From the Research
Bupropion dose should be reduced in patients with moderate to severe chronic kidney disease (CKD). For patients with moderate renal impairment (GFR 30-59 mL/min), the recommended dose is 150 mg once daily. For severe renal impairment (GFR <30 mL/min), the dose should be further reduced to 150 mg every other day. No dose adjustment is typically needed for mild renal impairment. This dose reduction is necessary because bupropion and its metabolites are primarily excreted through the kidneys, and impaired kidney function leads to decreased drug clearance and potential accumulation of the medication and its metabolites, as shown in a study on the effect of renal impairment on bupropion pharmacokinetics 1. Accumulation can increase the risk of adverse effects, particularly seizures, which are a dose-dependent risk with bupropion.
Key Considerations
- Patients with CKD should be monitored closely for side effects such as insomnia, headache, dry mouth, nausea, dizziness, and agitation.
- If side effects occur despite dose reduction, further decreasing the dose or switching to an alternative medication may be necessary.
- Always start with lower doses in CKD patients and titrate slowly based on response and tolerability.
- A study on antidepressants for depression in stage 3-5 chronic kidney disease found that dose reduction in CKD3-5 is necessary for bupropion, among other medications 2.
- Another study highlighted the importance of considering kidney function when prescribing medications like bupropion, especially in middle-aged and older patients 3.
Dosing Recommendations
- For moderate renal impairment (GFR 30-59 mL/min): 150 mg once daily.
- For severe renal impairment (GFR <30 mL/min): 150 mg every other day.
- For mild renal impairment: no dose adjustment typically needed.
Monitoring and Titration
- Monitor patients closely for side effects and adjust the dose as needed.
- Titrate the dose slowly based on response and tolerability.
- Consider alternative medications if side effects persist despite dose reduction.