Story 50 – Bupropion

A woman in rural BC writes :

You’ve asked for stories, and I’m needing to vent, so here goes…

I finally landed on the right drug at the right dosage after decades of struggling with depression. Bupropion XL 300mg turned my life around, and with my 60th birthday looming, I was actually looking forward to the rest of my life. I had given up on antidepressants because they just seemed to make things worse.

I’ve also struggled most of my life with my weight and have been growing increasingly desperate about it. I heard about a new weight-loss drug called Contrave, a combination of the generic drugs bupropion (an antidepressant) and naltrexone (used in drug rehab), which sounded both promising and safe. While Contrave had been available in the US for a few years, it was not yet available in Canada, but my doctor was willing to prescribe these two generic drugs in dosages that approximated Contrave.

As it turned out, this didn’t help a whole lot with my weight, but what a difference it made to my energy and mood! I was ME again!

I had tried bupropion before, but only 150mg, and I had given up on it because I experienced mild side effects and no real therapeutic effects. Just add it to the long list of antidepressants I’ve tried. But at 300mg (and perhaps in combination with the naltrexone), it was life-saving. I just needed to take more of it.
So, I was pretty upset when I went for a refill at the end of October to find that this drug that I was stable on wasn’t available. That is, the extended release (XL) form wasn’t, so instead the pharmacist gave me the sustained release (SR) form with the instructions to take 150mg twice a day instead of a single dose of 300mg. Well, twice a day for me is in the morning when I get up and then just before bed.

It took me several weeks before I figured out that the onset of severe sleep problems coincided with this change in drug regimen. I called my pharmacist, who said it definitely was the drug and that he should have told me not to take it before bed.

Well, the doses are supposed to be at a minimum 8 hours apart, but even taking the second dose in the afternoon affected my sleep – it was still too late. So I am only able to take 150mg in the morning, half the dose I need. If I take the second dose, I don’t sleep.

I lost the entire month of November to lack of sleep because I was literally up all night most days of the month. So now I’m on half the dose of bupropion that I need, and while my sleep is better, I can feel my energy and mood slipping downward. I AM SO ANGRY! Finally, I was getting my life together, and now this? And no explanation? And will it EVER be available again?? I need a refill, and it looks like I’ll be getting the SR again.

So that’s my story. Do the pharmaceutical companies have no ethical standards???

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Update, Christmas Day:

In consultation with my pharmacist, I am now taking the second dose of bupropion 5 or 6 hours (i.e., less than 8 hours) after the first dose and have not experienced any adverse effects. I need to take the first dose as soon as I get up in the morning, and as long as I remember to take the second dose on time (cell phone reminders are very helpful!), I’m managing. I’ve now been on the full therapeutic dose for a couple of weeks and am beginning to feel decent again. But I feel like I’ve lost two months of my life, and I really resent having to be so vigilant about the timing of my meds when it shouldn’t be necessary.