What is the recommended strength for Wellbutrin (Bupropion) ER?

Recommended Strength for Wellbutrin ER (Extended Release)

For Wellbutrin ER (Extended Release), the standard recommended strength is 150 mg once daily initially, which can be increased to 300 mg once daily as a maintenance dose. 1, 2

Dosage Forms Available

• Wellbutrin XL (Extended Release) is available in two strengths:
  • 150 mg tablets (creamy-white to pale yellow round coated tablets) 2
  • 300 mg tablets (creamy-white to pale yellow round coated tablets) 2

Dosing Guidelines by Indication

For Major Depressive Disorder

• Initial dose: 150 mg once daily in the morning 1
• Maintenance dose: 150-300 mg once daily 1
• Maximum dose: 450 mg per day 1

For Smoking Cessation

• Standard dosing: 150 mg twice daily (300 mg total) of the SR formulation 1
• Treatment should begin 1-2 weeks before the target quit date 1
• Typical duration: 7-12 weeks 1

Dose Adjustments for Special Populations

Hepatic Impairment

• For moderate to severe hepatic impairment: Total daily dose should not exceed 150 mg daily 3, 1

Renal Impairment

• For moderate to severe renal impairment: Total daily dose should be reduced by half 3, 1
• For end-stage renal disease: Avoid use 3

Older Adults

• Starting dose: Lower starting doses (approximately 50% of standard dose) 1
• Maximum dose: 150 mg twice daily (300 mg total daily dose) 1

Administration Guidelines

• Extended-release formulation should be taken once daily in the morning 1, 4
• Do not crush, chew, or divide tablets as this may alter the release properties 4
• Take at the same time each day to maintain consistent blood levels 4

Monitoring and Efficacy Assessment

• Evaluate response after 6-8 weeks at an adequate dose 1
• If patient has not shown adequate response after this period, consider alternative treatment 1

Important Precautions

• Bupropion may lower the seizure threshold and should be avoided in patients with seizure disorders 3, 1, 5
• Contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 1
• Avoid use in patients requiring opioid therapy due to potential for reduced efficacy of opioids or precipitation of withdrawal 3
• Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years 1
• Monitor vital signs, particularly blood pressure, as bupropion should be avoided in patients with uncontrolled hypertension 1

Common Side Effects

• Insomnia (administer the dose before 3 p.m. to minimize risk) 1, 5
• Dry mouth 6, 5
• Headache 5
• Nausea 5
• Anxiety 5

Clinical Pearls

• Bupropion may be particularly beneficial for patients with depression who also want to quit smoking 1
• Unlike many other antidepressants, bupropion is less likely to cause sexual dysfunction or weight gain 6, 4
• If dose-related adverse effects occur (such as insomnia or anxiety), consider reducing to a lower dose 7
• The XL formulation offers the convenience of once-daily dosing compared to twice-daily dosing with SR formulation 4