Bupropion (Wellbutrin) treats major depressive disorder, seasonal affective disorder, and aids in smoking cessation. Although generally well-tolerated, a rash is an uncommon hypersensitivity reaction requiring prompt medical attention. Skin reactions can range from mild itching to severe, life-threatening conditions. Recognizing the signs and taking appropriate action is important for safe management.
Recognizing the Signs of a Wellbutrin Rash
A bupropion rash is an allergic reaction whose appearance varies significantly. Mild reactions often present as urticaria (hives), which are raised, itchy welts that may be red or skin-colored. Generalized redness, flushing, or mild skin itchiness are also signs of a mild allergic response, occurring in 1% to 4% of users.
The rash often has a delayed onset, appearing two to four weeks after starting the medication. Less common, moderate reactions can resemble a serum sickness-like reaction, involving fever, joint pain, muscle aches, and a widespread rash. Any new rash developing while taking bupropion should be reported to the prescribing physician immediately.
Immediate Home Management and Safety Steps
Upon noticing any skin changes, contact the prescribing healthcare provider immediately. Do not abruptly stop taking bupropion without consulting a medical professional, unless symptoms are severe, as sudden discontinuation can cause other effects. The physician will determine if the drug should be stopped or if the rash can be managed while continuing treatment.
While awaiting medical advice for a mild rash, over-the-counter interventions can provide symptom relief. Applying cool compresses helps soothe irritation and reduce redness. Taking an H1-antihistamine (e.g., cetirizine or loratadine) can lessen itching and reduce hives, though first-generation options like diphenhydramine may cause drowsiness. Calamine lotion can also be applied to soothe itchiness.
When to Seek Urgent Medical Attention
Severe, potentially life-threatening reactions require immediate emergency care (call 911 or go to the nearest emergency room). These symptoms progress rapidly and should not be waited out. Angioedema, or swelling of the face, lips, tongue, or throat, is a red flag that can quickly lead to difficulty breathing.
Watch for signs of severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN). These often begin with flu-like symptoms, including fever and body aches. The rash appears painful, spreading red or purple, and can develop into blisters causing the skin to peel. Blistering or sores on mucous membranes (mouth, eyes, or genital area) also demands emergency medical intervention.
Medical Management and Transitioning Off the Drug
Once a drug-induced rash is confirmed, the standard protocol is prompt discontinuation of bupropion. The healthcare team manages the process of stopping the drug and treating the allergic reaction. For mild to moderate reactions, a physician may prescribe stronger, prescription-strength antihistamines or a course of oral or topical corticosteroids to reduce inflammation.
Systemic corticosteroids, such as oral prednisone, are often used to treat more extensive rashes and are effective in resolving symptoms quickly. Patients with severe reactions like SJS or TEN are typically hospitalized, often in a burn unit, for aggressive supportive care and specialized wound management. After the rash resolves, the bupropion allergy must be documented in all medical records to prevent future exposure. The patient must then work with their prescriber to find an alternative medication, as re-challenging with bupropion is considered unsafe.