What is the recommended dose of Wellbutrin (bupropion) for Attention Deficit Hyperactivity Disorder (ADHD)?

Bupropion Dosing for ADHD

For ADHD treatment in adults, bupropion should be initiated at 150 mg XL (extended-release) once daily and titrated up to a maintenance dose of 150-300 mg daily, with a maximum dose of 450 mg per day. 1

Dosing Protocol

Initial Dosing

• Start with bupropion 150 mg XL (extended-release) once daily in the morning
• For SR (sustained-release) formulation: Start with 100-150 mg once daily 1

Titration

• Increase dose after 7-14 days if needed and tolerated
• Typical titration: 150 mg → 300 mg XL daily
• For SR formulation: Increase to 100-150 mg twice daily 1

Maintenance Dosing

• Effective maintenance dose: 150-300 mg XL once daily
• Maximum recommended dose: 450 mg per day 1
• For SR formulation: 100-150 mg twice daily

Efficacy in ADHD

Bupropion has demonstrated efficacy for ADHD treatment, though it's considered a second-line option:

• Low-quality evidence shows bupropion decreases ADHD symptom severity (standardized mean difference -0.50,95% CI -0.86 to -0.15) 2
• Bupropion increases the proportion of patients achieving clinical improvement (RR 1.50,95% CI 1.13 to 1.99) 2
• In comparative studies, bupropion has shown efficacy comparable to methylphenidate in some populations 3

Important Considerations

Off-Label Use

• Bupropion is not FDA-approved for ADHD treatment
• It's typically used as an alternative when stimulants are contraindicated or ineffective 1

Timing of Administration

• XL formulation: Take in the morning
• SR formulation: Take second dose before 3 PM to minimize insomnia risk 1

Monitoring

• Monitor for activation effects (insomnia, agitation)
• Should not be used in patients with seizure disorders
• Monitor for improvement in energy levels, which may occur relatively quickly 1

Special Populations

• Use with caution in patients with risk factors for seizures
• Start with lower doses and titrate more slowly in patients with risk factors 4
• Avoid in patients with a history of seizures, eating disorders, or recent head trauma

Advantages and Disadvantages

Advantages

• Non-controlled substance (unlike stimulants)
• "Around-the-clock" effects
• May be beneficial in patients with comorbid depression
• Alternative for patients who cannot tolerate stimulants

Disadvantages

• Less effective than stimulants for core ADHD symptoms 1
• Delayed onset of full therapeutic effect (may take several weeks)
• Risk of insomnia, agitation, and other side effects
• Contraindicated in patients with seizure disorders 1

Common Pitfalls

1. Seizure risk: Avoid in patients with seizure disorders or factors that lower seizure threshold
2. Dosing too late in the day: Can cause insomnia; second dose of SR formulation should be taken before 3 PM 1
3. Inadequate trial duration: Full benefits may take 4-8 weeks to emerge
4. Expecting stimulant-equivalent efficacy: Bupropion is generally less effective than stimulants for ADHD 1
5. Drug interactions: Be aware of potential interactions with other medications

Remember that stimulants remain first-line therapy for ADHD in adults, with bupropion considered as a second-line option when stimulants are contraindicated, not tolerated, or ineffective 1.