How to Taper Bupropion
When discontinuing bupropion, a gradual tapering protocol is recommended, including reducing the dose to 150 mg once daily for 1-2 weeks before complete discontinuation, to minimize neuropsychiatric symptoms. 1
Recommended Tapering Protocol
General Approach
- Taper slowly to minimize withdrawal symptoms
- For standard doses (300mg XL or 150mg SR twice daily):
- Reduce to 150mg once daily for 1-2 weeks before stopping completely
- Patients already on 150mg daily may discontinue directly, but some clinicians recommend taking the medication every other day for 1 week before stopping 1
Special Populations
- Hepatic Impairment: Patients with moderate to severe hepatic impairment should maintain a reduced dose schedule (maximum 1 tablet daily) for 1-2 weeks before stopping 2, 1
- Renal Impairment: Those with renal impairment may need a more gradual taper due to altered drug clearance 1
Monitoring During Tapering
Symptoms to Monitor
- Neuropsychiatric symptoms (depression, anxiety, irritability)
- Suicidal ideation
- Cognitive changes
- Return of original symptoms being treated 1
Potential Withdrawal Symptoms
- Insomnia
- Headache
- Anxiety/jitteriness
- Mood changes
Clinical Considerations
Formulation Differences
- Different formulations (IR, SR, XL) are bioequivalent in terms of systemic exposure but have different release profiles 3
- Switching between formulations may be considered during tapering if needed (e.g., from XL to SR) to allow for more gradual dose reduction 4
Contraindications to Abrupt Discontinuation
- History of seizures
- Concurrent medications that lower seizure threshold
- History of adverse reactions to medication changes 1
Alternative Approaches for Difficult Cases
For patients experiencing significant withdrawal symptoms with standard tapering:
- Consider a slower taper (e.g., 10% reduction per month)
- Use the SR formulation to allow for more flexible dosing during taper 1
- Temporarily add supportive medications for specific withdrawal symptoms if needed
Important Caveats
- Avoid abrupt discontinuation when possible
- Patient abandonment through sudden cessation is considered unacceptable medical care 2
- Ensure patients understand that tapering is to minimize withdrawal symptoms, not because the medication is dangerous
- The FDA label for bupropion specifically recommends tapering the dose when discontinuing 5
Remember that tapering schedules should be adjusted based on individual response, with slower tapers generally being better tolerated, particularly for patients who have been taking bupropion for longer durations.