What is the maximum recommended daily dose of Wellbutrin (bupropion)?

Maximum Daily Dose of Wellbutrin (Bupropion)

The maximum recommended daily dose of Wellbutrin (bupropion) is 450 mg per day. 1

Formulation-Specific Dosing

Wellbutrin comes in different formulations, each with specific dosing recommendations:

Sustained-Release (SR) Formulation

• Starting dose: 100-150 mg once daily
• Maintenance dose: 100-150 mg twice daily
• Maximum dose: 400 mg daily (divided doses) 2

Extended-Release (XL) Formulation

• Starting dose: 150 mg once daily
• Maintenance dose: 150-300 mg once daily
• Maximum dose: 450 mg once daily 1

Dose Titration and Safety Considerations

Bupropion should be titrated gradually to minimize the risk of adverse effects, particularly seizures. The most serious adverse effect associated with bupropion is seizures, which is dose-related and more likely to occur at doses exceeding the maximum recommended daily dose 3.

Important Safety Considerations:

• Seizure risk: The risk of seizures increases significantly at doses above 450 mg daily 4
• Psychiatric effects: Higher doses may trigger manic episodes in susceptible individuals, particularly those with bipolar disorder 4
• Dystonic reactions: Dose-related dystonic reactions have been reported with bupropion, including neck stiffness, trismus, and temporomandibular joint pain 5

Special Populations

Patients with Renal Impairment

• For moderate to severe renal impairment: Total daily dose should be reduced by half 1
• For end-stage renal disease: Bupropion should be avoided 1

Patients with Hepatic Impairment

• For moderate to severe hepatic impairment: Total daily dose should not exceed 150 mg daily 1

Clinical Response Assessment

If a patient has not achieved adequate response after 12 weeks on the maintenance dose:

• For naltrexone-bupropion combination therapy: If 5% weight loss is not achieved after 12 weeks, discontinuation should be considered 1
• For depression treatment: Clinical response is typically seen within 2-4 weeks, with full efficacy attained at 4 weeks 3

Common Pitfalls to Avoid

1. Exceeding maximum dose: Never exceed 450 mg daily due to significantly increased seizure risk
2. Rapid titration: Always titrate gradually to minimize adverse effects
3. Concomitant medications: Avoid using with MAOIs or within 14 days of discontinuing MAOIs 1
4. Late-day dosing: For SR formulations, avoid taking the second dose late in the day to minimize insomnia 1
5. Use in contraindicated conditions: Avoid in patients with seizure disorders, eating disorders, or during abrupt discontinuation of alcohol or sedatives 1

Bupropion's unique mechanism of action (affecting norepinephrine and dopamine with minimal serotonergic effects) makes it a valuable option for depression treatment, particularly for patients who experience sexual dysfunction or weight gain with other antidepressants 3.