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Bulet SR

Bulet SR (Bupropion 150 mg SR) — NDRI antidepressant for major depression and smoking cessation. no sexual dysfunction, weight-neutral, activating.

Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring  · Laatst beoordeeld: mei 2026

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⚡ Snel antwoord

Bulet SR (Bupropion 150 mg, sustained-release (SR)) is a dopamine-noradrenaline reuptake inhibitor (NDRI) used for major depression, smoking cessation (Zyban indication), and seasonal affective disorder. Distinct profile: stimulating rather than sedating, weight-neutral or weight-reducing, no sexual side effects. SR is dosed BID; XL is OD. Both share the same pharmacology and indications.

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What Bulet SR is and how it works

Bulet SR is a 150 mg bupropion sustained-release (SR) tablet supplied by Intas. Bupropion is the only widely-prescribed antidepressant whose primary action is dopamine-noradrenaline reuptake inhibition — not serotonin reuptake. This makes it pharmacologically distinct from SSRIs/SNRIs/TCAs and explains its different side-effect signature.

The clinical translation: bupropion does not cause sexual dysfunction, does not cause weight gain (often weight loss), and is activating rather than sedating. The trade-off is a meaningful increase in seizure risk at high doses, an absolute contraindication in eating disorders, and an insomnia/anxiety burden in some patients.

Indicaties en dosering

IndicatieStartdoseringStreefdoseringMaximaal
Major depression — XL150 mg OD morning300 mg OD450 mg
Major depression — SR150 mg OD × 3 d → BID150 mg BID200 mg BID
Smoking cessation150 mg OD × 3 d → BID (SR) or 150 mg OD × 1 wk → 300 mg (XL)150 mg BID or 300 mg OD × 7–12 weeks
Seasonal affective disorder (XL)150 mg OD autumn start300 mg OD
SSRI sexual dysfunction (off-label)75–150 mg OD150 mg OD300 mg

Belangrijke veiligheidsoverwegingen

Seizure risk — absolute and dose-dependent

Bupropion lowers seizure threshold. Absolute contraindications: any seizure disorder, current or historical anorexia nervosa or bulimia, abrupt withdrawal from alcohol or sedatives. The seizure risk at 300 mg/day is approximately 0.1%; at 450 mg/day it is approximately 0.4% — a 4-fold rise. Single doses must not exceed 150 mg (SR) or 450 mg total (XL).

Eating-disorder contraindication

Anorexia and bulimia are absolute contraindications — both because eating-disorder physiology lowers seizure threshold (electrolyte derangement, ketotic state) and because bupropion’s appetite-suppressant effect can entrench restrictive behaviour. This is one of the few clear “do not use” boxes in psychiatry.

MAOI washout

14-day washout each direction. Concurrent use risks hypertensive crisis.

Zwarte waarschuwing voor suïcidaliteit (onder 25)

Alle antidepressiva dragen een FDA zwarte waarschuwing voor verhoogde suïcidale gedachten bij patiënten onder de 25.

Veelvoorkomende bijwerkingen

  • Stimulating profile: insomnia (avoid evening dosing), dry mouth, headache, agitation, tremor.
  • Cardiovasculair: small BP rise, tachycardia, palpitations.
  • Gewicht: weight loss is common — bupropion is one of the components of the Contrave anti-obesity combination.
  • Seksuele functie: none; often improves SSRI-induced sexual dysfunction when added.
  • Maag-darm: nausea (worse with high single doses), constipation.
  • Skin: rash, occasionally serious cutaneous reactions.

Geneesmiddelinteracties

  • MAO-remmers — absolute contraindication.
  • Strong CYP2B6 inducers/inhibitors (rifampicin, ritonavir, efavirenz, ticlopidine, clopidogrel, prasugrel) — alter bupropion levels; CYP2B6 inhibition by clopidogrel reduces hydroxybupropion (active metabolite) — modest clinical impact.
  • CYP2D6 substrates (most TCAs, many antipsychotics, type 1c antiarrhythmics, codeine, tramadol, tamoxifen) — bupropion is a strong CYP2D6 inhibitor; raises substrate levels.
  • Other seizure-threshold-lowering drugs (tramadol, fluoroquinolones, theophylline, antipsychotics) — additive risk.

Zwangerschap, borstvoeding, pediatrie

Pregnancy: limited data; not first-line antidepressant in pregnancy but no clear teratogenic signal. Breastfeeding: passes into milk; sometimes preferred for postpartum depression where weight gain or sedation would be problematic. Paediatric: not first-line; off-label use for ADHD is described.

Opslag

Store at 15–25 °C in original packaging.

Veelgestelde vragen

Why is Bulet SR sometimes preferred over SSRIs?

Three reasons: no sexual side effects, weight-neutral or weight-reducing, and activating rather than sedating. Patients who develop SSRI-induced sexual dysfunction or weight gain often do well on bupropion, alone or as augmentation.

Can Bulet SR be used to quit smoking?

Yes — bupropion is FDA-approved for smoking cessation under the trade name Zyban. The dose schedule is the same as for depression (300 mg/day). Start 1–2 weeks before the planned quit date and continue for 7–12 weeks. The mechanism for nicotine cessation is partly noradrenergic withdrawal-symptom suppression and partly dopamine-mediated craving reduction.

How is Bulet SR different from a stimulant?

Bupropion has weak stimulant properties but is not a controlled substance, does not produce euphoria at therapeutic doses, and has no abuse potential in oral form. Recreational misuse via insufflation has been described but is rare and unrewarding compared to true stimulants.

Can Bulet SR cause anxiety?

Yes — the activating profile produces anxiety, jitteriness, or insomnia in some patients, particularly in the first 1–2 weeks. This is why bupropion is generally not first-line for depression with prominent anxiety symptoms. Take in the morning to minimise insomnia.

Why is Bulet SR contraindicated in eating disorders?

Anorexia and bulimia produce electrolyte derangement and ketotic state, both of which lower seizure threshold. Bupropion further lowers seizure threshold, and the combination produced unacceptable seizure rates in early trials. The contraindication is absolute, not relative.

Will Bulet SR keep me awake at night?

If taken in the evening, often yes. Standard practice is to take Bulet SR in the morning; for SR, BID dosing is morning and early afternoon (not evening).

How do I stop Bulet SR?

Bupropion has a relatively short half-life and modest withdrawal — but a taper over 1–2 weeks is still the conservative move. Halve the dose for 1–2 weeks, then stop.

Can Bulet SR be combined with an SSRI?

Yes — common combination, particularly when adding bupropion to an SSRI to counter sexual side effects or to augment partial response. Both drugs influence different neurotransmitter systems; combination is well-tolerated. Specialist supervision recommended.

What is the seizure risk?

At 300 mg/day (typical target dose), seizure risk is approximately 0.1% per year — low but real. At 450 mg/day, the risk rises to approximately 0.4%. The risk is concentrated in patients with predisposing factors: head injury history, seizure disorder, eating disorder, alcohol or sedative withdrawal.

Wat als ik een dosis vergeet?

Take as soon as remembered the same day. Do not double up — the dose-dependent seizure risk is the reason. If close to next dose, skip.

Andere medicijnen voor geestelijke gezondheid

Medisch disclaimer. Deze pagina is educatief en geen vervanging voor persoonlijk medisch advies. Farmacotherapie voor geestelijke gezondheid dient te worden gestart, gecontroleerd en aangepast onder begeleiding van een gekwalificeerde clinicus. Als u of iemand die u kent in een suïcidale crisis verkeert, neem dan onmiddellijk contact op met de plaatselijke hulpdiensten, of bel de suïcidepreventielijn van uw land (VS/Canada: 988; VK: Samaritans 116 123; internationale lijst: findahelpline.com).

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