What is the recommended dosing for Sari to augment with Wellbutrin (bupropion)?

Recommended Dosing for Trazodone (Sari) Augmentation with Bupropion (Wellbutrin)

For trazodone augmentation with bupropion, start with trazodone 50-100 mg at bedtime and bupropion SR 100-150 mg in the morning, with potential titration of bupropion to 100-150 mg twice daily (maximum 300 mg/day) based on response and tolerability. 1

Dosing Guidelines

Bupropion (Wellbutrin) Dosing

• SR (Sustained Release) formulation:

  • Starting dose: 100-150 mg once daily in the morning 1
  • Maintenance dose: 100-150 mg twice daily 1
  • Maximum daily dose: 300 mg per day (divided doses) 1

• XL (Extended Release) formulation:

  • Starting dose: 150 mg once daily in the morning 1
  • Maintenance dose: 150-300 mg once daily 1
  • Maximum daily dose: 450 mg per day 1

Trazodone (Sari) Dosing for Augmentation

• Starting dose: 50-100 mg at bedtime
• Titration: Increase by 50 mg increments every 3-7 days as needed
• Typical augmentation dose range: 50-200 mg at bedtime

Clinical Considerations

Benefits of This Combination

• Complementary mechanisms of action:
  • Bupropion: Dopamine/norepinephrine reuptake inhibitor 2
  • Trazodone: Serotonin antagonist and reuptake inhibitor
• Trazodone can help manage insomnia that may occur with bupropion 3
• Bupropion's activating properties balance trazodone's sedating effects 3

Timing of Administration

• Bupropion SR: Morning dose and second dose (if applicable) before 3 PM to minimize insomnia 3
• Trazodone: Administer at bedtime to leverage sedating properties

Monitoring Parameters

• Assess for improvement in target symptoms after 4-6 weeks 1
• Monitor for side effects:
  • Insomnia, agitation, dry mouth (bupropion)
  • Sedation, orthostatic hypotension (trazodone)
  • Seizure risk (both medications, though low incidence)

Contraindications and Precautions

• Absolute contraindications:

  • Seizure disorders
  • Current or prior diagnosis of bulimia or anorexia nervosa
  • Concurrent use of MAOIs 3
  • Abrupt discontinuation of alcohol or sedatives

• Use with caution in:

  • Patients with history of cardiovascular disease
  • Renal or hepatic impairment (may require dose adjustment)
  • Elderly patients (start with lower doses)

Special Populations

Elderly

• Start with lower doses of both medications
• Bupropion SR: Start with 100 mg once daily
• Trazodone: Start with 25-50 mg at bedtime

Renal/Hepatic Impairment

• Bupropion: Reduce dose in moderate to severe impairment
• Trazodone: Start at lower doses and titrate slowly

Discontinuation Criteria

• If inadequate response after 6-8 weeks at optimal doses
• If intolerable side effects occur
• For bupropion SR/XL: Consider discontinuation if <5% improvement in target symptoms after 12 weeks 1

Potential Drug Interactions

• Monitor for increased risk of seizures when combining these medications
• Avoid alcohol consumption which may increase CNS depression with trazodone and seizure risk with bupropion
• Use caution with other medications that lower seizure threshold

This combination leverages the activating properties of bupropion with the sedating effects of trazodone, potentially addressing both daytime energy/motivation and nighttime sleep issues while minimizing the sexual side effects often seen with other antidepressant combinations.