What is the recommended dose of Wellbutrin (bupropion) for managing impulse control?

Bupropion Dosing for Impulse Control

For impulse control issues, the recommended dose of bupropion (Wellbutrin) is 100-150 mg daily initially, increasing to a maintenance dose of 150-450 mg daily. 1

Dosing Guidelines

• For the sustained-release (SR) formulation:

  • Start with 100-150 mg once daily 2, 1
  • Increase to maintenance dose of 150 mg twice daily (300 mg total daily) 2, 1
  • Maximum dose: 450 mg per day 1

• For the extended-release (XL) formulation:

  • Start with 150 mg once daily 2, 1
  • Increase to maintenance dose of 150-300 mg once daily 2, 1
  • Maximum dose: 450 mg per day 2, 1

Titration Schedule

• Dose should be increased every 3-5 days until therapeutic effect is achieved or maximum tolerated dose is reached 2
• Allow at least 7-14 days between significant dose increases to minimize risk of side effects 1
• If no response is seen after 6-8 weeks at an adequate dose, consider alternative treatment 1

Special Population Considerations

• For patients with moderate to severe hepatic impairment:

  • Total daily dose should not exceed 150 mg daily 1
  • More frequent monitoring for side effects is recommended 1

• For patients with moderate to severe renal impairment:

  • Total daily dose should be reduced by half 1
  • More careful titration is advised 1

• For older adults:

  • Consider starting with approximately 50% of standard dose 1
  • Titrate more slowly due to increased risk of adverse reactions 1

Safety Considerations

• Bupropion should be avoided in patients with:

  • Seizure disorders (lowers seizure threshold) 2, 1
  • Patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 2, 1
  • Uncontrolled hypertension 1

• Monitor for:

  • Neuropsychiatric adverse effects, especially in individuals younger than 24 years 1
  • Blood pressure changes 1
  • Signs of activation or agitation 3

Clinical Advantages for Impulse Control

• Bupropion acts primarily on dopamine and norepinephrine systems, which are implicated in impulse control 4, 3
• Unlike some other antidepressants, bupropion:
  • Is generally non-sedating 4, 3
  • Has minimal sexual dysfunction side effects 4
  • Does not typically cause weight gain 3
  • Has fewer anticholinergic effects than tricyclic antidepressants 4, 3

Monitoring Recommendations

• Assess response to treatment after 4-6 weeks at therapeutic dose 1
• Monitor vital signs, particularly blood pressure, at baseline and periodically 1
• Evaluate for emergence of suicidal thoughts, especially during initial treatment period or dose changes 1