Standard Dosing of Bupropion for Major Depressive Disorder and Smoking Cessation
The standard dose of bupropion for major depressive disorder is 300 mg daily, while for smoking cessation the standard dose is also 300 mg daily, with different formulations affecting administration frequency. 1
Formulations and Dosing Schedules
- Bupropion Immediate Release (IR): Administered three times daily for a total of 300 mg/day 2
- Bupropion Sustained Release (SR): Administered as 150 mg twice daily for a total of 300 mg/day 3
- Bupropion Extended Release (XL): Administered as 300 mg once daily in the morning 3, 1
Dosing for Major Depressive Disorder (MDD)
- Initial dosing should start at lower doses and titrate up to minimize side effects 1
- For Bupropion SR: Start with 150 mg once daily for 3 days, then increase to 150 mg twice daily 4
- For Bupropion XL: Start with 150 mg once daily for 1 week, then increase to 300 mg once daily 1
- Clinical trials have demonstrated efficacy at 300 mg daily for maintenance treatment of MDD 1
- Maximum recommended dose should not exceed 450 mg daily due to increased seizure risk 5
Dosing for Smoking Cessation
- Standard dosing is 150 mg twice daily (300 mg total) of the SR formulation 4
- Treatment should begin 1-2 weeks before the target quit date 4
- Typical duration of treatment is 7-12 weeks 4
- Limited data shows that combining bupropion with naltrexone at these doses can help with smoking cessation while mitigating associated weight gain 4
Dose Adjustments for Special Populations
- Hepatic Impairment: For moderate to severe hepatic impairment, total daily dose should not exceed 150 mg daily (one tablet) 4
- Renal Impairment: For moderate to severe renal impairment, reduce the total daily dose by half 4
- Avoid use in patients with seizure disorders as bupropion may lower the seizure threshold 4, 3
- Avoid use in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 4
Monitoring and Efficacy Assessment
- For MDD: If no improvement is seen after 6-8 weeks at the target dose, consider alternative treatment 1
- For smoking cessation: Efficacy should be assessed after 7-12 weeks of treatment 4
- Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years 4
- Monitor vital signs, particularly blood pressure, as bupropion should be avoided in patients with uncontrolled hypertension 4
Clinical Pearls
- The second dose of bupropion SR should not be taken late in the day to minimize the risk of insomnia 4
- All three formulations (IR, SR, XL) are bioequivalent in terms of systemic exposure to bupropion 2
- Bupropion may be particularly beneficial for patients with depression who also want to quit smoking 4
- Patients with higher anxiety scores on the Hospital Anxiety and Depression Scale may respond better to bupropion for smoking cessation 6