What is the recommended dosing and administration for Wellbutrin (bupropion) SR?

Dosing and Administration of Wellbutrin SR (Bupropion SR)

The recommended dosing for Wellbutrin SR is to start with 150 mg once daily in the morning for 3 days, then increase to the target dose of 150 mg twice daily, with the second dose taken before 3 p.m. to minimize insomnia risk. 1

Initial Dosing and Titration

• Start with 150 mg once daily in the morning for 3 days
• Increase to 150 mg twice daily (300 mg total daily dose)
• Maximum recommended dose: 150 mg twice daily (300 mg/day) 1, 2
• To minimize risk of insomnia, take the second dose before 3 p.m. 1
• Wellbutrin SR should be swallowed whole and not crushed, divided, or chewed 2
• May be taken with or without food 2

Special Population Considerations

Hepatic Impairment

• Moderate to severe impairment (Child-Pugh score 7-15): Maximum dose 150 mg every other day 2
• Mild impairment (Child-Pugh score 5-6): Consider reducing dose and/or frequency 2

Renal Impairment

• Consider reducing dose and/or frequency in patients with glomerular filtration rate less than 90 mL/min 2

Discontinuation Protocol

When discontinuing treatment with Wellbutrin SR:

• Taper gradually to minimize withdrawal symptoms
• For patients on 300 mg/day, decrease to 150 mg once daily for 1-2 weeks before complete discontinuation 2, 3

Important Precautions and Contraindications

• Seizure risk: Increase dose gradually to minimize seizure risk 2
• Contraindicated with MAOIs: Allow at least 14 days between discontinuing MAOIs and starting Wellbutrin SR, and vice versa 2
• Not recommended for: Patients with seizure disorders, eating disorders, or during abrupt discontinuation of alcohol, benzodiazepines, or antiepileptic drugs 3
• Avoid in: Patients with uncontrolled hypertension 3

Common Side Effects

• Most common: insomnia, dry mouth, headache, nausea, and anxiety 4
• Only insomnia and dry mouth occur significantly more frequently than with placebo 4
• Side effects are generally transient and often resolve without intervention 4
• If needed, side effects can be managed by dose reduction 4

Monitoring Recommendations

• Monitor blood pressure and heart rate, especially in the first 12 weeks of treatment 3
• Watch for neuropsychiatric symptoms, particularly in younger patients 3

Clinical Pearls

• Efficacy for depression treatment is directly related to dose, with 300 mg/day being optimal for most patients 5
• Bupropion SR can be activating and may rapidly improve energy levels 1
• The medication may be particularly useful in patients who are trying to quit smoking, as it is also FDA-approved for smoking cessation 4
• The incidence of seizures with proper dosing and screening is approximately 0.1% 4

By following these dosing guidelines and precautions, Wellbutrin SR can be effectively and safely administered for the treatment of depression while minimizing adverse effects.