What should I do if I miss a dose of Bupropion (Wellbutrin)?

Management of Missed Bupropion Doses

If you miss a dose of bupropion (Wellbutrin), take the missed dose as soon as you remember it, but do not take an extra dose to make up for the missed dose. 1

Specific Guidelines for Missed Bupropion Doses

Immediate-Release Bupropion

• If you remember within a few hours: Take the missed dose
• If it's close to your next scheduled dose (within 2-3 hours): Skip the missed dose and continue with your regular dosing schedule
• Never double up on doses to "catch up" 1

Sustained-Release (SR) or Extended-Release (XL) Bupropion

• If you remember within the same day: Take the missed dose
• If you don't remember until the next day: Skip the missed dose and continue with your regular schedule
• Maintain at least 6 hours between doses to minimize seizure risk 1

Important Safety Considerations

Seizure Risk

• Bupropion carries a dose-related risk of seizures 1
• Taking extra doses or doubling up significantly increases this risk 2
• Research shows seizures occurred in 0.8% of patients who took extra doses, which is twice the rate seen with therapeutic dosing 2

Other Potential Adverse Effects from Extra Doses

• A study of 476 patients who took extra doses of bupropion found:
  • 38.4% experienced at least one adverse effect
  • Common effects included agitation (8.2%), dizziness (7.4%), tremor (7.1%), nausea/vomiting (6.7%), and tachycardia (5.5%) 2
  • Higher doses were associated with increased risk of adverse effects (p=0.045) 2

Special Populations and Considerations

Hepatic or Renal Impairment

• For patients with moderate to severe hepatic impairment: Maximum daily dose should not exceed 1 tablet daily 3
• For patients with moderate to severe renal impairment: Total daily dose should be reduced by half 3

Angle-Closure Glaucoma Risk

• Bupropion can cause mild pupillary dilation, which may trigger angle-closure glaucoma in susceptible individuals 1
• If you have glaucoma, consult your healthcare provider about missed doses

Common Pitfalls to Avoid

1. Never double doses - This significantly increases seizure risk and other adverse effects 1, 2
2. Don't abruptly discontinue - Missing multiple doses may lead to withdrawal symptoms; if you've missed several days, consult your healthcare provider about proper restarting 3
3. Avoid alcohol when restarting - Alcohol consumption increases seizure risk with bupropion 1
4. Don't crush or chew - Always swallow tablets whole, especially when restarting after missed doses 1

Prevention Strategies

• Use pill organizers or medication reminder apps
• Take medication at the same time each day
• Set alarms on your phone or watch
• Keep a medication log
• Store medication in a visible, consistent location 4

If you've missed multiple doses over several days, contact your healthcare provider for guidance on safely restarting your medication regimen rather than attempting to self-adjust your dosing.