Wellbutrin XL 150mg Taper Schedule
For patients taking Wellbutrin XL (bupropion) 150mg, tapering should be done by decreasing to 150mg every other day for 1-2 weeks before discontinuation to minimize withdrawal symptoms.
Understanding Bupropion Discontinuation
Bupropion (Wellbutrin XL) is an antidepressant with a unique mechanism of action as a dopamine-norepinephrine reuptake inhibitor. While it generally has fewer discontinuation symptoms compared to SSRIs or SNRIs, a proper taper is still recommended to minimize potential withdrawal effects.
Pharmacology Considerations
- Bupropion XL has an extended-release formulation with a half-life of approximately 21 hours 1
- The primary active metabolite (hydroxybupropion) has a half-life of approximately 20 hours 1
- Other active metabolites (threohydrobupropion and erythrohydrobupropion) have longer half-lives (33-37 hours) 1
Recommended Taper Schedule for Wellbutrin XL 150mg
Step-by-Step Approach:
Initial Phase: Decrease from daily dosing to alternate-day dosing
- Take 150mg every other day for 1-2 weeks
- This follows the FDA label recommendation to "decrease the dose to 150mg once daily prior to discontinuation" 2
Final Phase: Complete discontinuation after the alternate-day period
- Stop medication completely after 1-2 weeks of alternate-day dosing
Monitoring During Taper
Potential Withdrawal Symptoms to Monitor:
- Irritability and anxiety
- Insomnia
- Headaches
- Fatigue or lethargy
- Mild dizziness
Follow-up Recommendations:
- Schedule follow-up within 1-2 weeks after initiating the taper
- Assess for withdrawal symptoms and provide supportive care as needed
- Consider slowing the taper if significant symptoms emerge
Special Considerations
When to Consider a Slower Taper:
- Patients who have been on Wellbutrin XL for ≥1 year
- Patients with history of difficult medication discontinuations
- Patients with anxiety disorders or sensitivity to medication changes
For these patients, consider extending the alternate-day dosing period to 3-4 weeks before complete discontinuation.
Contraindications to Rapid Discontinuation:
- History of seizure disorder (bupropion lowers seizure threshold) 2
- Current psychiatric instability
- Pregnancy (consult specialist before tapering) 3
Clinical Pearls and Pitfalls
Important Considerations:
- Bupropion withdrawal is typically less severe than SSRI/SNRI withdrawal 4
- Patient agreement and interest in tapering is a key component of successful tapers 3
- Withdrawal symptoms may be mistaken for depression recurrence 4
- Avoid abrupt discontinuation which can increase risk of adverse effects 3
Common Pitfalls to Avoid:
- Tapering too quickly in patients with long-term use
- Failing to distinguish between withdrawal symptoms and depression recurrence
- Not providing adequate follow-up during the taper process
- Overlooking the need for dose adjustments in patients with hepatic or renal impairment 2
This tapering schedule balances the need to minimize withdrawal symptoms while providing a practical approach to discontinuation of Wellbutrin XL 150mg.