Seizure risk from Wellbutrin?

I've heard such varying views on this, and would like some more information. (The med we're trying now doesn't seem to be cutting it so far, although that might change -- we can hope.)

My last pdoc took me off Wellbutrin, because of the seizure risk, which he said was dangerously high. My current pdoc says that he's never seen a problem with it, as long as you follow basic precautions in titrating up to a therapeutic dose. The drug info I've seen says that the risk is between one in two hundred and fifty and one in one thousand.

Now, the first doctor discontinued it because my skull was fractured in a car accident when I was a child. The new doctor says that he's prescribing it now for a man who has had five serious concussions over the past decade, with no problems. (He didn't say what dosages were involved nor how long the fellow has been taking it.) I do realize that there's no way to say for sure that it's safe or unsafe, and I realize that the risks increase as the dosage rises above 400 mg per day.

For what it's worth, I also have an eating disorder, but it's limited to restrictive eating -- no purging, no laxatives, etc.

Can anyone offer any other information? Thanks.

I've had two different doctors tell me that the seizure risk is only for people who have had seizures in the past. But your prior head trauma might put you in the high risk category as well. I have read and been told that Wellbutrin can exacerbate eating disorders, and I thought it spoke specifically of anorexia. So, if your disorder involves restrictive eating, then that might also be a reason the doc took you off Wellbutrin.

Actually, the seizure risk relating to eating disorders is directed at bulemia, not anorexia. That much I know, and it's thought to be related to resulting electrolyte imbalance.

I know that my new doctor's second choice med for me is Wellbutrin, which he considers safe for me, which is why I'm asking.

Thanks for your response.

The risk of seizure with Wellbutrin is 100%, but that is totally a dose-dependent effect. Literally, anybody will seize with bupropion, if they take too much. The issue is dose. It's always about dose.

I'm not trying to scare you. The subject has been fully explored, and the dose recommendations for depression and smoking cessation are derived with the seizure risk prominently considered. Here are the exact details.

If you were to create a graph showing the incidence of seizure against dose of Wellbutrin, you'd see a virtually flat line at barely above zero percent, below 300 mg/day. Between 300 mg and 450, the line starts to rise, but it's still only at 0.4% of all users by the time dose reaches that level. Between 450 and 600 mg, the line starts to rise more sharply, reaching around 4%. Above that, the risk of seizure exceeds the benefit of treatment. If you actually had data to complete the graph, you'd see that up above 5000 mg/day or so, the line reaches 100%. In other words, if you give every person a large enough dose of wellbutrin, they'll have a seizure. But, if you stay down at the lowest doses, the risk is really quite small. At 300 mg/day, the risk is about the same as from taking any other antidepressant drug.

From the drug monograph: "At doses of up to 300 mg/day, the incidence of seizures is approximately 0.1% (1/1000) but increases to approximately 0.4% (4/1000) at the recommended dose (for treatment of depression) of 400 mg/day of the sustained-release formulation or 450 mg/day of the immediate-release formulation. The risk of seizure also appears to be strongly associated with the presence of predisposing factors."

Note the issue of predisposing factors. There are certain health or physical factors that a doctor may decide make it more likely that an individual may seize. For those people, it's best to avoid potential triggers of seizure activity. That said, the risk from normal therapeutic doses of wellbutrin is really quite small.

Lar

Genevieve - Larry fairly much covered the details. My clinical experience has been that seizures from Wellbutrin™ (bupropion) occur when one is taking another medication that lower seizure threshold (eg. Mellaril™ - thoridazine, and other older phenothiazine major tranquilizers). I have been personally involved in two cases, both of which I would never have guessed that there would have been a problem. Both people had no personal or family history of seizures.

In both cases, the people were taking low doses of seizure-lowering medication (25mg of Mellaril in one case and 50mg Largactil™ - chlorpromazine) in the other. I personally have never been involved in a case where these medications alone have caused seizures, although I have read of cases in which they have happened; although the medication doses were usually quite high.

I guess what I am trying to say is that before these incidents I was very complacent about seizure risk with Wellbutrin. Now, I am a little gun shy. The ultimate decision to take Wellbutrin rests with you. I am a little leery of the new doc saying that because he is prescribing Wellbutrin for a person who has an increased risk of seizures, therefore it should be safe for you. I try to avoid these blanket generalizations because I have been burned several times when I have made similar claims myself (not just with the Wellbutrin).

OTOH, it is difficult to not be able to use a medication that works for you. It is so hard to find a medication, or combination of medications, that allow one to live a reasonably productive, fulfilling life. If you do decide to restart the Wellbutrin, make sure that your doctor follows your progress carefully.

I hope that this is of some help. - Cam

Thank you, Cam. I have another couple of questions, if you don't mind.

First, do you know if something like checking electrolyte panels regularly can help predict seizure risk? Is there anything that can reduce risks? Any warning signs? And is the seizure risk highest when starting the drug, raising the dosage, or does it remain the same over the course of using the drug?

Secondly, I'm a restrictive type anorexic. So far, I don't think that it's really done much damage to my chemistry, although the latest round of blood work isn't back yet. Isn't the risk higher for bulimics than anorexics?

Overall, I think I trust the new doctor more than the old doctor, but I'm still a bit concerned. Too many bad med reactions, you know.

Thanks again for your response.

Genevieve - I haven't heard of any connection between electrolyte levels and seizures; although I am not certain. I'm a community pharmacist and have never worked in a hospital, so I never really get to see an electrolyte panel, let alone be able to read one.

I have no idea when seizure risk is the highest; I have not seen a study that measured those variables. In the two cases that I have experience with, the seizures arose early, within the first couple weeks of therapy. If this is typical, I don't know. Since the drug company's drug monograph for Wellbutrin™ (bupropion) the risk of seizuring due to the medication increases with increasing dose. This would suggest to me that the risk of seizures is dose-related.

As for body chemistry, the body is fairly resilient. Feed it properly and it bounces back.

I'm sorry that I don't have many answers for you. - Cam