From the FDA Drug Label
2.5 To Discontinue Bupropion Hydrochloride Extended-Release Tablets (XL), Taper the Dose When discontinuing treatment in patients treated with bupropion hydrochloride extended-release tablets (XL) 300 mg once daily, decrease the dose to 150 mg once daily prior to discontinuation.
To wean off bupropion, the dose should be tapered. For patients taking 300 mg per day, the dose should be decreased to 150 mg once daily before discontinuation.
There is no information provided about Pristiq in the given drug labels.
From the Research
Weaning off Pristiq and Bupropion should always be done under medical supervision, with a recommended gradual reduction in dose over several weeks to months, prioritizing Pristiq due to its higher withdrawal potential, as supported by the most recent study 1. When considering the tapering process, it's essential to understand that both medications affect neurotransmitters like serotonin, norepinephrine, and dopamine, and abrupt discontinuation can lead to significant withdrawal symptoms and potential mood destabilization. The tapering schedule should be personalized, but a general approach is to reduce Pristiq by 25mg every 2-4 weeks and Bupropion by 50-75mg every 2-4 weeks, using pill cutters or lower-dose prescriptions as needed. Key points to consider during the tapering process include:
- Monitoring for withdrawal symptoms like dizziness, headaches, irritability, nausea, or mood changes
- Slowing the tapering schedule if withdrawal symptoms occur
- Reducing only one medication at a time, starting with Pristiq
- Consulting with a healthcare provider before beginning the tapering process, as individual factors may require personalized adjustments. According to 2, gradual dose reduction over days to weeks reduces the risk and severity of complications, and conservative switching strategies involve gradually tapering the first antidepressant followed by an adequate washout period before the new antidepressant is started. However, the most recent and highest-quality study 1 emphasizes the importance of gradual tapering and personalized approaches, highlighting the need for better guidance and randomized trials investigating interventions for discontinuing or tapering antidepressants.