Tapering Bupropion XL from 300mg to 150mg Daily
The recommended approach for tapering Wellbutrin XL from 300mg to 150mg daily is to decrease directly to 150mg once daily for at least one week before further reduction or discontinuation. 1
Evidence-Based Tapering Protocol
According to the FDA drug label for bupropion XL, when discontinuing treatment in patients on 300mg daily, the dose should be decreased to 150mg once daily prior to discontinuation 1. This same principle applies when reducing the dose from 300mg to 150mg daily:
- Reduce from 300mg XL once daily to 150mg XL once daily
- Continue taking the medication in the morning as previously prescribed
- Take with or without food, but swallow the tablet whole (do not crush, divide, or chew)
Rationale for This Approach
Bupropion XL is formulated specifically for once-daily dosing, with pharmacokinetics designed to deliver the medication gradually throughout the day 2. The extended-release formulation eliminates the need for a more gradual tapering schedule that might be required with immediate-release formulations.
Monitoring During Dose Reduction
- Watch for potential withdrawal symptoms or return of depressive symptoms during the first 1-2 weeks after dose reduction
- Common side effects that may occur during dose changes include insomnia, headache, dry mouth, and anxiety 3
- These symptoms are generally transient and often resolve without intervention
Important Considerations and Precautions
- Seizure risk: Bupropion is associated with a dose-dependent risk of seizures (approximately 0.1% at therapeutic doses) 4, 3
- Timing: Take the medication in the morning to minimize risk of insomnia 5
- Medication interactions: If you're taking other medications, particularly MAOIs, special precautions are needed 1
- Avoid abrupt discontinuation: While the step from 300mg to 150mg is considered appropriate, further reduction below 150mg should also be done gradually if needed in the future 1
Special Situations
- Hepatic impairment: If you have moderate to severe liver impairment, the maximum dose should be 150mg every other day 1
- Renal impairment: Consider more gradual dose reduction if you have kidney impairment 1
- Bipolar disorder: Monitor closely for manic symptoms during dose changes 6
This tapering schedule balances the need to minimize withdrawal effects while maintaining a straightforward approach that aligns with the medication's pharmacokinetic properties and FDA recommendations.