How long should a patient take the lower dose of bupropion (Wellbutrin) before stopping completely?

Tapering Bupropion (Wellbutrin) Before Discontinuation

When discontinuing bupropion, patients should taper by reducing to 150 mg once daily for 1-2 weeks before complete discontinuation to minimize withdrawal symptoms and neuropsychiatric side effects. 1

Recommended Tapering Protocol

The FDA-approved drug label for bupropion provides clear guidance on discontinuation:

1. For patients on 300 mg daily: Decrease to 150 mg once daily for 1-2 weeks before complete discontinuation 1
2. For patients already on 150 mg daily: May discontinue directly, though some clinicians still recommend taking the medication every other day for 1 week before stopping completely

Rationale for Tapering

Tapering bupropion is important for several reasons:

• Neuropsychiatric symptoms: Abrupt discontinuation may increase the risk of developing or worsening neuropsychiatric symptoms including depression and suicidal ideation 2, 3
• Withdrawal symptoms: Though less common than with SSRIs, some patients may experience withdrawal effects including irritability, anxiety, and mood disturbances
• Seizure risk: Bupropion carries a seizure risk (0.1% at therapeutic doses), and abrupt discontinuation could theoretically increase this risk in susceptible individuals 3

Monitoring During Tapering

During the tapering period, patients should be monitored for:

• Development or worsening of neuropsychiatric symptoms 2, 3
• Cognitive changes, as bupropion can affect concentration and memory 3
• Return of original symptoms (depression, if being used as an antidepressant, or nicotine cravings if used for smoking cessation) 2

Special Considerations

For Patients with Hepatic Impairment

• Patients with moderate to severe hepatic impairment already taking a reduced dose (150 mg every other day) should maintain this schedule for 1-2 weeks before stopping 1

For Patients with Renal Impairment

• Patients with renal impairment may need a more gradual taper due to altered drug clearance 1

Common Pitfalls to Avoid

1. Abrupt discontinuation: Never stop bupropion suddenly, especially at higher doses
2. Ignoring new symptoms: Any new or worsening neuropsychiatric symptoms during tapering require immediate medical attention
3. Inadequate monitoring: Weekly assessment during the first month after dose reduction is recommended 3
4. Failure to recognize formulation differences: The tapering schedule applies to all formulations (IR, SR, XL), though the pharmacokinetics differ slightly 4

By following this tapering protocol, patients can minimize the risk of adverse effects while safely discontinuing bupropion therapy.