What is the recommended procedure for discontinuing Wellbutrin (bupropion)?

Discontinuing Wellbutrin (Bupropion): Recommended Tapering Protocol

The recommended procedure for discontinuing Wellbutrin (bupropion) is to taper the dose gradually by first reducing to 150 mg once daily for 1-2 weeks prior to complete discontinuation, rather than stopping abruptly. 1

Rationale for Tapering Bupropion

Bupropion discontinuation should be approached carefully for several reasons:

• The FDA label specifically states: "When discontinuing treatment in patients treated with bupropion hydrochloride extended-release tablets (XL) 300 mg once daily, decrease the dose to 150 mg once daily prior to discontinuation." 1
• Gradual tapering helps minimize potential withdrawal symptoms and reduces the risk of relapse
• Abrupt discontinuation of antidepressants can lead to withdrawal symptoms including dizziness, headache, sleep disturbances, and mood swings 2

Step-by-Step Discontinuation Protocol

1. Initial Dose Reduction:

   • If taking 300 mg daily: Reduce to 150 mg once daily
   • If already on 150 mg daily: Consider taking 150 mg every other day

2. Duration of Tapering:

   • Maintain reduced dose for 1-2 weeks before complete discontinuation
   • Evidence suggests tapering periods of more than 4 weeks may be beneficial for antidepressants in general 2

3. Monitoring During Discontinuation:

   • Watch for withdrawal symptoms including insomnia, anxiety, agitation, tremor, tachycardia, and hypertension 3
   • Monitor for return of depressive symptoms, which should be distinguished from withdrawal effects

4. Post-Discontinuation Follow-up:

   • Schedule follow-up appointment 1-2 weeks after complete discontinuation 3
   • Assess for persistent withdrawal symptoms or return of original symptoms

Special Considerations

• Seizure Risk: Bupropion lowers seizure threshold; monitor closely during discontinuation, especially in patients with seizure history 1
• Psychiatric Symptoms: Watch for development or worsening of serious neuropsychiatric issues (depression, suicidal ideation) during discontinuation 4
• Individualized Approach: For patients who have been on bupropion long-term (>6 months), consider a more gradual taper over several weeks 5

Common Pitfalls to Avoid

• Confusing withdrawal with relapse: Withdrawal symptoms may mimic depression symptoms; proper assessment is critical 5
• Inadequate tapering: Most tapering regimens in studies were limited to four weeks or less, which may be insufficient for some patients 5
• Lack of patient education: Patients should be informed about potential withdrawal symptoms and the importance of not stopping medication without medical supervision

Evidence Quality Considerations

The evidence for specific bupropion discontinuation protocols is limited compared to other antidepressants. The FDA label provides clear guidance on reducing from 300 mg to 150 mg before stopping 1, but there is less specific guidance on tapering from 150 mg to zero. General antidepressant discontinuation principles suggest that longer tapering periods (>4 weeks) may be beneficial for minimizing withdrawal symptoms 2.

For patients experiencing severe withdrawal symptoms despite tapering, reinstating the previous dose and attempting an even more gradual taper may be necessary 6.