Wellbutrin Sexual Side Effects

Wellbutrin Increasing Dosage Sexual Side Effects

A visitor asked about an unusual side effect of increasing Wellbutrin (bupropion) dosage from 150 to 300 mg: increased libido.

I looked at the package insert (prescribing information that the FDA approves for a drug) and didn’t see increased libido in the side effect profiles, including the rare side effect profiles. I did a medline search and saw a couple of case reports of hypersexuality from bupropion:

J Clin Psychiatry. 2003 Oct;64(10):1268-9. “Effect of bupropion on sexual dysfunction induced by fluoxetine: a case report of hypersexuality.” Chollet CA, Andreatini R. Publication Types: * Case Reports * Letter PMID: 14658981 [PubMed – indexed for MEDLINE]

Can J Psychiatry. 1998 Aug;43(6):644-5. “Bupropion-SR-induced increased libido and spontaneous orgasm.” Labbate LA. Publication Types: * Case Reports * Letter PMID: 9729695 [PubMed – indexed for MEDLINE]

I wanted to see if anyone either knows additional information about this or have experienced this. Wellbutrin is often prescribed for those concerned with the sexual side effects of SSRI-type of drugs, and the low incidence of sexual side effect is a feature of this drug that the manufacturer markets to physicians. However, I’m not aware of this drug increasing libido to a debilitating level.

2010 Update

Since I had posted this in 2006, I’m surprised at the outpouring of feedback from people who have indeed experienced hypsersexuality as a side effect to Wellbutrin. You can learn a lot from reading the comments (there are 86 comments as of September 2010 and 300 comments as of 2015)!

Remember: As of this writing, Wellbutrin is approved for usage in the treatment of depression. Any other usage outside of this means that your doctor has prescribed it off-label. Here is a link to the PDF of the prescribing information (also known as package insert, or PI) from the FDA archive.

2012 Update

“Wellbutrin: The United States also alleges that, from January 1999 to December 2003, GSK promoted Wellbutrin, approved at that time only for Major Depressive Disorder, for weight loss, the treatment of sexual dysfunction, substance addictions and Attention Deficit Hyperactivity Disorder, among other off-label uses.

The United States contends that GSK paid millions of dollars to doctors to speak at and attend meetings, sometimes at lavish resorts, at which the off-label uses of Wellbutrin were routinely promoted and also used sales representatives, sham advisory boards, and supposedly independent Continuing Medical Education (CME) programs to promote Wllbutrin for these unapproved uses.

GSK has agreed to plead guilty to misbranding Wellbutrin in that its labeling did not bear adequate directions for these off-label uses. For the Paxil and Wellbutrin misbranding offenses, GSK has agreed to pay a criminal fine and forfeiture of $757,387,200.” http://www.justice.gov/opa/pr/2012/July/12-civ-842.html — “GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data – Largest Health Care Fraud Settlement in U.S. History”

Wellbutrin and Anorgasmia: Bupropion Can Cause Sexual Dysfunction

Most of the patient experience with bupropion (Wellbutrin, Zyban) has been an increase in libido, and this side effect has caused physicians to use this drug as a way to manage sexual dysfunction caused by serotonin-receptor based antidepressants (SSRI, SNRI). However, a reader wrote in about her experience with sexual dysfunction on bupropion.

I’m looking at medical literature and unfortunately not all of them will show me the abstract to the clinical study. Doctors have indeed observed this in patients even if rare, as far back as 1999:

Prim Care Companion J Clin Psychiatry. 1999 December; 1(6): 193. PMCID: PMC181094 Copyright © 1999, Physicians Postgraduate Press, Inc. Possible Sexual Dysfunction Associated With Bupropion for Smoking Cessation: A Case Report. Timothy R. Berigan, D.D.S., M.D. El Paso, Texas

"Sir: Sexual dysfunction induced by antidepressant medication is well documented in the literature. To date, there has been no report of possible sexual dysfunction induced by bupropion utilized in smoking cessation. In fact, bupropion has been reported to treat antidepressant-induced sexual dysfunction.1–3 The author describes a case of possible sexual dysfunction associated with the use of bupropion.

In 1998, the sustained-release form of bupropion, an antidepressant unlike others on the market, was launched for use as a pharmacologic agent in smoking cessation.4 It is believed that bupropion’s unique properties involving inhibition of neuronal reuptake of dopamine (possible reinforcement of the reward system) and norepinephrine (possible withdrawal) may play a role in facilitating smoking cessation.5 A case is presented in which a patient treated in a smoking cessation program with bupropion sustained release (SR) experienced sexual dysfunction, an effect not previously described." READ THIS CASE REPORT

There is another case report that I’ve found but without the abstract, your physician may be able to get the full article if he or she has access to the medical library:

J Clin Psychopharmacol. 2004 Aug;24(4):460-1. Anorgasmia in a patient treated with bupropion SR for smoking cessation. Martínez-Raga J, Sabater A, Cervera G. PMID: 15232346 [PubMed – indexed for MEDLINE]

Now the problem with these case reports is that they are on patients receiving the drug for smoke cessation (Zyban has been used to help people to stop smoking) – and one of the strategies to manage patients that experience sexual side effects on the drug is to simply take them off the drug. But if a patient is prescribed Wellbutrin for depression or as part of a treatment plan for a mental illness – you can’t very well “just take the patient off the drug” if the patient is doing well on the medication. So doctors have to find a different approach. Another issue is that we now have extended release forms of the drug, and this means the wash-out period of the drug is different than non-extended release forms. This means you have a very narrow window (if you even have a window) of time when there is a low enough amount of drug in your system where it may not interfere with sexual function.

This is definitely an issue that is not common, but I suspect not as rare as people may think. This is why it’s important to tell your doctor about these side effects and make sure they report it to the FDA, so that we can have a more complete set of side effects and the prevalence as consumers and healthcare providers.

Pubmed search: Bupropion and Anorgasmia

Remember: As of this writing, Wellbutrin is approved for usage in the treatment of depression. Any other usage outside of this means that your doctor has prescribed it off-label. Here is a link to the PDF of the prescribing information (also known as package insert, or PI) from the FDA archive.