From the Guidelines
Bupropion SR is not specifically FDA-approved for weight loss, but when used off-label for this purpose, it is typically prescribed at a dose of 300-400 mg daily, divided into two doses. The dosage and usage of bupropion (Wellbutrin) SR for weight loss should be approached with caution, considering the potential side effects and interactions. According to the most recent guidelines, including the 2022 AGA clinical practice guideline on pharmacological interventions for adults with obesity 1, bupropion is often used in combination with naltrexone for weight loss, but as a single agent, its dosage for weight loss is not explicitly defined in the context of FDA approval for this specific use. However, based on its use for depression and smoking cessation, where it is prescribed at similar doses, the recommended dosage for off-label use in weight loss is typically 300-400 mg daily, divided into two doses. It's crucial to start with a lower dose, such as 150 mg once daily, for the first 3-7 days to minimize side effects before increasing to the target dose. Bupropion works by affecting brain neurotransmitters like dopamine and norepinephrine, which can reduce appetite and food cravings. Common side effects include insomnia, dry mouth, headache, and anxiety, and it is contraindicated in patients with seizure disorders, eating disorders, or those taking MAO inhibitors. Weight loss results vary significantly between individuals, and bupropion should be used as part of a comprehensive weight management program that includes diet and exercise, under medical supervision, due to its off-label use for weight loss. Key considerations include monitoring for neuropsychiatric adverse effects, especially in younger individuals, and being cautious with its use in patients with uncontrolled hypertension or those requiring opiate therapy. Given the lack of long-term cardiovascular outcome data for bupropion when used for weight loss, careful patient selection and monitoring are essential. In summary, while bupropion SR can be considered for weight loss off-label, its use should be carefully managed, with attention to potential side effects, interactions, and the need for comprehensive weight management strategies.
From the FDA Drug Label
Table 5: Incidence of Weight Gain or Weight Loss (≥5 lbs) in MDD Trials Using Bupropion HCl Sustained-Release Weight Change Bupropion HCl Sustained- Release 300 mg/day (n=339) Bupropion HCl Sustained- Release 400 mg/day (n=112) Placebo (n=347) Gained >5 lbs 3% 2% 4% Lost >5 lbs 14% 19% 6%
The dosage and usage of bupropion (Wellbutrin) SR for weight loss is not explicitly stated in the label for this specific purpose.
- Dosage: The label mentions dosages of 300 mg/day and 400 mg/day for MDD trials.
- Usage: The label presents the incidence of body weight changes in MDD and SAD trials, showing a dose-related decrease in body weight. However, the label does not provide direct guidance on using bupropion SR for weight loss. 2
From the Research
Dosage and Usage of Bupropion SR for Weight Loss
- The dosage of bupropion SR for weight loss is not explicitly stated in the provided studies, but it is mentioned that therapeutic doses of bupropion SR were well tolerated and clinically efficacious at total daily doses up to 300 mg/day 3.
- A study comparing the efficacy and safety of 150 and 300 mg/d sustained-release bupropion tablets versus placebo in depressed outpatients found that both bupropion SR treatments were more effective in relieving the symptoms of depression than was placebo, and a greater mean weight loss was observed at the end of treatment in both the bupropion SR 150-mg and bupropion SR 300-mg groups compared with placebo 4.
- Another study found that bupropion SR 300 mg/d was associated with significantly greater short-term weight loss in overweight and obese women with binge-eating disorder, with a mean weight loss of 1.8% vs 0.6% BMI loss compared with placebo 5.
- The relationship between early weight loss and weight loss at 1 year with naltrexone ER/bupropion ER combination therapy was also studied, and it was found that participants who achieved a weight loss of at least 5% at Week 16 were likely to maintain clinically significant weight loss after 1 year of treatment 6.
Usage of Bupropion SR for Weight Loss
- Bupropion SR was initiated at 50 mg b.i.d. and increased to a maximum of 150 mg b.i.d. unless not tolerated in a study of depressed patients without a current or past diagnosis of an eating disorder and with no personal or family history of seizure disorders 3.
- In another study, bupropion SR was initiated at 100 mg once daily and increased at weekly intervals to a maximum of 150 mg twice daily as clinically indicated in elderly depressed subjects with medical comorbidity 7.
- Bupropion SR was well tolerated and produced significantly greater short-term weight loss in overweight and obese women with binge-eating disorder, but it did not improve binge eating, food craving, or associated eating disorder features or depression relative to placebo 5.