From the Guidelines
Bupropion (Wellbutrin XL) dosage should be reduced by one-half in patients with moderate to severe renal impairment, and avoided in end-stage renal disease. When considering renal function adjustments for Bupropion (Wellbutrin XL) in patients with impaired renal function, it is essential to prioritize the patient's safety and minimize the risk of adverse effects. According to the most recent and highest quality study available 1, in patients with moderate to severe renal impairment, the total daily dose of bupropion should be reduced by one-half. This adjustment is crucial to prevent the accumulation of bupropion and its metabolites, which can increase the risk of seizures, agitation, or insomnia. Some key points to consider when adjusting the dosage of bupropion in patients with impaired renal function include:
- Monitoring patients closely for side effects, especially during the initial treatment period
- Starting at a lower dose and evaluating response before any dose increases
- Avoiding the use of bupropion in patients with end-stage renal disease
- Being aware of the potential for decreased clearance of bupropion and its metabolites in patients with kidney impairment By taking a cautious approach and adjusting the dosage of bupropion accordingly, healthcare providers can help minimize the risk of adverse effects and ensure the safe use of this medication in patients with impaired renal function.
From the FDA Drug Label
2.7 Dose Adjustment in Patients with Renal Impairment Consider reducing the dose and/or frequency of bupropion hydrochloride extended-release tablets (XL) in patients with renal impairment (glomerular filtration rate less than 90 mL/min) [seeUse in Specific Populations (8.6)and Clinical Pharmacology (12.3)].
The recommended dose adjustment for Bupropion (Wellbutrin XL) in patients with impaired renal function is to consider reducing the dose and/or frequency of the medication in patients with a glomerular filtration rate less than 90 mL/min 2.
From the Research
Renal Function Adjustments for Bupropion (Wellbutrin XL)
There are no specific studies provided that directly address the renal function adjustments for Bupropion (Wellbutrin XL) in patients with impaired renal function. However, general guidelines for dosage adjustments in patients with renal impairment can be applied:
- Dosage adjustments are typically based on the patient's glomerular filtration rate (GFR) estimated by the Cockroft-Gault formula 3, 4, 5.
- The degree of renal impairment, patient size, and the fraction of the drug excreted unchanged in urine should be considered when adjusting drug doses 6.
- Estimates of renal function can guide dosing of renally cleared drugs, but may not be precise enough for drugs with narrow therapeutic indices 6.
- Renally excreted medications often require dose adjustment in patients with kidney impairment, and labeled dosing recommendations are typically based on pharmacokinetic studies and small numbers of patients 7.
General Considerations for Dosage Adjustments
- Chronic kidney disease affects renal drug elimination and other pharmacokinetic processes involved in drug disposition 4.
- Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes 4.
- Serum creatinine considered in isolation is not a reliable indicator of renal function, and the estimated glomerular filtration rate should be used to adjust medicine doses 5.
- Renal function monitoring is recommended for patients using medicines that can impair renal function or cause nephrotoxicity 5.