Bupropion Dosing for Depression and Smoking Cessation
For depression, bupropion should be initiated at 200 mg/day (100 mg twice daily), increased after 3 days to 300 mg/day (100 mg three times daily), with a maximum dose of 450 mg/day; for smoking cessation, the recommended dose is 150 mg/day for 3 days, then 300 mg/day. 1
Depression Treatment Dosing
Initial Dosing and Titration
- Start with 200 mg/day, given as 100 mg twice daily 1
- After 3 days, increase to 300 mg/day, given as 100 mg three times daily with at least 6 hours between doses 1
- For patients showing no clinical improvement after several weeks at 300 mg/day, dosing may be increased to a maximum of 450 mg/day 1
- Maximum single dose should not exceed 150 mg to minimize seizure risk 1
Formulation Options
- Immediate-release (IR): Administered three times daily (maximum 450 mg/day) 2
- Sustained-release (SR): Administered twice daily (maximum 400 mg/day) 3
- Extended-release (XR): Administered once daily 2
Duration of Treatment
- Acute episodes of depression typically require several months or longer of antidepressant treatment beyond the initial response 1
- Full efficacy is usually attained after 4 weeks of treatment 3
Smoking Cessation Dosing
- Typically initiated at 150 mg/day for 3 days, then increased to 300 mg/day (150 mg twice daily) 4
- Treatment is generally continued for 7-12 weeks 3
- Bupropion has been approved for smoking cessation and can have a combined role in treating nicotine cravings and depression 3
Dose Adjustments for Special Populations
Hepatic Impairment
- Mild impairment (Child-Pugh score 5-6): Consider reducing dose and/or frequency 1
- Moderate to severe impairment (Child-Pugh score 7-15): Maximum dose should be 75 mg/day 1
Renal Impairment
- For GFR less than 90 mL/min: Consider reducing dose and/or frequency 1
- For moderate to severe renal impairment: Reduce dose by 50% 5
- Avoid in end-stage renal disease 5
Important Safety Considerations
Seizure Risk
- Increase dose gradually to minimize seizure risk 1
- Do not exceed 100 mg/day increase in a 3-day period 1
- Contraindicated in patients with seizure disorders or conditions that lower seizure threshold 5
Cardiovascular Monitoring
- Regular monitoring of blood pressure and heart rate is necessary, especially during the first 12 weeks 5
- Contraindicated in patients with uncontrolled hypertension 5
Drug Interactions
- Allow at least 14 days between discontinuing MAOIs and starting bupropion 1
- Similarly, allow at least 14 days after stopping bupropion before starting an MAOI 1
- Contraindicated for use with MAOIs due to risk of hypertensive reactions 5, 1
Administration Guidelines
- Bupropion tablets should be swallowed whole, not crushed, divided, or chewed 1
- May be taken with or without food 1
Common Side Effects
- Dry mouth, insomnia, headache, nausea, anxiety/jitteriness, decreased appetite 5, 3
- Weight loss is common (0.5-1.0 kg on average) 6
- Less likely to cause sexual dysfunction compared to SSRIs 2
- May actually improve SSRI-associated sexual dysfunction when used in combination 4
Discontinuation
- Gradual tapering is recommended when discontinuing bupropion 5
- Reduction to 150 mg once daily for 1-2 weeks before complete discontinuation is suggested 5
Bupropion offers advantages of minimal weight gain and less sexual dysfunction compared to other antidepressants, making it a valuable option for both depression treatment and smoking cessation. However, careful attention must be paid to seizure risk and cardiovascular effects, particularly during dose titration.