What is the recommended dosage of Bupropion (Wellbutrin)?

From the Guidelines

The recommended dosage of Wellbutrin (bupropion) is typically started 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, divided into multiple doses with at least 8 hours between each, as indicated in the treatment of depression and other conditions 1. When considering the use of Wellbutrin, particularly in the context of obesity management as discussed in the study on naltrexone-bupropion ER 1, it's crucial to note that bupropion is a key component, and its dosage is critical for efficacy and safety.

• The dosage for sustained-release formulations (Wellbutrin SR) is usually targeted at 150 mg twice daily.
• For extended-release formulations (Wellbutrin XL), the typical dosage is 300 mg once daily in the morning. Key considerations include:
• Dosage adjustments for patients with liver or kidney impairment, who should generally start at lower doses.
• The mechanism of action involves inhibiting the reuptake of dopamine and norepinephrine in the brain, which helps improve mood and energy levels.
• Potential side effects include insomnia, dry mouth, headache, and an increased risk of seizures at higher doses, emphasizing the importance of not exceeding recommended doses and avoiding abrupt discontinuation 1. Given the information from the study on naltrexone-bupropion ER 1 and general knowledge about Wellbutrin, it is essential to follow the recommended dosage guidelines and monitor patients closely for adverse effects, especially in vulnerable populations such as those with a history of seizures or younger than 24 years, who may be at a higher risk of neuropsychiatric adverse effects 1.

From the FDA Drug Label

1. 6 Renal Impairment 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).
2. 7 Hepatic Impairment 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. In patients with mild hepatic impairment (Child-Pugh score: 5 to 6), consider reducing the dose and/or frequency of dosing [see Dosage and Administration (2.6) and Clinical Pharmacology (12.3)].

The dosage of Wellbutrin (bupropion) varies based on the patient's condition.

• For patients with renal impairment, a reduced dose and/or dosing frequency is recommended.
• For patients with hepatic impairment:
  • Moderate to severe (Child-Pugh score: 7 to 15): maximum dose is 150 mg every other day.
  • Mild (Child-Pugh score: 5 to 6): consider reducing the dose and/or frequency of dosing. However, the FDA label does not provide a standard dosage for patients without these conditions, so no conclusion can be drawn for the standard dosage of Wellbutrin. 2

From the Research

Wellbutrin Dosage

• Wellbutrin, also known as bupropion, is a medication used for smoking cessation and depression treatment 3, 4, 5, 6, 7
• The standard dosage of bupropion for smoking cessation is typically 150mg per day, taken orally 3, 4
• However, the dosage may vary depending on the individual's response to the medication and the presence of any side effects 5, 6
• Studies have shown that bupropion can be effective in reducing cravings and maintaining abstinence from smoking, especially when combined with other medications such as varenicline 3, 4, 5, 6
• It is essential to follow the prescribed dosage and treatment plan to minimize the risk of side effects and maximize the effectiveness of the medication 7

Combination Therapy

• Combination therapy with varenicline and bupropion has been shown to be effective in increasing smoking abstinence rates 5, 7
• However, this combination may also be associated with an increase in self-reported depressive symptoms, especially in the first two weeks of treatment 7
• Studies have found that the effects of combination therapy on depressive symptoms do not last beyond four weeks, and a history of depression does not moderate the efficacy of combination therapy for smoking abstinence 7

Side Effects and Efficacy

• Common side effects of bupropion include nausea, insomnia, anxiety, irritability, fatigue, and abnormal dreams 3, 4
• Despite these side effects, bupropion has been shown to be effective in reducing cravings and maintaining abstinence from smoking, especially when combined with other medications such as varenicline 3, 4, 5, 6
• Varenicline has been found to be more effective than bupropion in maintaining abstinence and reducing cravings, especially in patients with depressive symptoms 4, 6