Bupropion XL Dosing Recommendations
The recommended dosage for Bupropion XL is 150 mg once daily in the morning, which can be increased to 300 mg once daily after several days if clinically needed. 1, 2
Standard Dosing Protocol
- Initial dose: 150 mg once daily in the morning
- Maintenance dose: May increase to 300 mg once daily after 3-7 days if clinically indicated
- Maximum dose: 450 mg daily (though this higher dose is less common and requires careful monitoring)
- Administration: Take in the morning to minimize insomnia
Dosing Considerations Based on Patient Factors
Renal Impairment
- Moderate to severe impairment: Reduce dose by 50% (150 mg every other day initially)
- End-stage renal disease: Avoid use 1
Hepatic Impairment
- Moderate to severe impairment: Maximum of 150 mg once daily 1
Elderly Patients
- Consider lower starting doses due to increased risk of adverse effects
- Start with 150 mg once daily and maintain this dose if effective 1
Clinical Efficacy
Bupropion XL has demonstrated efficacy comparable to other antidepressants:
- As effective as SSRIs in treating major depressive disorder 1, 2
- Once-daily dosing appears to be at least as effective as twice-daily dosing of the SR formulation 3
- XL formulation provides bioequivalent systemic exposure to bupropion compared to IR and SR formulations 2
Adverse Effects to Monitor
- Common: Insomnia, dry mouth, anxiety/jitteriness, decreased appetite, headache 1
- Cardiovascular: Increased blood pressure and heart rate 1
- Neurological: Risk of seizures (dose-dependent) 1, 4
- Psychiatric: Potential for increased suicidal thoughts in young adults (black box warning) 1
Important Contraindications
Bupropion XL is contraindicated in patients with:
- Seizure disorders or conditions lowering seizure threshold
- Current use of MAO inhibitors
- Uncontrolled hypertension
- History of anorexia or bulimia
- Undergoing abrupt discontinuation of alcohol or sedatives 1
Discontinuation Protocol
When discontinuing bupropion XL:
- Implement gradual tapering, especially for patients on higher doses (300 mg or more)
- Reduce to 150 mg once daily for 1-2 weeks before complete discontinuation
- Monitor for withdrawal symptoms including neuropsychiatric symptoms, insomnia, headache, and mood changes 1
Clinical Pearls
- Morning administration helps minimize insomnia
- Weight loss rather than weight gain may occur with bupropion (average 0.5-1.0 kg) 3
- Less sexual dysfunction compared to SSRIs 2
- May be beneficial for patients with comorbid ADHD symptoms 1
- Avoid breaking, crushing, or chewing XL tablets as this can increase risk of adverse effects including seizures