What is the recommended dosing regimen for increasing SR Wellbutrin (bupropion) in a patient currently taking 150 mg?

Dosing Regimen for Increasing SR Wellbutrin (Bupropion)

For a patient currently taking 150 mg of SR Wellbutrin, the dose should be increased to 300 mg daily (150 mg twice daily) with at least 3-4 days between dose increases to minimize seizure risk. 1

Dosing Algorithm for SR Wellbutrin

1. Current dose: 150 mg SR once daily
2. Target dose: 150 mg SR twice daily (300 mg total daily dose)
3. Titration schedule:
   • Increase from 150 mg once daily to 150 mg twice daily
   • Allow at least 3-4 days between dose increases 1
   • Administer the second dose before 3 p.m. to minimize risk of insomnia 2

Administration Guidelines

• Take medication in the morning and add the second dose before 3 p.m. 2
• Swallow tablets whole; do not crush, divide, or chew 1
• May be taken with or without food 1

Monitoring During Dose Increase

• Monitor for common side effects:

  • Insomnia (most common side effect) 3
  • Headache
  • Dry mouth
  • Nausea
  • Anxiety 3

• Watch for rare but serious adverse effects:

  • Seizures (incidence approximately 0.1% at 300 mg/day) 3
  • Hypersensitivity reactions (approximately 0.1%) 3

Maximum Recommended Dose

• Maximum dose for SR formulation: 150 mg twice daily (300 mg total daily) 2, 1
• Do not exceed this dose as higher doses increase seizure risk 1

Important Considerations and Precautions

• Seizure risk increases with higher doses; gradual titration is essential 1

• Most side effects are mild to moderate and often transient 4

• If side effects become problematic, consider:

  • Spacing doses further apart
  • Temporarily returning to previous tolerated dose
  • Managing specific side effects (e.g., taking second dose earlier in the day for insomnia)

• Bupropion SR is generally well tolerated with discontinuation rates due to adverse events of only 6-12% in clinical trials 3

• Bupropion should not be used in patients with:

  • Seizure disorders
  • Current or prior diagnosis of bulimia or anorexia nervosa
  • Patients undergoing abrupt discontinuation of alcohol or sedatives 1

Remember that most improvement in depressive symptoms occurs within the first 2 weeks, even at lower doses (100-200 mg/day) 5, but a full therapeutic trial requires at least 4-8 weeks 2.