Bupropion Dosage and Use for Major Depressive Disorder and Smoking Cessation
For major depressive disorder, bupropion should be started at 150 mg once daily for 4 days, then increased to the target dose of 300 mg once daily, while for smoking cessation, the recommended dose is 150 mg once daily for 3 days, then 150 mg twice daily (300 mg total) for 7-12 weeks. 1, 2
Major Depressive Disorder (MDD) Treatment
Dosing Protocol
- Starting dose: 150 mg once daily 2
- Target dose: 300 mg once daily 2
- Titration: After 4 days, may increase to 300 mg once daily if tolerated 2
- Maximum dose: 450 mg per day (exceeding this significantly increases seizure risk) 1
Administration Considerations
- Increase dose gradually to reduce seizure risk 2
- Periodically reassess the need for maintenance treatment 2
- Extended-release tablets should be swallowed whole, not crushed or chewed 2
Smoking Cessation Treatment
Dosing Protocol
- Starting dose: 150 mg once daily for days 1-3 1
- Target dose: 150 mg twice daily (300 mg total) 1
- Treatment duration: 7-12 weeks 1
- Timing: Initiate treatment 1-2 weeks before the target quit date 1
Enhanced Efficacy
- Can be combined with nicotine replacement therapy (NRT) for better results 1
- Continue treatment for the full recommended duration even if early success is achieved 1
Special Population Considerations
Hepatic Impairment
- Moderate to severe impairment: 150 mg every other day 2
- Mild impairment: Consider reducing dose and/or frequency 2
Renal Impairment
- Moderate to severe impairment: Reduce total daily dose by half 1
- End-stage renal disease: Avoid use 1
Elderly Patients
- Consider lower starting doses due to increased risk of adverse effects 1
Contraindications
- Seizure disorder 2
- Current or prior diagnosis of bulimia or anorexia nervosa 2
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, antiepileptic drugs 2
- Monoamine Oxidase Inhibitors (MAOIs) use within 14 days 2
- Concomitant use with linezolid or intravenous methylene blue 1, 2
- Known hypersensitivity to bupropion or other ingredients 2
- Brain metastases 1
- Tamoxifen therapy 1
- Closed-angle glaucoma 1
Monitoring and Side Effects
Common Adverse Effects
- Insomnia, dry mouth, anxiety/jitteriness, decreased appetite, headache 1
- Potential for increased blood pressure and heart rate 1
Serious Adverse Effects to Monitor
- Seizures: Risk is dose-related (0.1% at doses ≤450 mg/day) 1
- Neuropsychiatric symptoms: Especially in patients younger than 24 years 1
- Suicidal thoughts/behaviors: Particularly in children, adolescents, and young adults 2
- Severe skin reactions: Including widespread rash, urticaria, or angioedema 1
- Activation of mania/hypomania: Screen patients for bipolar disorder 2
Discontinuation Protocol
- Implement gradual tapering to minimize withdrawal symptoms 1
- Recommended reduction to 150mg once daily for 1-2 weeks before complete discontinuation 1
- Monitor for withdrawal symptoms: depression, anxiety, irritability, insomnia, headache 1