From the Guidelines
Bupropion dosage should be reduced by one-half in patients with moderate to severe renal impairment, to a maximum of 1 tablet twice per day, which is equivalent to 180 mg of bupropion per day, and avoided in end-stage renal disease. When considering the treatment of patients with impaired renal function, it is crucial to adjust the dosage of bupropion to minimize the risk of adverse effects, such as seizures, agitation, and insomnia, which can be exacerbated by the accumulation of bupropion and its metabolites in the body 1. The recommended dosage reduction is based on the fact that approximately 20% of bupropion and its metabolites are excreted through the kidneys, and renal impairment can lead to decreased clearance and increased risk of adverse effects. Key considerations for dosing adjustments include:
- Moderate to severe renal impairment: reduce the total daily dose by one-half, to a maximum of 1 tablet twice per day, which is equivalent to 180 mg of bupropion per day
- End-stage renal disease: avoid the use of bupropion due to the increased risk of adverse effects Regular monitoring of renal function and assessment for side effects is essential when prescribing bupropion to patients with kidney disease, and further dose reduction or discontinuation may be necessary if adverse effects occur 1.
From the FDA Drug Label
Consider a reduced dose and/or dosing frequency of bupropion hydrochloride extended-release tablets (XL) in patients with renal impairment (glomerular filtration rate: <90 mL/min). Bupropion and its metabolites are cleared renally and may accumulate in such patients to a greater extent than usual Monitor closely for adverse reactions that could indicate high bupropion or metabolite exposures
The recommended dose for patients with impaired renal function is to consider a reduced dose and/or dosing frequency of bupropion hydrochloride extended-release tablets (XL) in patients with renal impairment (glomerular filtration rate: <90 mL/min) 2.
From the Research
Recommended Doses of Bupropion for Patients with Impaired Renal Function
- The recommended doses of bupropion for patients with impaired renal function are not explicitly stated in the provided studies, but some studies suggest that dose adjustment may be necessary in patients with renal impairment 3, 4.
- A study published in the British Journal of Clinical Pharmacology found that bupropion AUC was 126% higher and C(max) was 86% higher in patients with impaired renal function compared to healthy subjects, suggesting that dose adjustment may be necessary in patients with renal impairment 3.
- Another study published in The Consultant Pharmacist reported a case of an 84-year-old male with stage III chronic kidney disease who experienced adverse reactions to bupropion, including tremor, ataxia, and mental status changes, which improved after the dose was lowered, highlighting the need for dose adjustment in patients with renal impairment 4.
- However, a study published in Clinical Trials found that the basis for labeled dosing recommendations for patients with renal impairment is often limited, and more research is needed to understand the benefits and risks of new drugs in patients with renal impairment 5.
- The study published in the Journal of Nepal Health Research Council found that dosage adjustment of drugs that are toxic to the kidney and/or metabolized or eliminated by the kidney is less than optimum in a considerable number of patients at hospital discharge, highlighting the need for awareness and monitoring of inappropriate dosing in patients with renal dysfunction 6.
- The study published in the Journal of Clinical Medicine reported a case of rhabdomyolysis following an overdose of bupropion, highlighting the potential for muscular and renal complications in patients with impaired renal function 7.