What is the dosage of Bupropion (Wellbutrin)?

From the Guidelines

Wellbutrin (bupropion) dosing should be initiated at 150 mg once daily for 3-7 days, then increased to 150 mg twice daily if tolerated, with a maximum recommended dose of 450 mg per day, as supported by the most recent and highest quality study 1.

Key Considerations

• The dose should be separated by at least 8 hours to reduce seizure risk.
• For sustained-release (SR) formulations, dosing is typically 150 mg twice daily, while extended-release (XL) formulations are usually taken once daily in the morning at 150-300 mg.
• Lower doses are recommended for patients with liver or kidney impairment.
• Wellbutrin works by inhibiting the reuptake of dopamine and norepinephrine, which helps improve mood and energy levels.
• Side effects may include insomnia, dry mouth, headache, and agitation.

Important Safety Information

• Bupropion is contraindicated for patients with seizure risks, those taking MAO inhibitors, or those with closed-angle glaucoma.
• Patients should be observed for neuropsychiatric adverse effects, including suicidal thoughts and behaviors, especially in individuals younger than 24 years.
• Vital signs should be monitored in patients treated with bupropion, and it should be avoided in patients with uncontrolled hypertension.

Clinical Guidance

• The medication should be discontinued if the patient has not lost 5% of their total body weight after 12 weeks of therapy on the maintenance dose.
• Bupropion may be considered for patients in need of weight loss and assistance with smoking cessation, as supported by studies 1 and 1.
• It is essential to take Wellbutrin exactly as prescribed and not to adjust the dose without consulting a healthcare provider, as improper dosing can increase seizure risk.

From the FDA Drug Label

In the first study, the bupropion dose range was 300 mg to 600 mg per day administered in 3 divided doses; 78% of patients were treated with doses of 300 mg to 450 mg per day. The second study included 2 fixed doses of bupropion (300 mg and 450 mg per day) and placebo. In the third study, outpatients were treated with bupropion 300 mg per day The initial bupropion dose was 150 mg once daily for 1 week, followed by up-titration to 300 mg once daily. Patients who were deemed by the investigator to be unlikely or unable to tolerate 300 mg once daily were allowed to remain on, or had their dose reduced to, 150 mg once daily Consider a reduced dose and/or dosing frequency of bupropion hydrochloride extended-release tablets (XL) in patients with renal impairment (glomerular filtration rate: <90 mL/min). In patients with moderate to severe hepatic impairment (Child-Pugh score: 7 to 15), the maximum bupropion hydrochloride extended-release tablets (XL) dose is 150 mg every other day.

The dose of Wellbutrin (bupropion) can vary depending on the patient and the condition being treated.

• The typical dose range is 300 mg to 600 mg per day, administered in divided doses.
• The initial dose is often 150 mg once daily, which can be increased to 300 mg once daily after one week.
• Patients with renal impairment may require a reduced dose and/or dosing frequency.
• Patients with hepatic impairment may require a reduced dose, with a maximum dose of 150 mg every other day for those with moderate to severe impairment 2, 2, 2.

From the Research

Bupropion Dosing for Smoking Cessation

• The typical dose of bupropion for smoking cessation is 300 mg/day, as seen in studies 3, 4, 5, 6.
• In one study, bupropion was started at 150 mg/day and increased to 300 mg/day 3.
• The duration of treatment varies, but common durations are 7-12 weeks 5, 6.
• One study found that highly nicotine-dependent smokers who received bupropion were more likely to experience a decrease in depressive symptoms during active treatment, but also more likely to experience a rebound in depressive symptoms when bupropion was discontinued 7.

Efficacy of Bupropion for Smoking Cessation

• Bupropion has been shown to be effective for smoking cessation, with high-certainty evidence that it increases long-term smoking cessation rates 5, 6.
• The efficacy of bupropion is comparable to other smoking cessation treatments, such as nicotine replacement therapy (NRT) and varenicline 5, 6.
• However, bupropion may be less effective than combination NRT and varenicline 6.

Safety and Tolerability of Bupropion

• Bupropion has been associated with an increased risk of adverse events, including psychiatric adverse events 5, 6.
• There is moderate-certainty evidence that bupropion may increase the risk of serious adverse events, but the results are imprecise 6.
• Bupropion has also been associated with an increased risk of trial dropouts due to adverse events 5, 6.