April 16, 2014

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ratio-Bupropion SR

(bupropion (depression))

DIN (Drug Identification Number)


What side effects are possible with ratio-Bupropion SR?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • blurred vision
  • change in sense of taste
  • constipation
  • decrease in appetite
  • dizziness
  • drowsiness
  • dryness of mouth
  • feeling of fast or irregular heartbeat
  • frequent need to urinate
  • increased sweating
  • muscle pain
  • nausea or vomiting
  • sore throat
  • trembling or shaking
  • trouble sleeping
  • unexpected weight loss
  • unusual feeling of well-being

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • agitation
  • anxiety
  • buzzing or ringing in ears
  • confusion
  • extreme distrust
  • fainting
  • false beliefs that cannot be changed by facts
  • hallucinations
  • headache (severe)
  • seizures (convulsions), especially with higher doses
  • skin rash, hives, or itching
  • trouble concentrating

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • fast heartbeat
  • hallucinations
  • loss of consciousness
  • nausea
  • seizures
  • vomiting

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for ratio-Bupropion SR?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Drowsiness/reduced alertness: If you are taking bupropion, avoid operating hazardous machinery (including cars) until you are certain that the medication does not impair your mental alertness, judgment, or physical coordination.

Heart disease: It is not known whether bupropion is safe for use by people with a recent history of heart attack or unstable heart disease. If you have heart problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Identical medications: Wellbutrin® and Zyban® contain the same active ingredient (bupropion). If you are taking one of these medications, do not take the other or any other product containing bupropion, as the risk of seizures increases with an increased dosage. To reduce the risk of seizures, the total daily dose of this medication should not be greater than 300 mg.

Liver or kidney disease: Bupropion is cleared from the body through both the liver and the kidney. If you have liver or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Seizure risk: If you are at risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Things which increase the risk of seizures include:

  • addiction to cocaine, stimulants, or opiates (such as morphine)
  • diabetes treated with oral medications or insulin
  • excessive alcohol use
  • history of head trauma or seizures (including epilepsy)
  • severe liver problems
  • tumours of the brain or spinal cord
  • use of other medications that make seizures more likely (e.g., antipsychotics, antidepressants, lithium, theophylline, steroids)
  • use of over-the-counter stimulants or appetite suppressants

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour, or other behaviour changes: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. Your doctor will monitor you for emotional and behavioural changes while you are taking bupropion.

Pregnancy: The safety of bupropion during pregnancy has not been established. It has been reported that babies born to pregnant women who have taken medications of this kind during the last trimester of pregnancy may be adversely affected. Physicians and pregnant women should carefully consider the benefits and the risks of all treatment options. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Bupropion passes into breast milk. Because this medication presents risks to breast-feeding infants, a decision should be made whether to discontinue breast-feeding or to discontinue bupropion, taking into account the importance of the medication to the mother.

Children: The safety and effectiveness of bupropion have not been established for children and adolescents under 18 years old. The use of this medication in children below the age of 18 may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

Seniors: Because this medication is removed from the body by the kidney and liver, seniors may be at an increased risk of side effects, including seizures, if they use this medication. If you are over 65, discuss with your doctor whether any special monitoring is required.

What other drugs could interact with ratio-Bupropion SR?

There may be an interaction between bupropion and any of the following:

  • alcohol
  • amantadine
  • anti-malarial medications (e.g., mefloquine)
  • antipsychotics (e.g., haloperidol, risperidone, thioridazine)
  • beta-blockers (e.g., metoprolol)
  • carbamazepine
  • clopidogrel
  • codeine
  • corticosteroids (e.g., prednisone)
  • cyclophosphamide
  • droperidol
  • flecainide
  • levodopa
  • lithium
  • methotrimeprazine
  • monoamine oxidase inhibitors (MAO inhibitors; e.g., phenelzine, tranylcypromine, moclobemide) - bupropion should not be started until at least 14 days after MAO inhibitors are stopped
  • nicotine replacement therapy (e.g., nicotine patch)
  • orphenadrine
  • phenobarbital
  • phenytoin
  • propafenone
  • quinolone antibiotics (e.g., ciprofloxacin, moxifloxacin)
  • ritonavir
  • SSRIs (e.g., paroxetine, sertraline, fluoxetine)
  • tamoxifen
  • tetrabenazine
  • theophylline
  • thioridazine - bupropion should not be started until at least 14 days after thioridazine is stopped
  • ticlopidine
  • tricyclic antidepressants (e.g., nortriptyline, imipramine, desipramine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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Depression Symptom Checker Tool

The Depression Symptom Checker tool can help you learn about depression. Use this tool to create a list of your symptoms and rate how much the symptoms impact your life on a daily basis. The checklist is divided into 6 symptom categories that are associated with depression. You can also learn more about symptoms of depression here.

For each statement choose a number from 0 to 4 that describes the impact on your daily life, where 4 has the highest impact and 0 has no impact:

  • 0 = no impact on daily life/no symptoms
  • 1 = mild impact on daily life
  • 2 = moderate impact on daily life
  • 3 = severe impact on daily life
  • 4 = debilitating impact on daily life

It is important to remember that this is not a “score” but a way to help you communicate how much you feel the symptom impacts your daily life. When you finish you will be able to print out your symptoms and share this information with your doctor. Use the Doctor Discussion Guide to prepare for your doctor’s visit.

Rate how much the following symptoms apply to you.

1. Emotions

Depression can affect anyone at any age, although it most commonly appears between 15 and 45 years of age.

0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4

Visit your doctor with these results, when booking your appointment inform your doctor that you may need extra time to discuss these matters. Getting help for your depression can change your life. Don’t wait- depression is an illness that can, and should be treated.

Thoughts about death or suicide are common in depression, and it’s important to take such thoughts seriously. If you feel like giving up or as if you might hurt yourself, get help immediately: call your doctor, go to the emergency room or call 911.

This tool is adapted with permission from similar content found on www.depressionhurts.ca.

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