What is the maximum recommended dose of Wellbutrin (bupropion)?

Maximum Recommended Dose of Wellbutrin (Bupropion)

The maximum recommended dose of Wellbutrin (bupropion) is 450 mg per day. 1

Formulation-Specific Maximum Dosages

Different formulations of bupropion have specific maximum daily dosages:

• Immediate-Release (IR): Maximum 450 mg daily, divided into three doses 2
• Sustained-Release (SR): Maximum 400 mg daily (200 mg twice daily) 3
• Extended-Release (XL): Maximum 450 mg daily as a single dose 1

Dosing Guidelines by Indication

Major Depressive Disorder

• Starting dose: 150-200 mg/day
• Titration: Increase gradually to minimize side effects
• Maximum dose: 450 mg/day (IR), 400 mg/day (SR), or 450 mg/day (XL) 4, 1

Smoking Cessation

• Starting dose: 150 mg once daily for 3 days
• Maintenance dose: 150 mg twice daily
• Maximum dose: 300 mg daily 4
• Duration: 7-12 weeks 4

Special Populations

Hepatic Impairment

• Moderate to severe impairment: Reduce maximum dose; more gradual titration recommended 5
• Consider lower maximum doses (150-300 mg/day) with close monitoring

Renal Impairment

• Moderate to severe impairment: Reduce maximum dose; more gradual titration recommended 5

Important Safety Considerations

Seizure Risk

The most serious adverse effect of bupropion is seizures, with risk being dose-dependent:

• Doses exceeding the maximum recommendations significantly increase seizure risk 2
• Contraindicated in patients with seizure disorders or conditions that lower seizure threshold 4
• Contraindicated in patients with brain metastases due to seizure risk 4

Other Contraindications

• Current use of MAO inhibitors
• History of bulimia or anorexia nervosa
• Abrupt discontinuation of alcohol or sedatives
• Concurrent use with linezolid or IV methylene blue 1

Monitoring Requirements

• Monitor for neuropsychiatric symptoms (depression, suicidal ideation) 4
• Weekly monitoring during initial treatment and dose adjustments 5
• Blood pressure monitoring due to potential hypertensive effects

Administration Guidelines

• Administer doses at least 8 hours apart for multiple daily dosing regimens
• Take with food to minimize gastrointestinal side effects
• Avoid bedtime dosing to reduce insomnia risk 4

Common Pitfalls to Avoid

1. Exceeding maximum doses: Never exceed 450 mg/day as this significantly increases seizure risk
2. Inadequate spacing between doses: Ensure at least 8 hours between doses to minimize seizure risk
3. Rapid titration: Gradual dose increases help minimize side effects
4. Combining with contraindicated medications: Avoid MAOIs and other medications that lower seizure threshold
5. Abrupt discontinuation: Taper gradually when discontinuing to minimize withdrawal symptoms 5

Bupropion is a unique antidepressant that affects both norepinephrine and dopamine neurotransmission without significant serotonergic effects 2. This profile makes it particularly useful for patients who experience sexual dysfunction or excessive sedation with other antidepressants, but the maximum dose must be strictly observed to maintain safety.