Citalopram is a prescription medicine used in adults to treat depression.

Citalopram is also used to treat major depressive disorder (MDD).

Citalopram belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

Citalopram side effects

Get emergency medical help if you have signs of an allergic reaction to citalopram: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Citalopram may cause serious side effects. Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• blurred vision, eye pain or redness, seeing halos around lights;
• fast or pounding heartbeats, pain or fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• a seizure;
• unusual bleeding – nosebleeds, bleeding gums, abnormal vaginal bleeding, any bleeding that will not stop;
• manic episodes – racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative;
• severe nervous system reaction – very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors; or
• low blood sodium – headache, confusion, problems with thinking or memory, weakness, feeling unsteady.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Citalopram can affect growth in children. Tell your doctor if your child is not growing at a normal rate while using this medicine.

Common citalopram side effects may include:

• sexual problems;
• dizziness, drowsiness;
• dry mouth, thirst, increased sweating or urination;
• loss of appetite, nausea, diarrhea, constipation;
• feeling anxious, agitated, or shaky;
• feeling weak or tired, sleep problems (insomnia), yawning;
• increased muscle movement;
• nosebleed, heavy menstrual bleeding; or
• cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Do not stop taking citalopram without your doctor’s advice.

Citalopram can cause a serious heart problem. Call your doctor right away if you have chest pain, fast or pounding heartbeats, shortness of breath, and sudden dizziness.

You should not use citalopram if you also take pimozide, as the combination can cause problems with your heart rhythm.

Do not use citalopram if you have used a MAO inhibitor in the past 14 days (such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, or tranylcypromine) or have received a methylene blue injection. A fatal reaction may occur.

People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not stop using citalopram without first asking your doctor.

Before taking this medicine

You should not use this medicine if you are allergic to citalopram or escitalopram (Lexapro), or if you also take pimozide.

Do not use citalopram if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine. Wait at least 14 days after stopping an MAO inhibitor before you take citalopram.

Tell your doctor if you also use stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with citalopram could cause a serious condition called serotonin syndrome.

To make sure citalopram is safe for you, tell your doctor if you have ever had:

• heart problems, high blood pressure, long QT syndrome;
• a stroke;
• bleeding problems;
• sexual problems;
• narrow-angle glaucoma;
• seizures or epilepsy;
• bipolar disorder (manic depression) in you or a family member;
• an electrolyte imbalance (such as low levels of potassium, magnesium, or sodium in your blood); or
• liver or kidney disease.

People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

Taking this medicine during the last 3 months of pregnancy may harm the unborn baby, but stopping the medicine may not be safe for you. Do not start or stop citalopram without asking your doctor.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of citalopram on the baby.

Ask a doctor if it is safe to breastfeed while using this medicine.

How should I take citalopram?

Take citalopram exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the medicine your doctor prescribes.

You may take citalopram with or without food, but take it the same way each time.

Measure liquid medicine with the supplied measuring device (not a kitchen spoon).

Your symptoms may not improve for up to 4 weeks.

Tell your doctor if you have any changes in sexual function, such as loss of interest in sex, trouble having an orgasm, or (in men) problems with erections or ejaculation. Some sexual problems can be treated.

Do not stop using citalopram suddenly, or you could have unpleasant symptoms (such as agitation, confusion, tingling or electric shock feelings). Follow your doctor’s instructions about tapering your dose.

You may need frequent vision exams before starting treatment.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Citalopram dosing information

Usual Adult Dose for Depression:

Initial dose: 20 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Maximum dose: 40 mg orally per day

Comments:
-The initial dose may be increased if necessary to 40 mg once a day after at least 1 week of therapy.
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy

Use: Treatment of depression

Usual Geriatric Dose for Depression:

Over 60 years of age:
Recommended dose: 20 mg orally once a day

Comments:
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy.

Use: Treatment of depression

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking citalopram?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with citalopram may cause you to bruise or bleed easily.

Do not drink alcohol.

Avoid driving or hazardous activity until you know how citalopram will affect you. Your reactions could be impaired.

What other drugs will affect citalopram?

Citalopram can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Tell your doctor about all your current medicines. Many drugs can interact with citalopram, especially:

• cimetidine;
• a blood thinner (warfarin, Coumadin, Jantoven);
• a diuretic or “water pill”; or
• gatifloxacin or moxifloxacin.

Celexa is a prescription medicine used to treat severe depression in adults, called major depressive disorder (MDD).

Celexa is a selective serotonin reuptake inhibitor (SSRI) that blocks the reuptake of serotonin (5-HT) by the nerves of the central nervous system, which enhances serotonergic activity. The exact way it works in depression is unclear.

Celexa belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Citalopram works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

Celexa side effects

Common Celexa side effects may include:

• sexual problems;
• dizziness, drowsiness;
• dry mouth, thirst, increased sweating or urination;
• loss of appetite, nausea, diarrhea, constipation;
• feeling anxious, agitated, or shaky;
• feeling weak or tired, sleep problems (insomnia), yawning;
• increased muscle movement;
• nosebleed, heavy menstrual bleeding; or
• cold symptoms such as stuffy nose, sneezing, or sore throat.

Serious side effects

Get emergency medical help if you have signs of an allergic reaction to Celexa: hives, difficulty breathing, swelling of your face, lips, tongue, or throat.

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Citalopram may cause serious side effects. Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• blurred vision, eye pain or redness, seeing halos around lights;
• fast or pounding heartbeats, pain or fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• a seizure;
• unusual bleeding – nosebleeds, bleeding gums, abnormal vaginal bleeding, any bleeding that will not stop;
• manic episodes – racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative;
• severe nervous system reaction – very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors; or
• low blood sodium – headache, confusion, problems with thinking or memory, weakness, feeling unsteady.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Citalopram can affect growth in children. Tell your doctor if your child is not growing at a normal rate while using Celexa.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Do not stop taking Celexa without your doctor’s advice.

Citalopram can cause a serious heart problem. Call your doctor right away if you have chest pain, fast or pounding heartbeats, shortness of breath, and sudden dizziness.

You should not use Celexa if you also take pimozide, as the combination can cause problems with your heart rhythm.

Do not use Celexa if you have used an MAO inhibitor in the past 14 days (such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, or tranylcypromine) or have received a methylene blue injection. A fatal reaction may occur.

Antidepressants, such as Celexa, increase the risk of suicidal thoughts and behaviors in young adults. People with depression or mental illness may have thoughts about suicide. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

Report any new or worsening symptoms to your doctor, such as mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

SSRIs, including Celexa, may cause sexual problems. Symptoms in males may include delayed ejaculation or inability to have an ejaculation, decreased sex drive, problems getting or keeping an erection. Symptoms in females may include decreased sex drive, delayed orgasm, or inability to have an orgasm. Talk to your healthcare provider if you develop any changes in your sexual function or if you have any questions or concerns about sexual problems during treatment with Celexa. There may be treatments your healthcare provider can suggest.

Do not stop using Celexa without first asking your doctor.

Before taking this medicine

You should not use Celexa if you are allergic to citalopram or escitalopram (Lexapro), or if you also take pimozide.

Do not use Celexa if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine. Wait at least 14 days after stopping an MAO inhibitor before you take Celexa.

Tell your doctor if you also use stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with citalopram could cause a serious condition called serotonin syndrome.

To make sure Celexa is safe for you, tell your doctor if you have ever had:

• heart problems, high blood pressure, long QT syndrome;
• a stroke;
• bleeding problems;
• sexual problems;
• narrow-angle glaucoma;
• seizures or epilepsy;
• bipolar disorder (manic depression) in you or a family member;
• an electrolyte imbalance (such as low levels of potassium, magnesium, or sodium in your blood); or
• liver or kidney disease
• are pregnant or intending to become pregnant
• are breastfeeding.

People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

Pregnancy

Taking this medicine during the last 3 months of pregnancy may harm the unborn baby, but stopping the medicine may not be safe for you. Do not start or stop Celexa without asking your doctor.

If you are pregnant, there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. You can register by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://womensmentalhealth.org/research/pregnancyregistry/antidepressants.

There is a less than 2-fold increased risk for severe bleeding after delivery (postpartum hemorrhage) in mothers exposed to SSRIs, particularly in the month before delivery.

Talk to your healthcare provider if you develop any changes in your sexual function or if you have any questions or concerns about sexual problems during treatment with Celexa. There may be treatments your healthcare provider can suggest.

Breastfeeding

Ask a doctor if it is safe to breastfeed while using this medicine.

How should I take Celexa?

Take Celexa exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the medicine your doctor prescribes.

You may take Celexa with or without food, but take it the same way each time.

Measure liquid medicine with the supplied measuring device (not a kitchen spoon).

Your symptoms may not improve for up to 4 weeks.

Tell your doctor if you have any changes in sexual function, such as loss of interest in sex, trouble having an orgasm, or (in men) problems with erections or ejaculation. Some sexual problems can be treated.

Do not stop using Celexa suddenly, or you could have unpleasant symptoms (such as agitation, confusion, tingling or electric shock feelings). Follow your doctor’s instructions about tapering your dose.

You may need frequent vision exams before starting treatment.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Celexa dosing information

Usual Adult Dose for Depression:

Initial dose: 20 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Maximum dose: 40 mg orally per day

Comments:
-The initial dose may be increased if necessary to 40 mg once a day after at least 1 week of therapy.
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy

Usual Senior Dose for Depression:

Over 60 years of age:
Recommended dose: 20 mg orally once a day

Comments:
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking Celexa?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with citalopram may cause you to bruise or bleed easily.

Do not drink alcohol.

Avoid driving or hazardous activity until you know how Celexa will affect you. Your reactions could be impaired.

What other drugs will affect Celexa?

Citalopram can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Tell your doctor about all your current medicines. Many drugs can interact with citalopram, especially:

• cimetidine;
• a blood thinner (warfarin, Coumadin, Jantoven);
• a diuretic or “water pill”;
• methadone, fentanyl, or other opioids; or
• gatifloxacin or moxifloxacin.

SSRIs, including Celexa, can precipitate serotonin syndrome, a potentially life-threatening condition. The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. John’s Wort) and with drugs that impair metabolism of serotonin, such as MAOIs. Serotonin syndrome can also occur when these drugs are used alone.

Bupropion is an antidepressant medication used to treat depression and seasonal affective disorder, it also supports smoking cessation and weight management. Bupropion is the active ingredient in Wellbutrin and Zyban, Auvelity contains bupropion and dextromethorphan, and Contrave contains bupropion and naltrexone. Bupropion improves mood regulation and nicotine cravings and, when combined with naltrexone, helps reduce food intake.

Bupropion is thought to work by changing levels of certain chemicals in the brain, including noradrenaline and dopamine.

Bupropion first became an FDA-approved medicine on 30 December 1985.

What is bupropion used to treat?

The brands of bupropion are FDA-approved for specific conditions.

• Wellbutrin SR is used to treat major depressive disorder.
• Wellbutrin XL is used to treat MDD and seasonal affective disorder (SAD).
• Zyban (discontinued) was used to help stop smoking.
• Auvelity (bupropion with dextromethorphan) is used to treat MDD in adults.
• Contrave (bupropion and naltrexone) is used for weight management for specific patients.

The information on this page is only about bupropion, and not bupropion with dextromethorphan (Auvelity) or bupropion with naltrexone (Contrave).

Bupropion side effects

Common bupropion side effects

The most common side effects may include:

• dry mouth, sore throat, stuffy nose;
• ringing in the ears;
• blurred vision;
• nausea, vomiting, stomach pain, loss of appetite, constipation;
• sleep problems (insomnia);
• tremors, sweating, feeling anxious or nervous;
• fast heartbeats;
• confusion, agitation, hostility;
• rash;
• weight loss;
• increased urination;
• headache, dizziness; or muscle or joint pain.

Serious bupropion side effects

Get emergency medical help if you have any of these signs of an allergic reaction to bupropion: (hives, itching, fever, swollen glands, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, depression, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• a seizure (convulsions);
• confusion, unusual changes in mood or behavior;
• blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• fast or irregular heartbeats; or
• a manic episode – racing thoughts, increased energy, reckless behavior, feeling extremely happy or irritable, talking more than usual, severe problems with sleep.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects.

Warnings

You should not take bupropion if you have seizures, an eating disorder, or suddenly stopped using alcohol, seizure medication, or sedatives. You should not take two medicines together that contain bupropion for example, if you take Wellbutrin for depression, you should not also take Contrave for weight control.

Do not use bupropion within 14 days before or 14 days after you have used a MAO inhibitors , such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Some young people (up to 24 years of age) have thoughts about suicide when first taking this medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

You should know that your mental health may change in unexpected ways when you take bupropion or other antidepressants even if you are an adult over age 24 or if you do not have a mental illness and you are taking bupropion to treat a different type of condition. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

This medicine may cause seizures, especially in people with certain medical conditions or when using certain drugs. Tell your doctor about all of your medical conditions and the drugs you use.

Bupropion can cause mild pupillary dilation, which can lead to an episode of angle-closure glaucoma in susceptible individuals. Angle-closure glaucoma has occurred in patients with untreated anatomically narrow angles treated with antidepressants.

Before taking this medicine

Do not use this medicine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

You should not take this medicine if you are allergic to it or if you have ever had:

• a seizure disorder;
• an eating disorder such as anorexia or bulimia; or
• if you have suddenly stopped using alcohol, seizure medication, or a sedative (such as Xanax, Valium, Fiorinal, Klonopin, and others).

Do not take this medicine to treat more than one condition at a time. If you take bupropion for depression, do not also take this medicine to quit smoking or for weight management.

Tell your doctor about all of your medical conditions and the drugs you use.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• a head injury, seizures, or brain or spinal cord tumor;
• narrow-angle glaucoma;
• heart disease, high blood pressure, or a heart attack;
• diabetes;
• kidney or liver disease (especially cirrhosis);
• depression, bipolar disorder or other mental illness; or
• if you drink alcohol.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using this medicine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Pregnancy

Talk to your healthcare provider if you are pregnant or plan to become pregnant about the risk to your unborn baby. It is not known whether this medicine will harm an unborn baby. Tell your doctor right away if you become pregnant. Do not start or stop taking bupropion without your doctor’s advice.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of this medicine on the baby.

Breastfeeding

Tell your healthcare provider if you are breastfeeding or plan to breastfeed while taking this medicine. This medicine passes into breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with this medicine.

How should I take bupropion?

Take bupropion exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. Too much of this medicine can increase your risk of a seizure.

Do not crush, chew, or break tablets. Swallow the tablet whole.

Take bupropion with food if the medication upsets your stomach.

If you have trouble falling asleep or staying asleep, do not take tablets too close to bedtime.

Your doctor will probably start you on a low dose of this medicine and gradually increase your dose.

It may take 4 weeks or longer before you feel the full benefit of this medicine. Continue to take your tablets even if you feel well. Do not stop taking this medicine without talking to your doctor. Your doctor may decrease your dose gradually.

You should not change your dose or stop using bupropion suddenly unless you have a seizure while taking this medicine. Stopping suddenly can cause unpleasant withdrawal symptoms.

Ask your doctor how to stop using bupropion safely.

Some people taking bupropion have severe high blood pressure, especially when using a nicotine replacement product (patch or gum). Your blood pressure may need to be checked before and during treatment with this medicine.

This medicine can cause you to have a false positive drug screening test ( amphetamines). If you provide a urine sample for drug screening, tell the laboratory staff you are taking this medicine.

For smoking cessation.

If you take bupropion to help you stop smoking, you may continue to smoke for about 1 week after you start the medicine. Set a date to quit smoking during the second week of treatment. Talk to your doctor if you are having trouble quitting after you have used bupropion for at least 7 to 12 weeks.

Your doctor may prescribe a nicotine replacement product (such as patches or gum) to help you stop smoking. Start using the nicotine replacement product on the same day you stop (quit) smoking or using tobacco products.

You may have nicotine withdrawal symptoms when you stop smoking, including increased appetite, weight gain, trouble sleeping, trouble concentrating, slower heart rate, having the urge to smoke, and feeling anxious, restless, depressed, angry, frustrated, or irritated. These symptoms may occur with or without using medication such as bupropion.

Smoking cessation may also cause new or worsening mental health problems, such as depression.

Bupropion hydrochloride dosing information

Usual Adult Bupropion Dose for Depression:

Immediate-release tablets:

• Initial dose: 100 mg orally twice a day, increase if necessary after 3 days to 100 mg orally three times a day.
• Maintenance dose: 100 mg orally three times a day
• Maximum dose: 450 mg/day in up to 4 divided doses; single doses should not exceed 150 mg
• Immediate-release tablets should be given at least 6 hours apart.
• Dose increases of the immediate-release tablet should not exceed 100 mg per day in a 3-day period.

Sustained-release tablets:

• Initial dose: 150 mg orally once a day in the morning, increase if necessary after 3 days to 150 mg orally twice a day.
• Maintenance dose: 150 mg orally twice a day
• Maximum dose: 400 mg/day; maximum single dose should not exceed 200 mg
• Sustained-release oral tablets should be given at least 8 hours apart

Extended-release tablets:

• Initial dose: 150 mg orally once a day in the morning, increase if necessary after 4 days to 300 mg orally once a day.
• Maintenance dose: 300 mg orally once a day
• Maximum dose: 450 mg/day
• Extended-release oral tablets should be given at least 24 hours apart

Comments:

So as not to exceed the maximum single dose of 150 mg for immediate-release tablets, a dose of 100 mg orally four times a day (using the 100 mg tablet) may be administered.
Patients who are taking 300 mg/day for at least 2 weeks (OR are currently taking 450 mg/day) of any formulation may be switched to the extended-release 450 mg dose.
Bupropion hydrobromide 174 mg oral tablet is equivalent to bupropion hydrochloride 150 mg.
Patients should be periodically reviewed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Usual Adult Bupropion Dose for Seasonal Affective Disorder:

Extended-release tablets:

• Initial dose: 150 mg orally once a day in the morning, increased if necessary after 7 days to 300 mg orally once a day
• Maintenance dose: 150 to 300 mg orally once a day
• Maximum dose: 300 mg/day

Comments:

Treatment should be initiated in the autumn prior to the onset of depressive symptoms, continued through the winter season, and discontinued in early spring.
If bupropion hydrochloride 300 mg orally per day is not tolerated, it should be reduced to 150 mg once a day before discontinuing treatment.
Patients taking bupropion hydrochloride 300 mg orally per day during the autumn-winter season should have their dose tapered to 150 mg once a day for 2 weeks prior to discontinuation.
The timing of initiation and treatment duration for seasonal affective disorder should be individualized according to the patient’s historical pattern of seasonal major depressive episodes.

Usual Adult Dose for Smoking Cessation:

Sustained-release tablets:

• Initial dose: 150 mg orally once a day for 3 days, increased to 150 mg orally twice a day
• Maintenance dose: 150 mg orally twice a day
• Maximum dose: 300 mg/day; maximum single dose should not exceed 150 mg
• Duration of therapy: 7 to 12 weeks

Comments:
Begin dosing one week before quit day; the target stop date should be set within the first 2 weeks of treatment, preferably in the second week.
There should be an interval of at least 8 hours between doses.
May be used with a nicotine transdermal system.
If there is no effect after 12 weeks, treatment should be discontinued; longer treatment should be guided by the relative benefits and risks for the individual patient.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of bupropion can be fatal. Overdose symptoms may include muscle stiffness, hallucinations, fast or uneven heartbeat, shallow breathing, or fainting.

What to avoid

Drinking alcohol with bupropion may increase your risk of seizures. If you drink alcohol regularly, talk with your doctor before changing the amount you drink. This medicine can also cause seizures in people who drink a lot of alcohol and then suddenly quit drinking when they start using the medication.

Bupropion may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

What other drugs will affect bupropion?

You may have a higher risk of seizures if you use certain other medicines while taking bupropion.

Many drugs can interact with bupropion. Tell your doctor about all medicines you use, and those you start or stop using during your treatment. This includes prescription and over-the-counter medicines, vitamins, and herbal products.

Some examples of drugs that interact with bupropion are:

• Digoxin: May decrease plasma digoxin levels. Monitor digoxin levels
• MAOIs: Increased risk of hypertensive reactions can occur when used concomitantly with this medication.
• Drugs that lower seizure threshold: Dose bupropion with caution.
• Medicines that are CYP2B6 inducers: Dose increase may be necessary if coadministered with CYP2B6 inducers (e.g., ritonavir, lopinavir, efavirenz, carbamazepine, phenobarbital, and phenytoin) based on clinical response, but should not exceed the maximum recommended dose.
• Medicines metabolized by CYP2D6: Bupropion inhibits CYP2D6 and can increase concentrations of antidepressants (e.g., venlafaxine, nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline), antipsychotics (e.g., haloperidol, risperidone, thioridazine), beta-blockers (e.g., metoprolol), and Type 1C antiarrhythmics (e.g., propafenone, flecainide). A dose reduction of these medicines may be considered when used with bupropion.
• Dopaminergic drugs (levodopa and amantadine): CNS toxicity can occur when used concomitantly with this medicine.

Avonex is a disease-modifying therapy (DMT) used to treat relapsing multiple sclerosis (MS) in adults (including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease). Avonex injection (interferon beta-1a injection) is given intramuscularly (into a muscle), usually once weekly at bedtime.

For people living with MS, Avonex helps manage the disease by resembling the mechanism of action of interferons, which are proteins naturally produced by our immune system that help regulate the body’s immune response and fight viral infections.

• Avonex contains interferon beta 1-a, which is a man-made form of interferon that works in the same way, binding to specific receptors on cell surfaces and decreasing the activity of immune cells that attack the myelin sheath, reducing inflammation in the central nervous system, and helping to suppress the autoimmune response that characterizes MS.
• Avonex belongs to the drug class called interferons. It may also be called an immunomodulator.

Important: Avonex injection will not cure MS; it will only decrease the frequency of relapse symptoms.

Avonex (interferon beta-1a) gained FDA approval on May 17, 1996. There is no Avonex generic (more correctly called a biosimilar).

• Another form of interferon beta-1a, called Rebif, also used for MS, is given 3 times a week by subcutaneous (under the skin) injection.

Avonex and MS

Multiple sclerosis (MS) is an autoimmune disease that occurs when the immune system attacks the myelin sheath protecting nerve fibers, disrupting brain-body communication and causing MS symptoms like vision problems, muscle weakness, and coordination difficulties.

Avonex for MS addresses this disease process by modulating the immune response. The interferon beta-1a reduces immune attacks on myelin, decreases central nervous system inflammation, and prevents new MS lesions. For MS patients, this means fewer relapses, reduced disease activity, and slower disability progression.

Warnings

Liver Damage: Avonex injection can harm your liver. Call your doctor if you have symptoms such as nausea, loss of appetite, tiredness, confusion, easy bruising or bleeding, dark urine, clay-colored stools, or yellowing of your skin or eyes.

Mental Health: Some MS patients using interferon beta-1a have thoughts about suicide. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Before using Avonex injection, tell your doctor if you are allergic to any drugs, or if you have liver disease, a thyroid disorder, epilepsy or other seizure disorder, heart disease, chest pain (angina), congestive heart failure, a heart rhythm disorder, or a history of depression or suicidal behavior.

Before taking this medicine

Do not use Avonex injection if you are allergic to natural or recombinant interferon beta or albumin.

To make sure Avonex injection is safe for you, tell your doctor if you have:

• depression, mental illness, or suicidal thoughts or actions;
• liver disease;
• bleeding problems or a blood clot;
• low blood cell counts;
• heart disease;
• a thyroid disorder;
• a latex allergy;
• an autoimmune disorder such as rheumatoid arthritis, lupus, or psoriasis;
• a seizure; or
• if you drink alcohol.

Plasma-derived products: Some brands of interferon beta-1a contain donated human plasma and may contain viruses or other infectious agents. Donated plasma is tested and treated to reduce the risk of contamination, but there is still a small possibility it could transmit disease. Ask your doctor about any possible risks.

Tell your doctor if you are pregnant or plan to become pregnant, or if you are breastfeeding.

Interferon beta-1a is not approved for use by anyone younger than 18 years old.

How to Give an Avonex Injection

Use Avonex exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Avonex Injection Guidelines:

• Frequency: Once weekly at bedtime, on the same day each week (such as every Monday)
• Method: Intramuscular injection into a muscle
• Injection devices: Available as a prefilled syringe or a prefilled autoinjector pen
• Site rotation: Use a different place each time you give an injection.

Avonex Injection Site Safety:

• Injection site reactions can occur with Avonex injections, including injection site necrosis
• About 2 hours after the Avonex injection, check for skin redness, swelling, or pain
• Report immediately: Any break in skin with blue-black discoloration, swelling, or drainage
• Call your doctor if the injection site reaction doesn’t go away within a few days.

Storage Instructions:

• Store in refrigerator, protect from light, do not freeze
• Prefilled syringe/autoinjector: Remove 30 minutes before injection to reach room temperature
• Do not leave the prefilled syringe/autoinjector out of the refrigerator for longer than 7 days.

Avonex Side Effects

Get emergency medical help if you have signs of an allergic reaction to Avonex (hives, itching, anxiety, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Life-threatening blood clots: Interferon beta-1a can cause life-threatening blood clots in the small blood vessels inside your organs, such as your brain or kidneys. Seek medical help right away if you have symptoms of this condition, such as a fever, tiredness, decreased urination, bruising, or nosebleeds.

Call your doctor at once if you have:

• pain, swelling, bruising, redness, oozing, or skin changes where the injection was given;
• a light-headed feeling, like you might pass out;
• unusual changes in mood or behavior (feeling hopeless, anxious, nervous, irritable, or depressed);
• thoughts about suicide or hurting yourself;
• easy bruising, unusual bleeding;
• a seizure;
• heart problems – swelling, rapid weight gain, feeling short of breath, rapid heartbeats, chest pain spreading to your jaw or shoulder, nausea, sweating;
• liver problems – nausea, loss of appetite, tiredness, confusion, easy bruising or bleeding, dark urine, clay-colored stools, or jaundice (yellowing of your skin or eyes);
• signs of infection – fever, chills, cough with mucus, bloody diarrhea, pain or burning when you urinate; or
• thyroid problems – mood swings, trouble sleeping, tiredness, hunger, diarrhea, pounding heartbeats, muscle weakness, sweating, dry skin, thinning hair, menstrual changes, weight changes, puffiness in your face, feeling more sensitive to hot or cold temperatures
• breathing difficulties. Pulmonary arterial hypertension can occur with interferon beta products,
  including Avonex. Symptoms may include new or increasing fatigue or shortness of breath.

Common Avonex side effects may include:

• low blood cell counts;
• skin changes where the injection was given;
• depression;
• abnormal liver function tests;
• stomach pain; or
• flu symptoms – headache, fever, chills, chest pain, back pain, tiredness, weakness, muscle aches.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects.

Dosing Information

Usual Adult Maintenance Dose of Avonex for MS

• 30 mcg intramuscularly once a week.

Titrate the dose as follows to reduce the incidence and severity of influenza-like symptoms:

• Week 1: 7.5 mcg intramuscularly once weekly
• Week 2: 15 mcg intramuscularly once weekly
• Week 3: 22.5 mcg intramuscularly once weekly
• Week 4+: 30 mcg intramuscularly once weekly.

Available forms: Avonex injection is available as a single-dose prefilled syringe and single-dose prefilled autoinjector.

Missed Dose

Use the medicine as soon as you can, but do not inject Avonex two days in a row. Do not use two doses at one time.

Overdose

Seek emergency medical attention or call the Poison Help line .

What other drugs will affect Avonex?

Other drugs may interact with interferon beta-1a, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Avonex Injection Ingredients

Active ingredient: interferon beta-1a
Inactive ingredients: Avonex Single-Dose Prefilled Syringe: arginine hydrochloride, glacial acetic acid, polysorbate 20, sodium acetate trihydrate in water for injection.

Inactive ingredients: Avonex Single-Dose Prefilled Autoinjector Pen: arginine hydrochloride, glacial acetic acid, polysorbate 20, sodium acetate trihydrate in water for injection. 

Who makes Avonex?

Biogen Inc. makes Avonex.

Frequently Asked Questions

How long does it take for Avonex to work?

Avonex typically takes 3-6 months to show its full effect in reducing MS relapses. Some patients may notice improvements in fatigue and overall well-being within the first few weeks, but the medication’s primary benefit of reducing relapse frequency and slowing disability progression becomes more apparent over time. It’s important to continue treatment even if you don’t immediately notice changes, as the medication works to prevent future MS activity.

Can I travel with Avonex injections?

Yes, you can travel with Avonex, but it requires careful planning. Keep medication in its original packaging with prescription labels. For air travel, pack Avonex in carry-on luggage with a cooling pack (but not frozen). Bring a doctor’s letter explaining your medical need for the injection.

For international travel, research medication regulations in your destination country. Consider bringing extra supplies in case of delays. Avonex can be stored at room temperature for up to 7 days (prefilled syringe) or 30 days (vial) if refrigeration isn’t available.

What’s the difference between Avonex and Rebif?

Both Avonex and Rebif contain interferon beta-1a, but they differ in dosing and administration. Avonex is given once weekly by intramuscular injection (into the muscle), while Rebif is given three times weekly by subcutaneous injection (under the skin). Rebif typically has a higher cumulative weekly dose.

Both medications have similar effectiveness for MS treatment, but some patients may prefer the less frequent Avonex injections, while others may tolerate the smaller, more frequent Rebif doses better. Your neurologist can help determine which is best for your situation.

How can I manage flu-like symptoms from Avonex?

Flu-like symptoms are common, especially when starting Avonex, but usually improve over time. To minimize symptoms: take Avonex at bedtime so you sleep through the worst effects, pre-treat with over-the-counter pain relievers like acetaminophen or ibuprofen 30 minutes before injection and continue for 24 hours after, stay well-hydrated, use a heating pad for muscle aches, and ensure adequate rest.

The dose titration schedule (starting with lower doses) also helps reduce these symptoms. Most patients find flu-like effects diminish significantly after 2-3 months of treatment.

Can I drink alcohol while taking Avonex?

While there’s no absolute prohibition on alcohol with Avonex, you should use caution. Both Avonex and alcohol can affect liver function, so combining them may increase the risk of liver problems. Additionally, alcohol can worsen some MS symptoms like fatigue, balance problems, and depression. If you choose to drink, do so in moderation and discuss your alcohol consumption with your healthcare provider, especially if you have any liver function abnormalities or are taking other medications.

How to administer the Avonex injection?

Avonex is given by intramuscular injection, typically in the thigh (vastus lateralis muscle) or upper arm (deltoid muscle). Rotate between different sites to prevent tissue damage and injection site reactions.

For thigh injections, alternate between left and right thighs, and vary the exact location within each thigh. If using the upper arm, you may need assistance from someone else for proper injection technique.

Keep a record of injection sites to ensure proper rotation. Never inject into areas that are red, bruised, infected, or have scar tissue.

What blood tests do I need while taking Avonex?

Regular monitoring is essential while taking Avonex. Typical tests include: complete blood count (CBC) to check for low white blood cells, red blood cells, or platelets; liver function tests to monitor for hepatotoxicity; and thyroid function tests since Avonex can affect thyroid function. Initially, these tests may be done monthly for the first few months, then every 3-6 months once you’re stable. Your neurologist will determine the appropriate testing schedule based on your individual situation and any side effects you experience.

Can I get pregnant while taking Avonex?

If you’re planning to become pregnant or become pregnant while taking Avonex, discuss this immediately with your healthcare provider. Avonex is pregnancy category C, meaning effects on pregnancy aren’t fully known. Some studies suggest interferons may increase risk of miscarriage.

Your neurologist will weigh the benefits of continued MS treatment against potential risks to pregnancy. There are alternative MS treatments that may be safer during pregnancy. Don’t stop Avonex abruptly without medical supervision, as this could lead to MS relapses.

Is there financial assistance available for Avonex?

Yes, several options exist to help with Avonex costs. Biogen, the manufacturer, offers the Avonex Patient Support Program which may provide co-pay assistance for eligible patients with commercial insurance. The program may cover up to a certain amount per prescription.

Additionally, patient assistance programs are available for uninsured or underinsured patients who meet income requirements. The National MS Society also provides information about financial assistance programs. Contact Biogen’s patient support services or speak with your healthcare provider’s financial counselor to explore available options.

What should I do if I experience injection site reactions?

Mild injection site reactions (redness, swelling, pain) are common and usually resolve within a few days. Apply ice before injection and heat afterward to minimize discomfort. However, watch for signs of serious reactions: persistent pain, increasing redness or swelling after 2-3 days, skin breakdown or ulceration, blue-black discoloration, or drainage from the injection site. These could indicate injection site necrosis, which requires immediate medical attention.

Always rotate injection sites and never inject into irritated or damaged skin. If reactions persist or worsen, contact your healthcare provider.

Can I receive vaccines while taking Avonex?

Generally, inactivated (killed) vaccines are safe while taking Avonex, but live vaccines should typically be avoided as they may pose risks for people on immunomodulatory therapy. Common safe vaccines include the flu shot (inactivated), the pneumonia vaccine, and the hepatitis B vaccine.

However, timing and specific recommendations can vary. Always inform healthcare providers that you’re taking Avonex before receiving any vaccine. Your neurologist and primary care provider should coordinate your vaccination schedule to ensure optimal protection while maintaining MS treatment safety.

Avonex Biosimilars

Biosimilar and interchangeable products are biological products that are highly similar to and have no clinically meaningful differences from the reference product.

Reference products

These are biological products that have already been approved by the FDA, against which biosimilar products are compared. There are 2 for Avonex.Avonex (interferon beta-1a) – Biogen Inc.

Auvelity is a combination antidepressant medicine used to treat major depressive disorder (MDD) in adults. Auvelity contains dextromethorphan, an NMDA receptor antagonist, and bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI). 

Auvelity works by targeting multiple brain pathways involved in depression. Dextromethorphan works by blocking NMDA receptors, increasing the levels of glutamate, a chemical messenger (neurotransmitter),  to improve mood and brain connectivity. While bupropion helps dextromethorphan last longer in the body and increases dopamine and norepinephrine levels to improve depression symptoms.

Auvelity’s usual dose is 1 tablet taken once daily for 3 days, followed by 1 tablet twice daily, separated by at least 8 hours.  Tablets should be swallowed whole and not crushed or chewed.

Auvelity is a rapid-acting antidepressant that started working as early as 1 week, and patients’ depression symptoms continued to improve over time when compared to placebo in a 6-week clinical study for MDD (Study 1, NCT04019704).

Auvelity became an FDA-approved medicine on August 18, 2022, for adults with major depressive disorder (MDD).

How does Auvelity work?

Auvelity’s active ingredient, dextromethorphan, works as a N-methyl D-aspartate (NMDA) receptor antagonist and is also an agonist at the sigma-1 receptors. This helps to improve depressive symptoms by increasing glutamate levels, changing glutamate signalling, and regulating other neurotransmitters.

The second active ingredient, bupropion, helps dextromethorphan work more effectively by slowing how quickly it’s broken down in the body. It does this by blocking an enzyme called CYP2D6, allowing dextromethorphan to stay active longer. As a norepinephrine-dopamine reuptake inhibitor, bupropion also helps improve mood by increasing levels of dopamine and norepinephrine in the brain.

What is the cost of Auvelity?

The cost of prescription drugs varies depending on your insurance plan and which pharmacy you use. Refer to our price guide page for more information about the cost of Auvelity.

You may also be eligible for an Auvelity savings card or an Auvelity coupon. Ask your doctor or pharmacist if you qualify.

Auvelity side effects

Common Auvelity side effects

The most common Auvelity side effects include:

• dizziness
• diarrhea
• dry mouth
• excessive sweating
• headache
• feeling sleepy
• sexual function problems

Serious Auvelity side effects

Also, see Warnings.

Auvelity may cause serious side effects, including:

Seizures. There is a risk of seizures during treatment with this medicine. The risk is higher in people who:

• take higher doses of this medicine
• have certain medical problems
• take it with certain other medicines

Do not take Auvelity with other medicines unless your healthcare provider tells you to.
If you have a seizure during treatment, stop taking this medicine and call your healthcare provider right away. Do not take this medicine again if you have a seizure.

Increases in blood pressure (hypertension). Some people may get high blood pressure during treatment. Your healthcare provider should check your blood pressure before you start taking and during treatment.

Manic episodes. Manic episodes may happen in people with bipolar disorder who take Auvelity. Symptoms may include:

• greatly increased energy
• racing thoughts
• unusually grand ideas
• talking more or faster than usual
• severe trouble sleeping
• reckless behavior
• excessive happiness or irritability

Unusual thoughts or behaviors. One of the ingredients in Auvelity (bupropion), can cause unusual thoughts or behaviors, including delusions (believing you are someone else), hallucinations (seeing or hearing things that are not there), paranoia (feeling that people are against you), or feeling confused. If this happens to you, call your healthcare provider.

Eye problems (angle-closure glaucoma). Auvelity may cause a type of eye problem called angle-closure glaucoma in people with certain other eye conditions. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are. Call your healthcare provider if you have eye pain, changes in your vision, or swelling or redness in or around the eye.

Dizziness. this medicine may cause dizziness, increasing your fall risk.

Serotonin syndrome. A potentially life-threatening problem called serotonin syndrome can happen when you take Auvelity with certain other medicines. Call your healthcare provider or go to the nearest hospital emergency room right away if you have any of the following signs and symptoms of serotonin syndrome:

• agitation
• seeing or hearing things that are not there (hallucinations)
• confusion
• coma
• fast heartbeat
• changes in blood pressure
• dizziness
• sweating
• flushing
• high body temperature (hyperthermia)
• shaking (tremors), stiff muscles, or muscle twitching
• loss of coordination
• seizures
• nausea, vomiting, diarrhea