From the FDA Drug Label
Although there are no independent trials demonstrating the efficacy of bupropion hydrochloride extended-release tablets (XL) in the acute treatment of MDD, studies have demonstrated similar bioavailability between the immediate-, sustained-, and extended-release formulations of bupropion HCl under steady-state conditions The initial bupropion dose was 150 mg once daily for 1 week, followed by up-titration to 300 mg once daily. The mean bupropion doses in the 3 trials ranged from 257 mg to 280 mg per day.
The recommended dosing for Bupropion (Wellbutrin) extended-release (XL) is to start with 150 mg once daily for 1 week, then up-titrate to 300 mg once daily. The mean dose in clinical trials ranged from 257 mg to 280 mg per day 1.
From the Research
Bupropion XL is typically started at 150 mg once daily in the morning for the first 3-4 days, then increased to the target dose of 300 mg once daily if tolerated, as this dosing regimen has been shown to be effective in smoking cessation and has a favorable safety profile 2. The maximum recommended dose is 450 mg per day, though this higher dose should only be used under medical supervision due to increased seizure risk. Some key points to consider when prescribing bupropion XL include:
- Doses should be taken in the morning to minimize insomnia
- Tablets must be swallowed whole, never crushed or chewed, as this would destroy the extended-release mechanism and potentially cause dangerous rapid drug release
- Patients with hepatic or renal impairment usually require lower doses, typically 150 mg daily
- Bupropion works by inhibiting the reuptake of dopamine and norepinephrine, which helps regulate mood and energy levels
- Common side effects include insomnia, dry mouth, headache, and nausea
- It's essential to avoid alcohol while taking bupropion as this combination increases seizure risk
- Patients should also be aware that full therapeutic effects may take 2-4 weeks to develop, so it's crucial to continue taking the medication even if benefits aren't immediately apparent 3, 4, 5. In terms of specific patient populations, studies have shown that bupropion XL can be effective in smoking cessation for patients with a history of depressive disorders, with minimal weight gain and no evidence of emergent depression 4. Additionally, anxiety and depression levels have been found to influence the outcome of bupropion treatment, with higher anxiety scores predicting better response to treatment 5. Overall, the recommended dosing for bupropion XL should be individualized based on patient factors, such as medical history and tolerance, to maximize efficacy and minimize adverse effects.