Recommended Dosing for Wellbutrin (Bupropion)
The standard recommended dosing for bupropion is to start at 150 mg once daily for 3 days, then increase to 150 mg twice daily (300 mg total daily dose), with a maximum dose of 300 mg per day for most indications. 1
Initial Dosing and Titration
- Starting dose: 150 mg once daily for the first 3 days
- Target dose: 150 mg twice daily (300 mg total daily dose)
- Maximum dose: 300 mg per day (for most patients)
- Administration: Doses should be given at least 8 hours apart to minimize seizure risk
Formulation-Specific Considerations
Extended-Release (XL) Formulation
- Administered once daily
- Initial dose: 150 mg once daily in the morning
- Can be increased to 300 mg once daily after several days
- Bioequivalent to immediate and sustained-release formulations under steady-state conditions 1
Sustained-Release (SR) Formulation
- Administered twice daily
- Initial dose: 150 mg once daily for 3 days
- Target dose: 150 mg twice daily 2
Special Populations and Considerations
Smoking Cessation
- Start 1-2 weeks prior to quit date
- Days 1-3: 150 mg once daily
- Day 4 through week 12: 150 mg twice daily
- Treatment duration: 7-12 weeks 2
Elderly Patients
- Lower starting doses and slower titration recommended due to increased risk of side effects 3
- May still reach full adult doses if tolerated 4
Seizure Risk Management
- Do not exceed 300 mg per day to maintain seizure risk at approximately 0.1% 5
- Screen patients for seizure risk factors (stroke, brain metastases, history of seizures) 2
- Contraindicated in patients with seizure disorders, brain metastases, or those taking MAO inhibitors 2
Monitoring and Side Effect Management
Common Side Effects
- Insomnia (most common)
- Dry mouth
- Headache
- Nausea
- Anxiety 5
Management of Side Effects
- Most side effects (insomnia and dry mouth) are generally transient
- If necessary, reduce dose to manage side effects 5
- Monitor for neuropsychiatric issues (depression, suicidal ideation) 2, 1
Important Warnings and Precautions
- Seizure risk: Increases with doses above 300 mg daily 5
- Neuropsychiatric effects: Monitor for worsening depression, suicidal ideation, hostility, or unusual behavior changes, especially during initial treatment or dose adjustments 1
- Contraindications: Seizure disorders, current or prior diagnosis of bulimia or anorexia nervosa, use of MAO inhibitors, abrupt discontinuation of alcohol or sedatives 2
Clinical Pearls
- Bupropion has minimal sexual side effects compared to SSRIs and can be used to treat SSRI-induced sexual dysfunction at doses of 100-300 mg/day 6
- When switching from SSRIs to bupropion due to side effects, most improvement in sexual function occurs within the first 2 weeks and at lower doses (100-200 mg/day) 6
- Bupropion should be taken in divided doses to minimize seizure risk 1
- Avoid abrupt discontinuation; taper gradually to minimize withdrawal symptoms 3
By following these dosing guidelines and monitoring parameters, bupropion can be effectively and safely used for depression treatment with minimal risk of serious adverse effects.