What is the recommended tapering schedule for Wellbutrin (bupropion) XL 150 mg?

Tapering Wellbutrin XL 150 mg for Inpatient Setting

The fastest and safest way to taper Wellbutrin (bupropion) XL 150 mg in an inpatient setting is to decrease to 150 mg every other day for 1 week before discontinuation. 1

General Principles for Tapering Bupropion

• When discontinuing treatment with bupropion hydrochloride extended-release tablets (XL) 300 mg once daily, decrease the dose to 150 mg once daily prior to discontinuation 1
• For patients already on 150 mg daily (as in this case), tapering to 150 mg every other day for approximately one week before complete discontinuation is recommended 2, 1
• Discontinuing an antidepressant over 10 to 14 days generally limits withdrawal symptoms 2

Inpatient Tapering Considerations

• Inpatient setting allows for closer monitoring of withdrawal symptoms and medical supervision during the taper 2
• Withdrawal symptoms to monitor include:
  • Irritability, anxiety, insomnia 2
  • Possible dysphoria or vague sense of being unwell 2
  • Potential for increased depressive symptoms 2

Important Monitoring During Taper

• Assess for emergence or worsening of depressive symptoms, as these may predict taper discontinuation 2
• Monitor for any signs of increased agitation, which can occur with bupropion withdrawal 2
• Evaluate sleep patterns, as insomnia may worsen during the taper 2

Adjunctive Treatments to Consider

• Short-term use of agents to mitigate anxiety, insomnia, or irritability may be beneficial during the taper 2
• Trazodone for insomnia can be helpful if sleep disturbance becomes problematic 2
• Non-pharmacological interventions such as supportive therapy should be implemented alongside medication taper 2

Cautions and Contraindications

• Avoid abrupt discontinuation when possible, as this can increase withdrawal symptoms 2
• Ultrarapid detoxification is associated with substantial risks and should not be used 2
• Unlike some other medications (like SSRIs), alternate-day dosing is generally acceptable for bupropion due to its pharmacokinetic profile 1, 2

Special Considerations

• If the patient has a history of seizure disorder, more cautious tapering may be warranted as bupropion lowers seizure threshold 1
• For patients with hepatic impairment, the taper should be even more gradual 1
• If withdrawal symptoms become severe, consider slowing the taper by returning to the previous dose temporarily before attempting a more gradual reduction 2

Post-Discontinuation Follow-up

• After complete discontinuation, continue to monitor for any protracted withdrawal symptoms for several weeks 2
• Be aware that some symptoms that emerge after discontinuation may be recurrence of the original condition rather than withdrawal 2

By following this tapering schedule in an inpatient setting, the risk of withdrawal symptoms can be minimized while achieving relatively rapid discontinuation of Wellbutrin XL 150 mg.