What is the recommended procedure for discontinuing Wellbutrin (bupropion)?

Recommended Procedure for Discontinuing Wellbutrin (Bupropion)

When discontinuing Wellbutrin (bupropion), gradually taper the dose by reducing to 150 mg once daily before complete discontinuation. 1

Tapering Protocol

• For patients on Wellbutrin XL (extended-release) 300 mg daily, decrease the dose to 150 mg once daily prior to discontinuation 1
• Tapering should be individualized based on:
  • Duration of treatment (patients on bupropion for >1 year may require more cautious tapering) 2
  • Current dosage 2
  • Patient's response to dose reduction 2
• The tapering process should occur gradually over weeks to months to minimize discontinuation symptoms 3

Monitoring During Discontinuation

• Monitor for return of original symptoms for which bupropion was prescribed (depression, seasonal affective disorder) 2
• Be aware that symptoms may not return immediately but could emerge weeks to months after discontinuation 2
• Watch for potential discontinuation symptoms, which may include:
  • Insomnia 3
  • Mood disturbances 3
  • Dizziness 3
  • Flu-like symptoms 3

Special Considerations

Patients at Higher Risk for Discontinuation Difficulties

• Those with history of difficult medication discontinuation 2
• Patients who have been on bupropion for extended periods (>1 year) 2
• Individuals with recurrent depression 4

Managing Discontinuation Symptoms

• If severe discontinuation symptoms occur, consider reinstating the previous dose and then tapering more gradually 3
• For patients using bupropion for obesity treatment as part of combination therapy, follow specific discontinuation guidelines for that formulation 2

Clinical Pearls

• Avoid abrupt discontinuation when possible, as this increases risk of discontinuation symptoms 5
• Patient education and reassurance throughout the discontinuation process are essential 6
• For patients with severe discontinuation symptoms, symptomatic management may be needed in addition to slower tapering 3
• Discontinuation symptoms can last from days to months, and different symptoms may have different durations 3

Contraindications and Precautions

• At least 14 days should elapse between discontinuation of bupropion and starting an MAOI antidepressant 1
• If a patient on bupropion requires urgent treatment with linezolid or intravenous methylene blue, bupropion should be stopped promptly 1

By following these guidelines, healthcare providers can help minimize discontinuation symptoms and ensure a smoother transition off Wellbutrin for their patients.