From the Guidelines
Bupropion is primarily indicated for major depressive disorder (MDD) and smoking cessation, with a recommended starting dose of 150 mg once daily, which can be increased to 300 mg daily if tolerated 1. The typical dosing guidelines for Bupropion are as follows:
- For depression, the immediate-release formulation starts at 150 mg once daily, potentially increasing to 300 mg daily (given as 100 mg three times daily) after several days if tolerated.
- For the sustained-release (SR) formulation, treatment begins with 150 mg once daily, potentially increasing to 150 mg twice daily.
- For the extended-release (XL) formulation, treatment starts at 150 mg once daily in the morning, with possible increase to 300 mg once daily after several days.
- For smoking cessation (as Zyban), the recommended regimen is 150 mg once daily for three days, then 150 mg twice daily for 7-12 weeks 1. Some important considerations when prescribing Bupropion include:
- Taking the medication with food to minimize gastrointestinal side effects
- Separating doses by at least 8 hours to reduce seizure risk
- Monitoring for common side effects such as insomnia, headache, dry mouth, and nausea
- Contraindications in patients with seizure disorders, current or prior diagnosis of bulimia or anorexia nervosa, and in those undergoing abrupt discontinuation of alcohol or sedatives. Additionally, Bupropion should be used with caution in patients with a history of seizures or with clinical factors that may increase the risk of seizures, and it is contraindicated in patients with epilepsy 1. It's also worth noting that Bupropion has been shown to be effective for the long-term treatment of recurrent major depression, and it may also be considered for patients in need of weight loss and assistance with smoking cessation 1.
From the FDA Drug Label
Bupropion hydrochloride extended-release tablets (XL) are indicated for the treatment of major depressive disorder (MDD), as defined by the Diagnostic and Statistical Manual (DSM) The efficacy of the immediate-release formulation of bupropion was established in two 4-week controlled inpatient trials and one 6-week controlled outpatient trial of adult patients with MDD Bupropion hydrochloride extended-release tablets (XL) are indicated for the prevention of seasonal major depressive episodes in patients with a diagnosis of seasonal affective disorder (SAD) The recommended starting dose for MDD is 150 mg once daily in the morning. After 4 days of dosing, the dose may be increased to the target dose of 300 mg once daily in the morning. The recommended starting dose for SAD is 150 mg once daily. After 7 days of dosing, the dose may be increased to the target dose of 300 mg once daily in the morning.
The indications for Bupropion are:
- Major Depressive Disorder (MDD): treatment of MDD, as defined by the Diagnostic and Statistical Manual (DSM)
- Seasonal Affective Disorder (SAD): prevention of seasonal major depressive episodes in patients with a diagnosis of SAD
The dosing guidelines for Bupropion are:
- MDD:
- Starting dose: 150 mg once daily
- Target dose: 300 mg once daily
- SAD:
- Starting dose: 150 mg once daily
- Target dose: 300 mg once daily
- Hepatic Impairment:
- Moderate to severe hepatic impairment: 150 mg every other day
- Mild hepatic impairment: consider reducing the dose and/or frequency of dosing
- Renal Impairment: consider reducing the dose and/or frequency of dosing 2 2 2
From the Research
Indications for Bupropion
- Bupropion is indicated for the treatment of major depressive disorder [(3,4,5,6)]
- It is also licensed for smoking cessation [(3,4)]
- Bupropion is used for the prevention of seasonal major depressive episodes in patients with seasonal affective disorder [(3,7)]
- It has demonstrated efficacy for attenuation of symptoms of attention deficit hyperactivity disorder 3
- Bupropion may have anti-inflammatory action against proinflammatory cytokines [(3,4)]
Dosing Guidelines for Bupropion
- The recommended dosage for bupropion is typically maintained at 450 mg/day or less in a divided schedule 6
- For smoking cessation, the twice-daily sustained-release formulation has been extensively evaluated 3
- Bupropion XL 150-300 mg daily by mouth has been used for the prevention of seasonal affective disorder 7
- Doses of 2.7g and upward can lead to seizures and cause encephalopathy and cardiovascular effects 5
- Patients with an increased risk of cardiovascular issues and seizures should be evaluated before starting the medication or increasing the dosage 5
Side Effects and Precautions
- Common side effects of bupropion include insomnia, headache, dry mouth, dizziness, and nausea [(3,4,6)]
- Bupropion is a cytochrome p450 2D6 inhibitor and care must be taken when coprescribing with drugs cleared by this enzyme 3
- It should not be combined with monoamine oxidase inhibitors 4
- Bupropion is relatively safe in overdose, but seizures are a concern [(4,5,6)]