Bupropion Hydrochloride (bupropion hydrochloride 150 mg) Dailymed

6. Adverse Reactions

Most common adverse reactions are (incidence ≥5%; ≥2  placebo rate): dry mouth, nausea, insomnia, dizziness, pharyngitis, abdominal pain, agitation, anxiety, tremor, palpitation, sweating, tinnitus, myalgia, anorexia, urinary frequency, rash (6.1)

To report SUSPECTED ADVERSE REACTIONS, contact Wockhardt USA LLC. at 1-800-346-6854 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

The following adverse reactions are discussed in greater detail in other sections of the labeling:

• Suicidal thoughts and behaviors in children, adolescents, and young adults [see Warnings and Precautions (5.1) ]
• Neuropsychiatric symptoms and suicide risk in smoking cessation treatment [see Warnings and Precautions (5.2) ]
• Seizure [see Warnings and Precautions (5.3) ]
• Hypertension [see Warnings and Precautions (5.4) ]
• Activation of mania or hypomania [see Warnings and Precautions (5.5) ]
• Psychosis and other neuropsychiatric events [see Warnings and Precautions (5.6) ]
• Angle Closure Glaucoma [see Warnings and Precautions (5.7) ]
• Hypersensitivity reactions [see Warnings and Precautions (5.8) ]

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Commonly Observed Adverse Reactions in Controlled Clinical Trials of Sustained-Release Bupropion Hydrochloride

Adverse reactions that occurred in at least 5% of patients treated with bupropion HCl sustained-release (300 mg and 400 mg per day) and at a rate at least twice the placebo rate are uled below.

300 mg/day of bupropion HCl sustained-release: anorexia, dry mouth, rash, sweating, tinnitus, and tremor.

400 mg/day of bupropion HCl sustained-release: abdominal pain, agitation, anxiety, dizziness, dry mouth, insomnia, myalgia, nausea, palpitation, pharyngitis, sweating, tinnitus, and urinary frequency.

Bupropion hydrochloride extended-release tablets (XL) have been demonstrated to have similar bioavailability both to the immediate-release and sustained-release formulations of bupropion. The information included under this subsection and under the subsection 6.2 is based primarily on data from controlled clinical trials with the sustained-release and extended release formulations of bupropion hydrochloride.

Major Depressive Disorder

Adverse Reactions Leading to Discontinuation of Treatment with Bupropion HCl Immediate-Release, Bupropion HCl Sustained-Release, and Bupropion HCl Extended-Release in Major Depressive Disorder Trials

In placebo-controlled clinical trials with bupropion HCl sustained-release, 4%, 9%, and 11% of the placebo, 300 mg/day and 400 mg/day groups, respectively, discontinued treatment because of adverse reactions. The specific adverse reactions leading to discontinuation in at least 1% of the 300 mg/day or 400 mg/day groups and at a rate at least twice the placebo rate are uled in Table 2.

Table 2: Treatment Discontinuation Due to Adverse Reactions in Placebo-Controlled Trials in MDD

Adverse  Reaction  Term	Placebo ( n = 385 )	Bupropion  HCl  Sustained - Release  300  mg / day ( n = 376 )	Bupropion  HCl  Sustained - Release  400  mg / day ( n = 114 )
Rash	0%	2.4%	0.9%
Nausea	0.3%	0.8%	1.8%
Agitation	0.3%	0.3%	1.8%
Migraine	0.3%	0%	1.8%

In clinical trials with bupropion HCl immediate-release, 10% of patients and volunteers discontinued due to an adverse reaction. Reactions resulting in discontinuation, (in addition to those uled above for the sustained-release formulation), included vomiting, seizures, and sleep disturbances.

Adverse Reactions Occurring at an Incidence of >1% in Patients Treated with Bupropion HCl Immediate-Release or Bupropion HCl Sustained-Release in MDD

Table 3 summarizes the adverse reactions that occurred in placebo-controlled trials in patients treated with bupropion HCl sustained-release 300 mg/day and 400 mg/day. These include reactions that occurred in either the 300 mg or 400 mg group at an incidence of 1% or more and were more frequent than in the placebo group are included.

Table 3: Adverse Reactions in Placebo-Controlled Trials in Patients with MDD

* Incidence based on the number of female patients.
† Hyphen denotes adverse reactions occurring in greater than 0 but less than 0.5% of patients
Body  System / Adverse  Reaction	Placebo ( n = 385 )	Bupropion  HCl  Sustained - Release  300  mg / day ( n = 376 )	Bupropion  HCl  Sustained - Release  400  mg / day ( n = 114 )
Body (General)
Headache	23%	26%	25%
Infection	6%	8%	9%
Abdominal pain	2%	3%	9%
Asthenia	2%	2%	4%
Chest Pain	1%	3%	4%
Pain	2%	2%	3%
Fever	-	1%	2%
Cardiovascular
Palpitation	2%	2%	6%
Flushing	-	1%	4%
Migraine	1%	1%	4%
Hot flashes	1%	1%	3%
Digestive
Dry mouth	7%	17%	24%
Nausea	8%	13%	18%
Constipation	7%	10%	5%
Diarrhea	6%	5%	7%
Anorexia	2%	5%	3%
Vomiting	2%	4%	2%
Dysphagia	0%	0%	2%
Musculoskeletal
Myalgia	3%	2%	6%
Arthralgia	1%	1%	4%
Arthritis	0%	0%	2%
Twitch	-	1%	2%
Nervous System
Insomnia	6%	11%	16%
Dizziness	5%	7%	11%
Agitation	2%	3%	9%
Anxiety	3%	5%	6%
Tremor	1%	6%	3%
Nervousness	3%	5%	3%
Somnolence	2%	2%	3%
Irritability	2%	3%	2%
Memory decreased	1%	-	3%
Paresthesia	1%	1%	2%
Central nervous system stimulation	1%	2%	1%
Respiratory
Pharyngitis	2%	3%	11%
Sinusitis	2%	3%	1%
Increased cough	1%	1%	2%
Skin
Sweating	2%	6%	5%
Rash	1%	5%	4%
Pruritus	2%	2%	4%
Urticaria	0%	2%	1%
Special Senses
Tinnitus	2%	6%	6%
Taste perversion	-	2%	4%
Blurred vision of diplopia	2%	3%	2%
Urogenital
Urinary frequency	2%	2%	5%
Urinary urgency	0%	-	2%
Vaginal hemorrhage*	-	0%	2%
Urinary tract infection	-†	1%	0%

The following additional adverse reactions occurred in controlled trials of bupropion HCl immediate-release (300 to 600 mg per day) at an incidence of at least 1% more frequently than in the placebo group were: cardiac arrhythmia (5% vs. 4%), hypertension (4% vs. 2%), hypotension (3% vs. 2%), menstrual complaints (5% vs. 1%), akathisia (2% vs. 1%), impaired sleep quality (4% vs. 2%), sensory disturbance (4% vs. 3%), confusion (8% vs. 5%), decreased libido (3% vs. 2%), hostility (6% vs. 4%), auditory disturbance (5% vs. 3%), and gustatory disturbance (3% vs. 1%).

Seasonal Affective Disorder

In placebo-controlled clinical trials in SAD, 9% of patients treated with bupropion hydrochloride extended-release tablets (XL) and 5% of patients treated with placebo discontinued treatment because of adverse reactions. The adverse reactions leading to discontinuation in at least 1% of patients treated with bupropion and at a rate numerically greater than the placebo rate were insomnia (2% vs. <1%) and headache (1% vs. <1%).

Table 4 summarizes the adverse reactions that occurred in patients treated with bupropion hydrochloride extended-release tablets (XL) for up to approximately 6 months in 3 placebo-controlled trials. These include reactions that occurred at an incidence of 2% or more and were more frequent than in the placebo group.

Table 4: Adverse Reactions in Placebo-Controlled Trials in Patients with SAD

System  Organ  Class / Preferred  Term	Placebo ( n = 511 )	Bupropion  HCl  Extended - Release ( n = 537 )
Gastrointestinal Disorder
Dry mouth	15%	26%
Nausea	8%	13%
Constipation	2%	9%
Flatulence	3%	6%
Abdominal pain	<1%	2%
Nervous System Disorders
Headache	26%	34%
Dizziness	5%	6%
Tremor	<1%	3%
Infections and Infestations
Nasopharyngitis	12%	13%
Upper respiratory tract infection	8%	9%
Sinusitis	4%	5%
Psychiatric Disorders
Insomnia	13%	20%
Anxiety	5%	7%
Abnormal dreams	2%	3%
Agitation	<1%	2%
Musculoskeletal and Connective Tissue Disorders
Myalgia	2%	3%
Pain in extremity	2%	3%
Respiratory, Thoracic, and Mediastinal Disorders
Cough	3%	4%
General Disorders and Administration Site Conditions
Feeling jittery	2%	3%
Skin and Subcutaneous Tissue Disorders
Rash	2%	3%
Metabolism and Nutrition Disorders
Decreased appetite	1%	4%
Reproductive System and Breast Disorders
Dysmenorrhea	<1%	2%
Ear and Labyrinth Disorders
Tinnitus	<1%	3%
Vascular Disorders
Hypertension	0%	2%

Changes in Body Weight

Table 5 presents the incidence of body weight changes (≥5 lbs) in the short-term MDD trials using bupropion HCl sustained-release. There was a dose-related decrease in body weight.

Table 5: Incidence of Weight Gain or Weight Loss (≥5 lbs.) in MDD Trials Using Bupropion HCl Sustained-Release

Weight  Change	Bupropion  HCl  Sustained - Release  300  mg / day ( n = 339 )	Bupropion  HCl  Sustained - Release  400  mg / day ( n = 112 )	Placebo ( n = 347 )
Gained >5 lbs	3%	2%	4%
Lost >5 lbs	14%	19%	6%

Table 6 presents the incidence of body weight changes (≥5 lbs) in the 3 SAD trials using bupropion HCl extended-release. A higher proportion of subjects in the bupropion group (23%) had a weight loss ≥5 lbs., compared to the placebo group (11%). These were relatively long-term trials (up to 6 months).

Table 6: Incidence of Weight Gain or Weight Loss (≥5 lbs) in SAD Trials Using Bupropion HCl Extended-Release

Weight  Change	Bupropion  HCl  Extended - Release  150  to  300  mg / day ( n = 537 )	Placebo ( n = 511 )
Gained >5 lbs	11%	21%
Lost >5 lbs	23%	11%

6.2 Postmarketing Experience

The following adverse reactions have been identified during post-approval use of bupropion hydrochloride extended-release tablets (XL). Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Body (General)

Chills, facial edema, edema, peripheral edema, musculoskeletal chest pain, photosensitivity, and malaise.

Cardiovascular

Postural hypotension, hypertension, stroke, vasodilation, syncope, complete atrioventricular block, extrasystoles, myocardial infarction, phlebitis, and pulmonary embolism.

Digestive

Abnormal liver function, bruxism, gastric reflux, gingivitis, glossitis, increased salivation, jaundice, mouth ulcers, stomatitis, thirst, edema of tongue, colitis, esophagitis, gastrointestinal hemorrhage, gum hemorrhage, hepatitis, intestinal perforation, liver damage, pancreatitis, and stomach ulcer.

Endocrine

Hyperglycemia, hypoglycemia, and syndrome of inappropriate antidiuretic hormone secretion.

Hemic and Lymphatic

Ecchymosis, anemia, leukocytosis, leukopenia, lymphadenopathy, pancytopenia, and thrombocytopenia. Altered PT and/or INR, associated with hemorrhagic or thrombotic complications, were observed when bupropion was coadministered with warfarin.

Metabolic and Nutritional

Glycosuria.

Musculoskeletal

Leg cramps, fever/rhabdomyolysis, and muscle weakness.

Nervous System

Abnormal coordination, depersonalization, emotional lability, hyperkinesia, hypertonia, hypesthesia, vertigo, amnesia, ataxia, derealization, abnormal electroencephalogram (EEG), aggression, akinesia, aphasia, coma, dysarthria, dyskinesia, dystonia, euphoria, extrapyramidal syndrome, hypokinesia, increased libido, neuralgia, neuropathy, paranoid ideation, restlessness, suicide attempt, and unmasking tardive dyskinesia.

Respiratory

Bronchospasm and pneumonia.

Skin

Maculopapular rash, alopecia, angioedema, exfoliative dermatitis, and hirsutism.

Special Senses

Accommodation abnormality, dry eye, deafness, increased intraocular pressure, angle-closure glaucoma, and mydriasis.

Urogenital

Impotence, polyuria, prostate disorder, abnormal ejaculation, cystitis, dyspareunia, dysuria, gynecomastia, menopause, painful erection, salpingitis, urinary incontinence, urinary retention, and vaginitis.