Bupropion Vs. Lamotrigine: Drug Comparison

Bupropion is the active ingredient in the brand-name medication Wellbutrin SR^®. The information below is about brand name Wellbutrin SR. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Wellbutrin SR (bupropion sustained-release) is an antidepressant that works by inhibiting the reuptake of norepinephrine and dopamine in the brain, which helps improve mood and reduce symptoms of depression. Its FDA-approved indication includes the treatment of major depressive disorder (MDD). Off-label uses may include smoking cessation, anxiety, and attention-deficit hyperactivity disorder (ADHD). Wellbutrin SR is available in sustained-release tablet form, typically taken once or twice daily. Common side effects include insomnia, dry mouth, constipation, and headache, and it has a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults during the initial stages of treatment.

Lamotrigine is the active ingredient in the brand-name medication Lamictal^®. The information below is about brand name Lamictal. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Lamictal (lamotrigine) is an anticonvulsant medication used to treat epilepsy and bipolar disorder by stabilizing electrical activity in the brain and reducing the release of certain neurotransmitters involved in seizures and mood regulation. Its FDA-approved indications include the treatment of partial seizures, generalized seizures, and the maintenance of mood stability in bipolar disorder. Lamictal is available in tablets, chewable tablets, and orally disintegrating tablets. Common side effects include dizziness, headache, blurred vision, and nausea. It carries a boxed warning for the risk of serious skin rashes, including Stevens-Johnson syndrome, which requires immediate medical attention.

Aminoketone antidepressant

Anticonvulsant

Wellbutrin SR (bupropion hydrochloride) is indicated:

• For the treatment of major depressive disorder (MDD)

Lamictal (lamotrigine) is indicated for:

• Epilepsy—adjunctive therapy in patients aged 2 years and older:

  • Partial-onset seizures

  • Primary generalized tonic-clonic seizures

  • Generalized seizures of Lennox-Gastaut syndrome

• Epilepsy—monotherapy in patients aged 16 years and older: Conversion to monotherapy in patients with partial-onset seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single antiepileptic drug

• Bipolar disorder: Maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy

• Typically taken orally twice daily

• Comes in 100 mg, 150 mg, and 200 mg tablets

• Typically taken orally with dosing based on concomitant medications, indication, and patient age

• Comes in 25 mg, 100 mg, 150 mg, and 200 mg tablets; 2 mg, 5 mg, and 25 mg tablets for oral suspension; and 25 mg, 50 mg, 100 mg, and 200 mg orally disintegrating tablets

Most common adverse reactions (incidence ≥5% and ≥2% more than placebo rate) are:

• Headache

• Dry mouth

• Nausea

• Insomnia

• Dizziness

• Inflammation of the throat

• Constipation

• Agitation

• Anxiety

• Abdominal pain

• Ringing in the ears

• Tremor

• Fluttering heartbeat

• Muscle pain

• Sweating

• Rash

• Anorexia

Epilepsy: Most common adverse reactions (incidence ≥10%) in adults were:

• Dizziness

• Headache

• Double vision

• Poor muscle control

• Nausea

• Blurred vision

• Sleepiness

• Inflammation of the nasal passages

• Inflammation of the throat

• Rash

• Additional adverse reactions (incidence ≥10%) reported in children included:

  • Vomiting

  • Infection

  • Fever

  • Accidental injury

  • Diarrhea

  • Abdominal pain

  • Tremor

Bipolar disorder: Most common adverse reactions (incidence >5%) in adults were:

• Nausea

• Insomnia

• Sleepiness

• Back pain

• Fatigue

• Rash

• Inflammation of the nasal passages

• Abdominal pain

• Dry mouth

• Seizure disorder

• Current or prior diagnosis of bulimia or anorexia nervosa

• Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, antiepileptic drugs

• Monoamine oxidase inhibitors (MAOIs)

• Known hypersensitivity to bupropion or other ingredients of Wellbutrin SR.

• Drug interactions: CYP2B6 inducers, drugs metabolized by CYP2D6, digoxin, drugs that lower seizure threshold, dopaminergic drugs (levodopa and amantadine), MAOIs

• Drug-laboratory test interactions: Wellbutrin SR can cause false-positive urine test results for amphetamines

• Hypersensitivity to the drug or its ingredients

• Drug interactions: valproate, carbamazepine, phenytoin, phenobarbital, primidone, rifampin, estrogen-containing oral contraceptives, protease inhibitors lopinavir/ritonavir and atazanavir/lopinavir, organic cationic transporter 2 substrates

• Neuropsychiatric adverse events during smoking cessation

• Seizure risk

• High blood pressure

• Activation of mania/hypomania

• Psychosis and other neuropsychiatric reactions

• Angle-closure glaucoma

• Life-threatening serious rash and/or rash-related death

• Hemophagocytic lymphohistiocytosis

• Fatal or life-threatening hypersensitivity reaction

• Cardiac rhythm and conduction abnormalities

• Blood dyscrasias (e.g., neutropenia, thrombocytopenia, pancytopenia)

• Suicidal behavior and ideation

• Aseptic meningitis

• Medication errors due to product name confusion

• Pregnancy: Based on animal data may cause fetal harm

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents and young adults taking antidepressants.

Monitor for worsening and emergence of suicidal thoughts and behaviors.

WARNING: SERIOUS SKIN RASHES

Cases of life-threatening serious rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, and/or rash-related death have been caused by lamotrigine. The rate of serious rash is greater in pediatric patients than in adults. Additional factors that may increase the risk of rash include:

• Coadministration with valproate

• Exceeding recommended initial dose of Lamictal

• Exceeding recommended dose escalation for Lamictal

Benign rashes are also caused by lamotrigine; however, it is not possible to predict which rashes will prove to be serious or life threatening. Lamictal should be discontinued at the first sign of rash, unless the rash is clearly not drug related.

*This information is from the label for brand name Wellbutrin SR^®. See the Full Prescribing Information for more complete information. Bupropion, the active ingredient in Wellbutrin XL, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient bupropion.

*This information is from the label for brand name Lamictal^®. See the Full Prescribing Information for more complete information. Lamotrigine, the active ingredient in Lamictal, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient lamotrigine.