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Wellbutrin SR vs. Wellbutrin XL

Discussion in 'Pharmacy' started by geekinthepink, 10.25.07.

  1. geekinthepink

    geekinthepink Miraz!!

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    A physician called our pharmacy today asking us about the difference between Wellbutrin SR and Wellbutrin XL. The pharmacist told him that the main difference was that XL was typically prescribed only once daily versus twice daily for the SR.

    I'm often confused about the XL's and the SR's of the pharmacy world so I did some research to clarify the difference between these two.

    It looks like SR is approved for smoking cessation and XL is not. Also, it lists XL as being approved for Seasonal Affective Disorder, but not SR. Are these differences in approval just due to the fact that studies were done for the specific dosage form and perhaps not on the other? It seems to me that if XL would work for a disorder that SR would probably also work for that disorder, but that maybe noone has done a study to prove that specifically.

    What are the side effect profiles like? I would think they are most likely similar, but maybe since the SR is often split into twice daily dosing it has slightly less SE's?

    Anyone know any other specifics on the differences between these two drugs? Would you recommend one over the other?
  2. Old Timer

    Old Timer SDN Advisor SDN Advisor

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    The first thing you have to know is that XL, SR, CR, CD, TR, LA and other abbreviations for long acting medications have no scientific foundations. They are whatever the manufacturer wants them to be.

    No matter what anyone tells you, the reason there is a Wellbutrin XL is because there is a generic for Wellbutrin SR. If there were no generic SR, there never would have been an XL. This is the game drug companies play. Did you know Nexium ("The Little Purple Pill") is only 3% more effective than Prilosec. Did you also know Nexium came out a few months before the generic for Prilosec, what a coincidence.

    So while I have no studies to back me up, I would wager a jelly donut there is no clinical significance between Wellbutrin XL and Wellbutrin SR. where efficacy is concerned.

    If you want to know about drug companies, please watch this video.
  3. BMBiology

    BMBiology on maternity leave (again)

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    According to the Pharmacist's Letter, the consensus is that there's no difference, clinically.

    "Many patients and health professionals are hearing that Nexium is more effective than the other proton pump inhibitors...Prilosec (omeprazole)...Prevacid (lansoprazole)...Aciphex (rabeprazole)...Protonix (pantoprazole).

    Nexium (esomeprazole) contains just the S-isomer of omeprazole. Prilosec contains both R- and S-isomers.

    Compared to omeprazole, Nexium is metabolized slower...and suppresses acid longer. But don't count on these differences resulting in improved outcomes.
    Both Nexium and Prilosec heal erosive esophagitis in about 90% of patients after 8 weeks of treatment.

    Some drug reps might tell you that Nexium works FASTER than Prilosec. There is some evidence that Nexium works slightly faster than Prilosec. This isn't surprising since these studies used double the dose of Nexium...Nexium 40 mg daily compared with Prilosec 20 mg daily. Most experts agree that ALL of the PPIs are similarly effective. If patients are doing fine on one PPI, there's no clinically important reason to switch.

    American Gastroenterological Association. American Gastroenterological Association Consensus on GERD Management. November 14, 2002. Available at www.gastro.org/public/media/newsreleases/GERD-Nov02.html"
  4. njac

    njac Senior Member

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    I'm told XL does last longer and I know people who choose to go SR rather than XL so they can skip a dose if they get tachycardic or shaky.
  5. geekinthepink

    geekinthepink Miraz!!

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    I thought this might be the case. Darn drug companies trying to make a buck! :laugh: :smuggrin:

    This makes good sense.

    Do you ever see patients taking SR on a regular once daily schedule due to the SE profile?
  6. Epic

    Epic Removed

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    That is the truest.

    Ambien & Ambien CR. Ambien goes generic.. so Sanofi decides "we must continue our revenue from Ambien.." so here comes Ambien CR (Continuous Revenue)
  7. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Drug companies suck. The whole Nexium - Prilosec debate with customers kills me. Oh, that OTC stuff doesn't work I need Nexium. I do not even bother trying to explain the difference any more.

    I still have the physicians letter from a few years ago that summarizes a study comparing generic Prozac to all the new brand name only SSRI's. The bottomline was they found no difference in effectiveness between fluoxitine and all the other newer brand name SSRI's.
  8. alwaystired

    alwaystired

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    mmm. I think I'm going to go get a jelly donut. thanks!
  9. njac

    njac Senior Member

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    Right but with SSRIs aren't the SE profiles better with the newer agents? By newer I'm talking Citalopram (generic) rather than stuff that isn't generic yet (Lexapro, Cymbalta).

    Even if the efficacy is the exact same, if the side effects are miserable, compliance will be better with the drug with fewer SE.
  10. Epic

    Epic Removed

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    So what's the deal with New Mexico...I'm getting urgent emails and solicitations.. for pharmacists in New Mexico...
  11. SexyPlexi

    SexyPlexi

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    I take Nexium...maybe I should try Prilosec. I have so many other prescriptions, it would be good to reduce the cost some. I didn't realize Prilosec worked practically just as well. I wonder if it matters if the cause of indigestion is the effect of another medication...

    Gotta love that...they give you meds to combat the side effects of the original meds. :rolleyes:
  12. eeyore spice

    eeyore spice

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    According to some people who've been switched from one to the other, there's a noticeable difference, and apparently NOT something psychosomatic.

    Maybe a difference in the rate/duration of release? Excipients? *shrug*
  13. njac

    njac Senior Member

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    well, it sucks here.

    actually, it could be worse. it's cheap to fly in and out of.

    of course pharmacists should want to work here. I can be their intern!
  14. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    If I may be unsensitve for a moment I believe most people who use antidepressants are suffering from a psychosomatic problem. They would probably do just as well on a sugar pill if you told them it was the latest greatest drug.
  15. Old Timer

    Old Timer SDN Advisor SDN Advisor

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    No the patient may notice a difference. The release and duration are different, but they will adjust over time.. What you have to note is you have 1000 depresses patients and 500 get XL and and 500 get SR, the success rate will be the same. NO clinical significance.....
  16. RX CARE

    RX CARE Eye Have You!!

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    Uuuhm....I don't think that is necessarily true. I do agree that drug companies will play games to keep making profit by changing the dosage form, however they already hold a patent to the name and design of the drug, so they can redesign the drug whenever they feel like it. But xl,sr,cr,cd,xr,la are not all the same. They have different pharmacokinetics. Some fall under the same category, but it really is not just a name. They are distinguished by what are called "delivery systems", according to their pharmacokinetics....e.g SR and CR are called 2nd generation delivery systems and have a hyperbolic curve because they cannot control their own bioavailability, while XL, XR and LA are 3rd generation delivery systems because they have a zero-order rate, which kinda rises..then plateaus....indicating a constant serum level for a significant period of time......anyway I hope i'm not ranting......just trying to make a point that it not just about picking any of those from a random ballot box and sticking it on the label....if that was the case, the every manufacturer would just stick an extra cool sounding xr or cr to the name of their drug going generic, just to get a new patent and make profits, since they have no scientific basis. I'm pretty sure there would have been A LOT more drug on our shelves....
  17. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Uhhhh...thats exactly what the do.
  18. Old Timer

    Old Timer SDN Advisor SDN Advisor

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    Bingo, we have a winner.....
  19. RX CARE

    RX CARE Eye Have You!!

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    Yea...that might be the case but the design of the drug is changed as well. There may or may not be a change in therapeutic level of the drug but the kinetics of the drug is changed as well. That is why new indications sometimes come up with the new drug according to therapeutic experiences, due to the change in bioavailability of the drug.
    ..I still am not denying that drug companies push for profits. But to say that a company just places a suffix to the drug name without any scientific foundations or change is not correct.. and I hope any pharmacists do not really believe that....:oops:. All I'm trying to point out is that there is in fact a scientific change...and I am not debating whether there is a change in efficacy or not. It's subjectively based on the drug.
  20. geekinthepink

    geekinthepink Miraz!!

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    Along the same lines... Are budeprion and bupropion the same thing??
  21. geekinthepink

    geekinthepink Miraz!!

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    A classmate just told me that budeprion is actually a "branded-generic" of Wellbutrin. Now it's all becoming clear! :laugh:
  22. Old Timer

    Old Timer SDN Advisor SDN Advisor

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    What I'm saying is there is no official designation by the FDA or the USP or any official body to determine what these abbreviations mean. They are what the drug companies say they are. There is also usually very little. if any, clinical significance between the various dosage forms. The reason you know that is the timing of their release. They are always released just before the generic of the earlier version comes out.....

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