, it is the use of the drug in a population where it is contraindicated. While it is possible that a very small number of psychiatrists would still use bupropion in children with depression as a drug of the last resort, it is inconceivable and highly improbable that anyone would use it for ADHD in children, since bupropion’s efficacy in children with ADHD has not been demonstrated. (In the largest double-blind study conducted bupropion was not better than placebo, for the review see PMID: 9554326). Thus, bupropion for ADHD in children is in no way a common off-label use, and it is not necessary to include the tics issue in the article. By the way, do you think I should add to the article that bupropion is not efficacious for ADHD in children?Paul gene 01:28, 27 August 2007 (UTC)

I linked the article to placebo and blind clinical studies. The two latter articles contain explanations sufficient for understanding the concept of double-blind placebo study.Paul gene 04:34, 25 August 2007 (UTC)

• • • Recent, but a well-established phenomenon (something I happen to know because of the issue of self-medication with nicotine in Tourette syndrome); there probably is data to sort that out without getting into OR. If someone does the research and tells me there's no data, I'll strike, but there has been a lot of work on this concept with TS, so I strongly suspect there should be something. If the drug is actually treating underlying depression or attention deficit, it may not actually be acting as an effective smoking cessation med—did the studies showing that it helps with smoking cessation control for comorbid psychiatric disorders? Someone has to dig up the research, or convince me there is none; if they haven't controlled for other disorders, that needs to be sorted out somehow, if there's any literature. Similar on exacerbation of tics; people with TS won't touch the stuff because it has that rap. Is the exacerbation actually due to the natural waxing and waning of tics, and do controlled studies show bupropion increases tics no more than placebo (as in the case of stimulants as discussed at Treatment of Tourette syndrome? I really don't know; I don't follow bupropion studies as closely as I follow the stimulants, because people with TS avoid the stuff. ) SandyGeorgia (Talk) 13:48, 24 August 2007 (UTC)
      • Ps, on the hint hint, I would if I knew where to find these answers or if I had free full access to journal articles—I don't—and I'm up to my eyeballs trying to salvage Asperger syndrome at FAR right now. At least I can point others in the direction to look. SandyGeorgia (Talk) 13:50, 24 August 2007 (UTC)
        • I thought of another idea that might help you track this down: are there trials of smoking cessation comparing bupropion to methylphenidate or other stimulants, or SSRIs? If the bupropion is actually working to control smoking because it's addressing self-medication of underlying psychiatric disorders via nicotine, we'd expect to find success in other medications that treat those conditions and comparisons between the types of medications. I just want us to take care in presenting it as a smoking cessation med without a full investigation of other studies; if it's actually working by treating self-medication of underlying conditions like depression or attention deficit, Prozac or Ritalin is probably cheaper, and we shouldn't become an "advert" for Wellbutrin. SandyGeorgia (Talk) 14:32, 24 August 2007 (UTC)

Bupropion is specific for smoking cessation and does not simply treat a possible underlying depression. Results of trials of other antidepressants such as SSRIs (four trials of fluoxetine, one of sertraline and one of paroxetine), venlafaxine and moclobemide for smoking cessation were all negative. See the Cochrane Database review reference in the article.Paul gene 04:34, 25 August 2007 (UTC)

While I haven't been able to find evidence in the literature that suggests that the smoking cessation mechanism works by treating self-medication of underlying conditions like ADHD or depression, this paper (PMID 12044800), published in 2002, does challenge the earlier research that bupropion is a nicotinic antagonist. The findings indicate that bupropion exhibits a similar overall feeling as nicotine, but works by a different mechanism of action that doesn't involve inhibition of the nicotinic acetylcholine receptor. Dr. Cash 02:54, 25 August 2007 (UTC)

The link does not work, please provide a formal citation or PMID Thank youPaul gene 04:34, 25 August 2007 (UTC). OK. This paper does not present a problem. That study was done on rats. As pointed out in the article, "As bupropion is rapidly converted in the body into several metabolites with differing activity, its action cannot be understood without reference to its metabolism." And "There are significant interspecies differences in the metabolism of bupropion, with guinea pigs' metabolism of the drug being closest to that of humans.[74] Particular caution is needed when extrapolating the results of experiments on rats to humans since hydroxybupropion, the main metabolite of bupropion in humans, is absent in rats.[75]" In mice bupropion does antagonize the behavioral action of nicotine (ref [2] in the article). Later, the authors of the paper you quote (PMID 12044800), found that some metabolites of bupropion antagonize nicotine's action in rats acting through nicotinic receptors, and some partially substitute for it, probably acting through the NE and SER uptake inhibition (see ref 81). Also look at the receptor inhibition data in the Table 1. The bottom line is, if you see a study of bupropion in rats, disregard it - the researchers did not do their homework.Paul gene 12:32, 25 August 2007 (UTC)

Two issues are troubling me. There is a very high rate of comorbid tics in ADHD (and vica-versa as well), so the issue of tic exacerbation when bupropion is used to treat ADHD needs to be addressed. I don't have the full-text of the Spencer study Fvasconcellos mentioned; I've only seen reference to it in other journal reviews. And, the statement in PMID 17685748 that stimulant use affected smoking but bupropion didn't raises the question of what's being treated. If there's no data, there's no data, but I wanted to make sure someone looked into this (and can the new study be incorporated?). Will someone pls ping me when these are resolved so I can strike?? Thanks, SandyGeorgia (Talk) 03:01, 25 August 2007 (UTC)

PMID 17685748 is included now. Drop a note on my user page if you need more detailsPaul gene 04:41, 25 August 2007 (UTC)

• According to my experience, while taking Celexa a SSRI medication was more useful in smoking cessation. (While not taking Wellbutrin) Seriously, have the scientist done studies on this subject? --1ws1 17:53, 24 August 2007 (UTC)

Yes they did. Bupropion is specific for smoking cessation and does not simply treat a possible underlying depression. Results of trials of other antidepressants such as SSRIs (four trials of fluoxetine, one of sertraline and one of paroxetine), venlafaxine and moclobemide for smoking cessation were all negative. See the Cochrane Database review reference in the article.Paul gene 04:41, 25 August 2007 (UTC)

• Also regarding "If bupropion is making you "sleep for hours straight" and makes you drowsy, I would think that you might be experiencing an interaction with another drug, or bupropion may just not work with you (drugs do have different effects on different people -- see pharmacogenomics). Anyway, it almost sounds more like you're seeking medical advice than responding to the article, so if you're still having drowsiness issues, I would suggest that you consult your physician." Perhaps, Fvasconcellos can provide the relevant studies which show that "In clinical studies, there was no difference in the incidence of drowsiness between bupropion and placebo.", please? --1ws1 18:00, 24 August 2007 (UTC)

• One more request to Fvasconcellos, can you provide that study you were talking about regarding Wellbutrin & Parkinson's disease, please? --1ws1 18:03, 24 August 2007 (UTC)

There's a couple of studies regarding bupropion and Parkinson's Disease, most of which are exploring its use to treat depression related to PD, not actual PD itself. This study however, found that it was mildly efficacious in treating PD, due to its dopaminergic agonist (actually, dopamine reuptake inhibitor) properties, but there were significant side effects in treating PD with bupropion. Here is a listing of other scientific publications relating to bupropion and PD, most of which are studies on treating depression related to PD instead of the PD itself. Dr. Cash 18:58, 24 August 2007 (UTC)

Thanks, Derek. Regarding drowsiness, the prescribing information summarizes this in the Adverse effects section. It's linked to from the article, or you can just go here. Again, this issue is best discussed with your physician. Fvasconcellos (t·c) 19:16, 24 August 2007 (UTC)

• Good job Derek in adding the PD section. Fvasconcellos from your link it says that Somnolence was reported in 2% people taking 300mg/day, 3% taking 400mg/day & placebo 2%. So what can be inferred from that? --1ws1 02:00, 25 August 2007 (UTC)

Nothing. The difference is by chance.Paul gene 12:32, 25 August 2007 (UTC)

Yep, that's basically it. Fvasconcellos (t·c) 14:29, 25 August 2007 (UTC)

• Also are there any scientific studies done to explain Why Increasing the dose of Bupropion Has an Opposite Effect in regards with smoking cessation? --1ws1 02:02, 25 August 2007 (UTC)

I've been looking for this at google scholar and pubmed. So far, I haven't found any scientific evidence that supports this assertion. Dr. Cash 02:55, 25 August 2007 (UTC)

• Support - Am I allowed to delete comments made before 20th August because all issues have been addressed right? Looking forward to seeing this article on the main page, so more scientific studies are done on solving treatment resistant depression. I have tried all the anti-depressants prescribed by my psychiatrist, nothing worked, 6 months per anti-depressant. My only alternative choice is Electric Shock Therapy, which I am scared of. I had rather suicide than let them put electricity in my bran. Do scientists read Wikipedia? --9urges 15:51, 27 August 2007 (UTC)

The above discussion is preserved as an archive. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

Removing the Overdose section

I am removing the overdose section. I have two reasons for that.

1.It is lifted almost verbatim from the prescribing info against the WP guidelines . 2.The detailed directions on how to treat the overdose are against the WP guidelines. They are also useless, since the first thing anyone would do in such a situation is to call the emergency.Paul gene 02:01, 23 August 2007 (UTC)

Sorry Paul, but I don't think these are directions; I would expect information in a drug article as to the existence or not of an antidote, necessary measures, whether dialysis is of value etc. I can't see how they could be construed as medical advice; "Leave the OG kit in the garage, dear—better call the paramedics"? :D I also happen to think information on the rarity of death as a result of overdose is an interesting factoid, but that's my take. I won't argue on the prescribing information bit; you have a point, although I'm not clear on the copyright status of PIs. Fvasconcellos (t·c) 02:12, 23 August 2007 (UTC)

I completely agree with Fvasconcellos. --WS 17:43, 23 August 2007 (UTC)

I agree with Fvasconcellos & Wouterstomp. There are no problems with the section, and it has been re-added to the article. Dr. Cash 18:12, 23 August 2007 (UTC)

The matter is not the copyright. Wikipedia:Manual of Style (medicine-related articles) specifically discourages cloning of RxList: "Try to avoid cloning drug formularies such as the BNF and online resources like RxList and Drugs.com."

Please compare the following.

RxList bupropion article: "Overdoses of up to 30 g or more of bupropion have been reported. Seizure was reported in approximately one third of all cases." Overdose section: "GlaxoSmithKline has reported that overdoses of 30 g or more of bupropion resulted in seizure in about one-third of cases."

RxList: Other serious reactions reported with overdoses of bupropion alone included hallucinations, loss of consciousness, sinus tachycardia, and ECG changes such as conduction disturbances or arrhythmias. Overdose section: Hallucinations, loss of consciousness, sinus tachycardia, and ECG changes such as conduction disturbance or arrhythmia were also reported as consequences of overdose.

RxList: Fever, muscle rigidity, rhabdomyolysis, hypotension, stupor, coma, and respiratory failure have been reported mainly when bupropion was part of multiple drug overdoses. Overdose section: Multi-drug overdoses that included bupropion resulted in fever, rhabdomyolysis, stupor, hypotension, coma, muscle rigidity, and respiratory failure.

RxList: No specific antidotes for bupropion are known. Overdose section: There is no specific antidote for bupropion

What is it if not cloning?Paul gene 02:22, 24 August 2007 (UTC)

Is the following a medical advice? "treatment is supportive, and focuses on maintaining airway patency and controlling seizures (usually with intravenous benzodiazepines). The manufacturer recommends gastric decontamination through use of activated charcoal and gastric lavage soon after ingestion, and electroencephalographic monitoring for 48 hours subsequently"

It is not directly applicable to the current situation but here is how Wikipedia:Reference desk/guidelines/Medical advice defines medical advice: A treatment is any type or form of medication (Conventional or Alternative) intended to alleviate the presented symptoms or cure the disease as diagnosed. For example, Y says "try chocolate cake; it works like magic with Alzheimer's".

So the Overdose section says: "Try benzodiazepines, activated charcoal and gastric lavage; it works like magic with bupropion overdosage"Paul gene 02:36, 24 August 2007 (UTC)

Erm, no. We are noting standard procedure and backing it up with a reliable reference. If we mention, say, in the myocardial infarction article:

”Aspirin should be given at the first signs of a heart attack.”,

that is inappropriate, prescriptive, and medical advice. If we say, however:

”Aspirin has an antiplatelet effect which inhibits formation of further blood clots that clog arteries. According to the American College of Cardiology and the American Heart Association, 911 dispatchers may advise people suffering heart attack symptoms to take 160–325 mg of aspirin, preferably a non–enteric-coated formulation and as long as they are not allergic to it, while they await the arrival of EMS.[74]”

that’s not medical advice. We are reporting the generally accepted recommendation of a relevant “authority”, and supporting it with a reference. That’s encyclopedic. Fvasconcellos (t·c) 11:47, 24 August 2007 (UTC)

Wickipedia Manual of Style discourages vague statements: "Vague: The wallaby is small. Precise: The average male wallaby is 1.6 metres (63 in) from head to tail."

The last sentence in the Overdose section is an excellent example of a vague statement: "Bupropion overdose rarely results in death, although cases have been reported, typically associated with massive overdosage." It contains zero information since it is applicable to most of the drugs. For example: "Zoloft overdose rarely results in death, although cases have been reported, typically associated with massive overdosage. Benzodiazepine overdose rarely results in death, although cases have been reported, typically associated with massive overdosage. Sodium chloride overdose rarely results in death, although cases have been reported, typically associated with massive overdosage."

The overdose section as it is has no place in the article. I rest my case.Paul gene 02:53, 24 August 2007 (UTC)

I can certainly live with that; I would, however, like this article to be as comprehensive as possible. What do you think could be done to improve this section? Fvasconcellos (t·c) 11:47, 24 August 2007 (UTC)

It needs to stay and if anything needs to be expanded relying less on the manufacturer’s information and more on the medical literature. As it stands now it looks 2/3 of people taking 30 g or more of bupropion will be fine when in overdose this drug is quite toxic. Bupropion has been known to cause seizures in high therapeutic doses and in acute overdoses. For example a 16 year old ingested 1.5 g and developed seizures and cardiotoxicity.[75] There are retrospective case series with good information on dose effect relationships[76][77] which could be used in the article. Additionally nobody uses gastric lavage anymore especially in someone about to have a seizure. - Mr Bungle | talk 23:36, 24 August 2007 (UTC)

In my opinion, it is a sore of plagiarism on the body of the article. There would not be much left if I remove the plagiarism. In my opinion this section is unimportant (proportional to its low probability and benign prognosis), and the overdose could be covered by a couple of lines in the adverse effects section. If you feel that the section needs to be rewritten and expanded please do so; I would gladly go along with you. However, the current situation with keeping it as is in the article aspiring to be featured is intolerable.Paul gene 02:06, 27 August 2007 (UTC)

Remove tics in children with ADHD add not efficacious for children with ADHD

I suggest removing the paragraph about bupropion possibly causing the tics in children with ADHD and Tourette's and adding the ref that bupropion is not efficacious for ADHD. The paragraph in question contains information which pertains to the cases which are very unlikely to happen for the following reasons:

Tics have been reported only in children treated with bupropion for ADHD, not in adults. Bupropion should not be used in children. Since 2004, it is not simply an off-label use, it is the use of the drug in a population where it is contraindicated. While it is possible that a very small number of psychiatrists would still use bupropion in children with depression as a drug of the last resort, it is inconceivable and highly improbable that anyone would use it for ADHD in children, since bupropion’s efficacy in children with ADHD has not been demonstrated. (In the largest double-blind study conducted bupropion was not better than placebo, for the review see PMID: 9554326). Thus, bupropion for ADHD in children is in no way a common off-label use, and the issue of tics in children is moot, and just takes room and distracts the reader.Paul gene 01:50, 27 August 2007 (UTC)

The cited article (2007, not the 1993 case series) claims that bupropion is a third-line agent in the treatment of ADHD, and (perhaps in Europe) should not be ruled out as therapy for ADHD in children when other approaches have failed. Maybe outside the U.S. this is indeed simply off-label use? Should it be included in some other article? Fvasconcellos (t·c) 02:05, 27 August 2007 (UTC)

Do you mean - Poncin Y, Sukhodolsky DG, McGuire J, Scahill L (2007). "Drug and non-drug treatments of children with ADHD and tic disorders"? No, those guys are Americans; did not you notice that, at least judging by the slow approvals of bupropion, Europeans are much more skeptical about it. The fact that bupropion makes teenagers with ADHD to take on smoking makes its use in them even more inconceivable. Can you imagine a child psychiatrist, who knows all of the above, in his right mind prescribing something clearly contraindicated for a disorder that is not critical for the health and wellbeing? Think lost malpractice lawsuit if the patient starts smoking. My guess would be that the authors used some older pre-2004 review or guidelines. Are you sure that the paper said third-line treatment for ADHD in children? Because in adults with ADHD bupropion is legit. Unfortunately, I have access to that journal with the 12-month delay. Do you care to drop an extended citation on my user page? When you ask, Should it be included in some other article? - do you mean the paragraph about bupropion possibly causing the tics in children with ADHD and Tourette's? Maybe to Tourette's... But will moving it make it more relevant? It will still be informational junk.Paul gene 02:44, 27 August 2007 (UTC)

FVasconcellos gave me the quote from the above reference: "In the absence of placebo-controlled data to confirm the attribution of tics to bupropion exposure, the use of bupropion with appropriate monitoring in children with ADHD and tics deserves consideration if other approaches have not been successful." So it looks like I was wrong - psychiatrists are willing to consider bupropion as the drug of last resort for the ADHD in children.Paul gene 00:33, 30 August 2007 (UTC)

Wellbutrin XL is available in the US as a generic formulation

Wellbutrin XL is available in the US as a generic formulation, for example, as Buproprion XL. See any pharmacy store, or drugstore.com onlinePaul gene 00:43, 30 August 2007 (UTC)

Nice catch. Fvasconcellos (t·c) 00:44, 30 August 2007 (UTC)

Metabolites image errors

In Image:Metabolites of bupropion.png in the Pharmacokinetics section, the first two compounds (identified as stereoisomers of hydroxybupropion) look wrong. Each has two absolute-configuration labels, but the structures each only have one apparent stereocenter. The "H" wedge/dot substituent is one of two of two "H" on that carbon, so that carbon isn't stereogenic. Should those be methyl groups instead? While that diagram is being fixed, the pedant in me notes that the "R" and "S" stereo-labels should be italicized, and the fourth compound (erythro) needs an optical-rotation designation. DMacks 05:20, 17 September 2007 (UTC)

Ouch! Dangers of copyediting... Thanks for noticing. I fixed it. In the literature I have, there is no optical rotation sign for the R,S-hydrobupropion. Perhaps, you, being a chemist, could check it in SciFinder? Paul gene 10:57, 17 September 2007 (UTC)

I looked further, and while some optical-rotation values are available, I'm not sure it's useful info given that the starting material is racemic. All four stereoisomers of hydrobupropion are known to be formed (Cooper BR, Wang CM, Cox RF, Norton R, Shea V, Ferris RM (1994). "Evidence that the acute behavioral and electrophysiological effects of bupropion (Welbutrin) are mediated by a noradrenergic mechanism". Neuropsychopharmacology 11: 133–141.  which cites M. Imad Damaj, F. Ivy Carroll, J. Brek Eaton, Hernan A. Navarro, Bruce E. Blough, Sadiq Mirza, Ronald J. Lukas, and Billy R. Martin. (2004). "Enantioselective Effects of Hydroxy Metabolites of Bupropion on Behavior and on Function of Monoamine Transporters and Nicotinic Receptors". Mol Pharmacol 66: 675–682. ) DMacks 18:15, 17 September 2007 (UTC) (got the "which one cited which one" backwards -- DMacks)

I have those. One of them says that 1R,2R and 1R,2S hydrobupropions form predominantly, that is why they are drawn. Although the starting material (bupropion) IS racemic, the reductases may be stereoselective. Indeed, this is one of the explanations for the predominance of these two enantiomers. Another evidence in favor of stereoselectivity of reductases is that one of the enantiomers of bupropion is consumed faster in vivo. That creates some kind of dynamic equilibrium between bupropion enantiomers since they slowly interconvert in vivo. Paul gene 10:57, 18 September 2007 (UTC)

Yeah, makes sense. I'm having a heck of a time finding rotation data (no SciFinder or Beilstein Crossfire here, and not a full complement of specialty biochem journals:( From abstracts, maybe in:

• doi:10.1002/chir.20356
• 10.1002/(SICI)1099-0801(199705)11:3<174::AID-BMC681>3.0.CO;2-E (have to cut'n'paste that one...breaks the Template:DOI (edit|talk|history|links|watch|logs) template)

Oh well, anyone really needing these values would need to pull the primary sources anyway. DMacks 02:20, 21 September 2007 (UTC)

Request

"In contrast to many psychiatric drugs, bupropion does not cause weight gain or sexual dysfunction." Sloppy and wrong. "Psychiatric drugs"? What this person means is "mood stabilizers and anti-depressants." Second, "does not cause"? Ridiculous and wrong. Wellbutrin is not COMMONLY ASSOCIATED with weight gain, and is not COMMONLY ASSOCIATED with certain types of sexual dysfunction, i.e. decreased libido, impotence, anhedonia. If the difference between "commonly associated" and "does not cause" is unclear to you, you shouldn't be editing an article that involves summarization of data from clinical trials. 02:19, 5 November 2007 128.84.159.160 (Talk) (27,326 bytes)

Sloppy and wrong. The newer questions should be placed at the bottom of the page, so I had to move this question from the top. 128.84.159.160 should have read the template header to this page, which says [[Wikipedia:Signatures|Please sign and date your posts by typing four tildes and Put new text under old text. It also would not hurt to Be polite.

Now to the questions.

• "Psychiatric drugs"? What this person means is "mood stabilizers and anti-depressants." No, what I mean is "many psychiatric drugs" that is many antidepressants, mood stabilizers and anti-seizure medications as well as most of antipsychotics, anxiolytics and hypnotics. And of course the psychostimulants are excluded.

• Second, what should be used in this case NOT COMMONLY ASSOCIATED or DOES NOT CAUSE? The difference is quite clear but, since bupropion is actually used to counteract weight gain and sexual dysfunction, one can quite safely reject such causality. Paul gene 12:27, 5 November 2007 (UTC)

Mainpage article

Why doesn't the article summary on the main page make any reference to the trade name Wellbutrin? People would be much more likely to read the article if it was clear that bupropion was the chemical name of Wellbutrin. Fuzzform (talk) 01:02, 21 December 2007 (UTC)

The problem with such a suggestion is that it appears the name Wellbutrin is not universal with different names such as Zyban being used by GSK in different countries. Furthermore it appears that bupropion has been out long enough that patent protection is no longer available and there are therefore numerous generics. Also, unlike say for example prozac where the drug became so popular that it is generally recognised under its tradename and not that of any of its generics it's not clear this is the case for bupropion. We will at the very least have to give the names "Wellbutrin, Zyban, Buproprion and Buproban" as in the article but even that may not be enough IMHO. Nil Einne (talk) 04:39, 21 December 2007 (UTC)

I asked on the Wikipedia:Main Page/Errors to put the two most widely known (Wellbutrin, Zyban) tradenames back into the summary. Please support me. Paul gene (talk) 11:17, 21 December 2007 (UTC)

nsri and ssri addiction

A heading should be added to the main page with regard to what is refered to as "discontinuation symptoms" which is a phrase used by the unscrupulous prescribers to avoid the implication of the addictive potential of these drugs. These drugs are highly addictive with sever withdrawal symptoms and the general public is not aware this until they choose to discontinue the drug. —Preceding unsigned comment added by 97.88.205.124 (talk) 17:57, 21 December 2007 (UTC)

• "addictive" and "addiction" are technical terms that have specific meaning. Anti-deppressants do not meet the conditions for the classic model of addiction. Due weight needs to be paid to the important tpoic of "discontinuation effects" - many people suffer them and are very vocal about the effect, but how many people don't suffer (or only suffer a bit) from discontinuation effects? Dan Beale-Cocks 20:26, 21 December 2007 (UTC)

• Agreed! Further, bupropion isn't even an SSRI or SNRI, it has no impact on serotonin at all. It's a DNRI. There have been neither clinical nor widespread anecdotal claims made about bupropion discontinuation. Grouping it with the Effexor's and Paxil's of the world is just plain wrong! —Preceding unsigned comment added by 24.252.247.93 (talk) 19:02, 15 February 2008 (UTC)

• About bupropion not being a serotonergic agent.. That's what I though, until I ran into this: "Modification of norepinephrine and serotonin, but not dopamine, neuron firing by sustained bupropion treatment." Dong, Blier. 2001 Phychopharm. (Berlin) 155(1): 52-7:

(from article text Discussion section): "sustained administration of bupropion, via osmotic minipumps implanted SC, produced an attenuation of the mean spontaneous firing rate of NE neurons that was dose-dependent. At the highest regimen, that of 5-HT neurons was 100% higher than in controls and, unexpectedly, bupropion did not alter the firing rate of DA neurons."

This being said, bupropion's effects on 5-HT are indirect through up-regulation of NE (I think). Moreover, "horrible withdrawal symptoms" probably vary quite a bit from patient to patient. I have been stable on bupropion and low-dose lorazepam for years without any tolerance or withdrawal symptoms (except for ONE time with the lorazepam). Very recently, I switched to oxytocin therapy, and almost completely stopped the bupropion therapy (I take about 37-75 mg IR form every two weeks as needed), and reduced the lorazepam usage from 3 mg/d to 1-2. Oxytocin is a natural neurohormone, and so it's action may be closer to correcting whatever "chemical imbalance" is at the *root* of depression, and I think don't think "addiction to bupropion" and "addiction to oxytocin" can quite be compared (how exactly do you define "addiction" to a chemical your body makes naturally? Especially one such as OT, whose level is not dynamic based on activity and social situation?) The fact that my usage of bupropion basically stopped entirely, with NO taper (perceived) "need" period whatsoever seems to work against the "horrible withdrawal symptoms" - at least as a blanket statement to be applied to everyone. People (especially doctors) need to remember that we don't know how these chemicals *really* work - we know what their primary effects on neurons are, but we have little if any understanding of the secondary, tertiary, or later effects, and to my knowledge have no real idea why depression develops in the first place, and why the brain maintains it. One size does NOT fit all with many many drugs, and neuro-active certainly are in that category. —Preceding unsigned comment added by 216.9.143.129 (talk) 19:58, 21 June 2008 (UTC)

Pill Coating in Adverse Effects section

At the end of the first paragraph of Adverse Effects it currently reads "The development of mild to moderate skin rashes is associated with sensitivity to dye components within the pill coating. This can often be alleviated simply by prescribing a differently colored pill.[52]". The current (August 2007) version of the Prescribing Information document that the #52 reference points to does not mention this coating alternative. Can anyone provide another reference supporting this statement? Thank you. 2old (talk) 23:03, 9 January 2008 (UTC)

smoking cessation

I just have a little question, if bupropion is used as a smoking cessation aid because it produces the same effects or provides the same feeling as nicotine, stimulates the same receptors - gives the same hit - would that not make it highly addictive? I'm looking at my options for quitting smoking and have found the article and the discussion group very helpful. ~ 20th February 2008 —Preceding unsigned comment added by 146.171.254.66 (talk) 22:16, 19 February 2008 (UTC)

Read the article: bupropion is less addictive than caffeine and shown the same efficacy as nicotine patch and lower efficacy than varenicline. Paul Gene (talk) 11:35, 20 February 2008 (UTC)

The pill does help. The challenge is breaking habits, such as smoking while driving, after meals, on the phone, etc... You don't get addicted to it like nicotine, but when you're on it you just stop thinking about nicotine. —Preceding unsigned comment added by 24.150.147.192 (talk) 05:39, 12 April 2009 (UTC)

So Called "Nicotine Replacement Therapy" is anything but. WhyQuit.com points out serious flaws in studies claiming the NRT can 2x chances of quiting vs, cessation alone, and cite studies suggesting cessation is most effective way to quit. The main article stated that Buproprion was similar in effectiveness to helping people quit 'like NRT.' I deleted the comparison to NRT b/c no source was cited studying the relative effectiveness of both approaches, AND i've presented countervailing evidence to the effectiveness of NRT (see WhyQuit.com). And through some personal experience every NRT i've tried (gum, patch) simply drags out withdrawal and creates a prolonged period of anxiety. Making successful completion rather difficult. With cessation alone, most symptoms of anxiety and cravings peak after only 3-5 days. (see WhyQuit.com) NRT therapies run for months. —Preceding unsigned comment added by 69.122.77.243 (talk) 23:40, 11 September 2010 (UTC)

Sexual functioning in men

Re the claim that "Bupropion does not affect any measures of sexual functioning in healthy men":

"In the men, significant improvements over baseline (p < .01) were observed with both doses in overall sexual satisfaction, ability to achieve an erection, and delay in reaching orgasm/ejaculation; significant improvements relative to placebo (p < .05) were observed in overall sexual satisfaction on both doses, ability to achieve erection on 150 mg/day, and delay in orgasm/ejaculation on 150 mg/day. Seventy percent of subjects reported improvement in libido, arousal, or orgasmic function during bupropion administration"

Source: Effect of bupropion-SR on orgasmic dysfunction in nondepressed subjects: a pilot study. Modell JG, May RS, Katholi CR. Department of Psychiatry, University of Alabama at Birmingham, USA. jgmodell@uab.edu http://www.ncbi.nlm.nih.gov/pubmed/10929571

If you believe the Salon.com account at http://archive.salon.com/sex/feature/2000/09/26/wellbutrin/print.html there is an interesting story behind the lack of publicity concerning the sexual side effects of Bupropion.

66.217.83.176 (talk) 04:04, 15 September 2008 (UTC)

The example you have given pertains to "men with orgasmic dysfunction" not healthy men. The statement in the article :"Bupropion does not affect any measures of sexual functioning in healthy men" Paul Gene (talk) 01:30, 17 September 2008 (UTC)

Every other part of the section talks about sexual dysfunction, and suddenly, right after a passage about sexual dysfunction in women, a statement out of the blue about healthy men is tacked on, giving the distinct impression that it is to be contrasted with the previous material about women. That's misleading, even if factually true. 66.217.82.160 (talk) 17:20, 1 October 2008 (UTC)

Nightmares

I went on Zyban last year to stop smoking. Before I went on it people had told me I might get nightmares (including my doctor). I shrugged it off and did not think anything of it. When I went on the drug I did experience some pretty messed up dreams. After talking to others who have taken the drug, it seems that everyone on it experiences crazy nightmares. This aspect should be included in the side-effects section. —Preceding unsigned comment added by 24.150.147.192 (talk) 05:46, 12 April 2009 (UTC)

I have used every available quit smoking aid on the market. I acieved ultimate success with Zyban. I had regular nightmares with each and every quitting aid, as well as with quitting cold turkey. — Preceding unsigned comment added by 209.77.204.244 (talk) 23:33, 2 September 2011 (UTC)

TNF-alpha inhibition

The article should not mention bupropion as TNF-alpha inhibitor for the following reasons:

• Bupropion is not a TNF inhibitor. In order to be classed as a TNF-alpha inhibitor the compound should bind to and inhibit TNF-alpha receptors. Bupropion does not do that according to the provided reference (PMID 16644475). It decreased TNF synthesis via stimulation of the adrenaline and dopamine pathways.

• The study findings are not relevant to humans. The provided reference is a study in mice. There have been no studies of TNF-related or anti-inflammatory activity of bupropion in humans. Since metabolism of bupropion in humans and mice is very different, the relevance of these findings is questionable.

• Not notable. There are more than 2000 scientific papers on bupropion in PubMed. This single unconfirmed animal study is simply not notable enough to be included.

The Sceptical Chymist (talk) 11:31, 10 May 2009 (UTC)

One more example of the problems caused by not following WP:MEDRS. This article has probably 10 times as many sources as it ought to, because it relies on primary reports rather than review papers. Once you start admitting primary sources, it's very difficult to draw a line. Looie496 (talk) 16:04, 10 May 2009 (UTC)

this isn't a case if a single unconfirmed animal study.Did you even do a google search? There are many articles, on TNF and Buproprion. I used this reference, because it was the one used in the article TNF inhibitor. Here are just a few of the others, you can find many more: [78], [79],[80],[81],[82] ... MistyWillows ^talk 17:42, 10 May 2009 (UTC)

RE: Looie496. Who cares about WP:MEDRS. The policy WP:NOR overrules WP:MEDRS, which is a mere guideline. The policy WP:NOR allows primary sources for descriptive claims. The Sceptical Chymist (talk) 21:53, 10 May 2009 (UTC)

RE: Misty Willows. I apologize. Bupropion, indeed, have been used in humans with autoinflammatory diseases. Please go ahead and insert your references. However, although bupropion decreases the level of TNF alpha, it is not TNF-alpha inhibitor. And none of the articles you quoted says so. The Sceptical Chymist (talk) 21:53, 10 May 2009 (UTC)

The article TNF inhibitor lists bupropion, and it was added there by a doctor. ... MistyWillows ^talk 23:51, 17 May 2009 (UTC)

New Link

Hi I'm not up to speed on making changes to these pages, but maybe someone else can. I found another page that should be linked to from this page. It is

http://en.wikipedia.org/wiki/Buproprion

Thanks

Marty —Preceding unsigned comment added by 76.21.91.99 (talk) 03:12, 20 June 2009 (UTC)

Y Done. Fvasconcellos (t·c) 23:34, 26 June 2009 (UTC)

Rating templates?

Okay, this I don't get...Casliber (talk · contribs) 11:22, 26 June 2009 (UTC)

WP:CHEM no longer accept FA-Class as part of their assessment schems, which now appears to be focused on the actual chemistry part of articles (e.g. a drug article may be FA, but if it doesn't go into much detail on chemistry, it will be B- or C-Class, etc.). Fvasconcellos (t·c) 23:51, 26 June 2009 (UTC)

Risk of suicide and other adverse affects

I don't have time to update Bupropion#Risk of suicide and/or the Adverse effects section just below this but this came out that looks relevant to the article:

• http://www.cnn.com/2009/HEALTH/07/01/fda.anti.smoking.drugs/index.html
• http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm170100.htm - FDA: Boxed Warning on Serious Mental Health Events to be Required for Chantix and Zyban
• http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm169988.htm Public Health Advisory: FDA Requires New Boxed Warnings for the Smoking Cessation Drugs Chantix and Zyban
• http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm169986.htm Information for Healthcare Professionals: Varenicline (marketed as Chantix) and Bupropion (marketed as Zyban, Wellbutrin, and generics) --Marc Kupper|talk 08:49, 2 July 2009 (UTC)

When I checked Varenicline I found someone had already added a note about the FDA requirements and so I massaged that into a version for this article. --Marc Kupper|talk 08:58, 2 July 2009 (UTC)

It is not clear what the practical consequences of the FDA warning in regards to bupropion are. Bupropion and all of its formulations already carry the boxed warning (new FDA preferred term instead of black-box warning) about suicidality.

Interestingly, the number of suicides for the 10 years of marketing of bupropion for smoking cessation equals the number of suicides for one year of varenicline marketing. The comparison of these two medications is biased without mentioning that. Cohrane Review already addressed the question of suicidality with bupropion for smoking cessation; it did not come to any conclusion, and this fact is already mentioned in the article.

Remarkably, nicotine preparations did not raise the risk of suicidality, and in that light they look like the best option. I would wait until the FDA-approved new label for Zyban will be posted on their website before making any major additions to the article. I'll also ask them about their logic for including bupropion into the warnings, if I have a chance. The Sceptical Chymist (talk) 14:36, 3 July 2009 (UTC)

Structural diagram vs. Image

Am I crazy, or is the chlorine atom in the structural diagram in a different position on the phenyl group than it is in the 3-d picture right below it? 67.176.82.104 (talk) 18:51, 30 July 2009 (UTC)

The two diagrams are the same structure, but of different conformations. The ring is a regular hexagon that can rotate as a unit relative to the carbonyl. In both structures, the chlorine is attached ortho ("2 positions away", with one hydrogen position between them) relative to where the carbonyl is attached. DMacks (talk) 20:14, 30 July 2009 (UTC)

The two diagrams represent the same structure, at least as far as the phenyl ring is concerned. The 3-D representation can only show one enantiomer (the one shown is the (S)-enantiomer), whereas the line diagram represents a mixture of the two. DMacks, I know you know better, the chlorine is attached meta to the carbonyl ("2 positions away", with one hydrogen position between them) in both cases! Physchim62 (talk) 20:55, 30 July 2009 (UTC)

Well crap, that's what I get for responding before coffee kicks in. *blush*:( DMacks (talk) 21:06, 30 July 2009 (UTC) A quick check of literature finds that the ortho-chloro isomer is scarily harder to make too. DMacks (talk) 21:14, 30 July 2009 (UTC)

Yeah, the chlorine is still meta relative to the carbonyl. My issue with the new structural diagram is it's colored. Why is that? Seemed like someone had too much time on their hands and edited the previous bupropion structure (which I might add, had the chlorine in the other meta position, consistent with the 3D graphic)from a fine black and white representation to some artsy crap. I personally think it should be reverted back to its prior version so that it's #1 consistent with the 3D graphic (to avoid confusion such as the original poster pointed out) and #2 consistent with all other structural diagrams on pharmaceutical and chemical structures. --Novaprospekt (talk) 21:59, 14 August 2009 (UTC)

No weight gain/sex dysfunction claim

The last sentence of the opening section that says "In contrast to many psychiatric drugs, including nearly all antidepressants, bupropion does not cause weight gain or sexual dysfunction."-- shouldn't this require a source? I take bupropion and it certainly has made me LOSE weight and actually made me enjoy sex more (in great contrast to the SSRI's I used to be on-- yuck) but this seems like a big claim that should have a source to back it up. What do you guys think? --Novaprospekt (talk) 03:58, 7 August 2009 (UTC)

REQUEST for review of Bibliography of inventor of Bupropion

I would like to include an article in Bupropion, that gives the bibliography of Nariman Mehta, the inventor of Bupropion. I made a clumsy effort trying to insert a link to his website earlier. I am now attempting to follow the guidelines that have been presented to me. A corrected article is located at user:beach4444/sandbox or the

website, [[83]].

Beach4444 (talk) 04:56, 3 September 2009 (UTC) Beach4444 (talk) 14:20, 3 September 2009 (UTC)

OCD

Nothing is said about OCD in this article, but these findings seem to be of importance. 78.48.108.115 (talk) 14:09, 26 October 2009 (UTC)

What is important about it? An open-label trial on 12 patients showed that bupropion is not effective for OCD... Big deal... The Sceptical Chymist (talk) 10:01, 27 October 2009 (UTC)

what is right?

(1) It acts as a strong norepinephrine and weak dopamine reuptake inhibitor (2) It is about twice as potent an inhibitor of dopamine reuptake than of norepinephrine reuptake

both can not be true —Preceding unsigned comment added by 78.42.4.217 (talk) 16:07, 10 January 2010 (UTC)

Discontinuation syndrome

The percentages are relatively low for this drug, but it should be touched upon.71.134.42.129 (talk) 18:45, 3 March 2010 (UTC)

Sex

I'm surprised that nobody has yet discovered that Bupropion is indeed a strong aphrodisiac. It certainly was for me. The Salon article from 2000 was written a long time ago, but now that Bupropion has been marketed for smoking cessation under the name Zyban, surely many healthy men without depression or sexual dysfunction have had plenty of experience with it and discovered, as I did, a tremendous boost in libido, as well as increased sensitivity in the genitals and stronger erections. My interest in sex was probably lower than most men's, but on Zyban, I soon started masturbating frequently and without experiencing "refractory" periods after orgasms. My penis actually grew and developed an area of hypersensitivity and turgor on the right side, which caused it to bend towards the left. That area became engorged, red, and sensitive when I got an erection, as if it were inflamed, that is, as if it were affected by inflammation. I noticed that my penis was larger even without an erection. Now that I've been off it for a long time, everything has gone back to the way it was before, except that (1) I'm a decade older and (2) I've lost my libido completely. That brings me to another subject, the terminology of "dysfunction", "anhedonia", "sexual problem", etc. Implied in all these discussions is the notion that people who aren't interested in sex at all have problems, and those who are driven to sexual activity are well. That's absurd. It's those with strong sex drives who have problems, and (at least among unmarried people) those who aren't the least bit interested in sex who have no sex problems. The idea that life is unpleasant without sex is simply baseless, and should be rejected as nonsense. Unfree (talk) 03:09, 5 March 2010 (UTC)

Used to treat anxiety??

In the opening paragraph of this article, it states "Bupropion (Wellbutrin, Zyban), previously known as amfebutamone,[1] is an atypical antidepressant and smoking cessation aid. It is also used to treat anxiety."

I'm pretty sure it is -not- used to treat anxiety, in fact I believe it exacerbates any pre-existing anxiety. Not only do I know this from personal experience taking the drug for 2 years now, but its mechanism of action involving norepinephrine, like other amphetamine-like drugs, can cause increased anxiety and is a hallmark side effect of stimulant medications. Bupropion is used to treat major depressive disorder but I've never seen it advertised to treat anxiety as well. There's no source corroborating this claim either so I think it should be removed unless I am wrong here. In the meantime, I added the fact tag to the initial claim, and when I looked further through the article it seems like somebody else fact-tagged another claim about its supposed usage in treating anxiety. -Novaprospekt (talk) 23:39, 29 May 2010 (UTC)

Adding Bupropion molecule structure image

I have added Bupropion molecule structure image as I think it clarifies the structure of this chemical element, 

but now the page is too heavy..or may be it's OK? (3DRivers (talk) 10:50, 10 June 2010 (UTC))

Half-Life

Seems the half life is listed as three different numbers in three different parts of this article. Creates some confusion... and casts doubt on the validity of this page since they are presented as "facts" in each case - not mentioning that there must be some controversy over the subject... —Preceding unsigned comment added by SundayDrinker (talk • contribs) 16:41, 25 November 2010 (UTC)

Bupropion Toxicokinetics

Hi I'm new to all this and am a bit computer illiterate. I saw a case report which has some interesting points about bupropion in over dose:

Clin Toxicol (Phila). 2010 May;48(4):385-7.

Bupropion toxicokinetic: a case report. Donnelly K, Walkowiak HB, Donnelly C, Jenkinson E, Rizkalla J, Langford N.

Abstract CONTEXT: The toxicokinetics of sustained-release bupropion are not well described.

CASE: A 23-year-old Caucasian male took an overdose of 5,700 mg of sustained release bupropion with no co-ingestant. Venous serum samples were assayed for bupropion concentrations over the next 5 days. The peak concentration was 1.114 mg/L. The observed T(max) was found to be 8.25 h, the calculated alpha half-life 10.9 h (+/-SE of 4.47%), and the calculated beta half-life 19.8 h (+/-SE 12.62%). The alpha half-life and T(max) differ significantly from those seen in therapeutic doses.

DISCUSSION: Bezoar formation may underlie these differences. Interventions which reduce the absorption of sustained release bupropion may be effective in overdose.

Interesting that overdose changes the kinetics. Could this go in either the overdose or kinetics section?

http://www.ncbi.nlm.nih.gov/pubmed/20230334

Cheers 194.176.105.41 (talk) 21:10, 14 January 2011 (UTC)Kyrone

Chem infobox references

Dear co-Wikis, The chem infobox is really great and actually has become a tool I use regularly. Thanks a lot for setting it up!

It would be great though if references where supplied alongside the values reported. When the data is inserted it should only cost a couple more seconds, later it's not easy at all... Dont know how that would work technically though as they seem to be a different 'thing' than the rest of the page. I was trying to reach where the protein binding information was stored, but couldnt find it. If a database is used (DrugBank, Chembl or ?) it would be great to have that specified.

Thanks again and hope a nice/practical solution can be found. ./Claus

Posted: 213.243.199.58 (talk) 11:10, 12 July 2011 (UTC)

update link to reference number 160

The hyperlink to the article on the FDA web site that is reference number 160 needs to be corrected. The one on there now doesn't work. The correct link is: http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm153270.htm

The name of the article for reference 160 is: Review of Therapeutic Equivalence Generic Bupropion XL 300 mg and Wellbutrin XL 300 mg

If someone could make that change who is familiar with editing these pages, I'd appreciate it!

Thanks. Srpattee (talk) 03:42, 5 January 2012 (UTC)

Fixed, thanks. Materialscientist (talk) 04:46, 5 January 2012 (UTC)