The white round pill debossed with the imprint 144 is an extended-release oral prescription medication containing Bupropion Hydrochloride Extended-Release (XL) 150 mg, an aminoketone antidepressant.
Pill Identification
Attribute – Specification
- Active Ingredient – Bupropion Hydrochloride, USP (150 mg)
- Imprint – 144 on one side; plain on reverse
- Color & Shape – White to pale yellow, round, biconvex, film-coated tablet
- Release Mechanism – Extended-Release 24-Hour (XL)
- Primary Manufacturers / Packagers – ScieGen Pharmaceuticals, Inc. / Radha Pharmaceuticals
- Drug Class – Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) / Aminoketone antidepressant
Mechanism of Action
Bupropion is chemically unrelated to selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), or monoamine oxidase inhibitors (MAOIs). Its clinical profile operates through dual neurotransmitter modulation:
- Neuronal Reuptake Inhibition: Bupropion and its active metabolites (hydroxybupropion, threohydrobupropion, and erythrohydrobupropion) act as weak inhibitors of the neuronal reuptake of norepinephrine (NE) and dopamine (DA).
- Minimal Serotonergic Effect: It has negligible activity on serotonin reuptake and does not inhibit monoamine oxidase.
- Nicotinic Receptor Antagonism: Bupropion functions as a non-competitive antagonist at neuronal nicotinic acetylcholine receptors , which contributes to its efficacy in reducing nicotine craving and withdrawal symptoms.
Indications and Clinical Uses
- Major Depressive Disorder (MDD): Treatment of depressive episodes in adults.
- Seasonal Affective Disorder (SAD): Prevention of seasonal major depressive episodes in autumn/winter.
- Off-Label Uses: Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD), smoking cessation (under the trade name Zyban in sustained-release formulations), and managing SSRI-induced sexual dysfunction.
Dosage and Administration
- Bupropion XL tablets must be swallowed whole with water; never crush, split, chew, or dissolve them, as doing so destroys the extended-release membrane and causes rapid drug dumping, significantly increasing the risk of seizures.
- Major Depressive Disorder:
- Starting Dose: 150 mg once daily in the morning.
- Target Maintenance Dose: If tolerated, the dose may be increased after 4 days to 300 mg once daily (taken as two 150 mg tablets or one 300 mg tablet).
- Maximum Dose: 450 mg once daily.
- Seasonal Affective Disorder:
- Initiate in autumn prior to symptom onset at 150 mg once daily, increasing after 1 week to 300 mg once daily through the winter season.
- Dosing Timing: Take in the morning to minimize the potential for drug-induced insomnia.
- Hepatic / Renal Impairment: Reduce dose and/or frequency (e.g., 150 mg every other day in moderate-to-severe hepatic impairment).
Side Effects
Common Adverse Effects:
- Central Nervous System: Insomnia, agitation, anxiety, tremor, headache, dizziness
- Gastrointestinal: Dry mouth, nausea, vomiting, abdominal pain, decreased appetite, weight loss, constipation
- Cardiovascular: Palpitations, tachycardia, mild elevation in blood pressure
- Dermatologic / Sensory: Excessive sweating (hyperhidrosis), tinnitus, blurred vision
Serious Adverse Reactions:
- Seizures (dose-dependent)
- Emergence or worsening of suicidal ideation and behaviors
- Psychosis, hallucinations, paranoia, mania/hypomania induction
- Severe hypertension (including hypertensive crises)
- Angle-closure glaucoma (in patients with anatomically narrow angles)
- Anaphylactoid/hypersensitivity reactions (Stevens-Johnson syndrome, erythema multiforme)
Key Drug Interactions
- MAO Inhibitors: Concurrent use with MAOIs or within 14 days of discontinuing an MAOI is strictly contraindicated due to the risk of severe hypertensive reactions.
- CYP2D6 Substrates: Bupropion and hydroxybupropion are potent inhibitors of cytochrome P450 CYP2D6. They can substantially increase blood levels of co-administered drugs metabolized by CYP2D6 (e.g., venlafaxine, fluoxetine, metoprolol, haloperidol, risperidone, atomoxetine, dextromethorphan).
- Drugs That Lower Seizure Threshold: Caution is required when combined with antipsychotics, theophylline, systemic corticosteroids, or abrupt reduction of sedative/hypnotic medications.
- Alcohol: Concomitant alcohol consumption should be minimized or avoided, as it may decrease alcohol tolerance and precipitate neuropsychiatric adverse events or alter seizure threshold.
Boxed Warnings and Contraindications
- Black Box Warning: Suicidal Thoughts and Behaviors Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (ages 18–24) during initial phases of treatment. Patients of all ages should be monitored closely for clinical worsening, agitation, and emergence of suicidal thoughts.
- Seizure Risk
- Bupropion carries a dose-dependent risk of seizures (approximately 0.1% at doses up to 300 mg/day and 0.4% at 400 mg/day). The drug should be permanently discontinued if a seizure occurs.
- Contraindications:
- Active or prior seizure disorder
- Current or prior diagnosis of bulimia or anorexia nervosa (due to a significantly higher incidence of seizures)
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic medications * Co-administration with or within 14 days of MAOIs
- Known hypersensitivity to bupropion or tablet excipients