Recommended Starting Dose of Wellbutrin (Bupropion) for Adults
The recommended starting dose of Wellbutrin (bupropion) for adults is 150 mg once daily for the first 3-4 days, then increasing to the target dose of 150 mg twice daily (300 mg total daily dose). 1, 2
Formulation-Specific Starting Doses
- For Wellbutrin SR (Sustained Release): Start with 150 mg once daily for 3 days, then increase to 150 mg twice daily 1
- For Wellbutrin XL (Extended Release): Start with 150 mg once daily in the morning, may increase to 300 mg once daily after 4 days 2
- For immediate-release formulation: Starting dose is also 150 mg, but administered in three divided doses 3
Indication-Specific Considerations
- For Major Depressive Disorder (MDD): Start with 150 mg once daily, then increase to 300 mg daily (either as 150 mg twice daily for SR or 300 mg once daily for XL) 2
- For Smoking Cessation: Start with 150 mg once daily for 3 days, then increase to 150 mg twice daily, with treatment beginning 1-2 weeks before the target quit date 1, 4
Dose Adjustments for Special Populations
- For patients with moderate to severe hepatic impairment: Maximum dose should not exceed 150 mg daily 1, 2
- For patients with moderate to severe renal impairment: Consider reducing the dose by 50% 1
- For older adults: Consider starting with a lower dose (approximately 50% of standard dose) 1
Important Safety Considerations
- To minimize seizure risk, always increase the dose gradually 2
- Bupropion tablets should be swallowed whole and not crushed, divided, or chewed 2
- Maximum recommended daily dose is 450 mg for XL formulation and 400 mg for SR formulation to minimize seizure risk 1
- Bupropion should be avoided in patients with seizure disorders, as it may lower the seizure threshold 1, 4
- Avoid use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 1, 2
Clinical Pearls
- Bupropion may be particularly beneficial for patients with depression who also want to quit smoking 1
- Unlike many other antidepressants, bupropion has minimal effects on sexual function 3
- The most common side effects include insomnia, headache, dry mouth, and nausea 4
- For patients prone to insomnia, administer the second dose before 3 p.m. 1
- Full therapeutic effect is typically observed after 4-6 weeks of treatment 5
Monitoring and Follow-up
- Assess efficacy for depression after 4-6 weeks at an adequate dose 1, 5
- For smoking cessation, assess efficacy after 7-12 weeks of treatment 1
- Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years 1
- If no response is seen after 6-8 weeks at an adequate dose, consider alternative treatment 1
Remember that while the starting dose is typically 150 mg once daily, the maintenance dose for most adults is 300 mg total daily dose, administered either as 150 mg twice daily (SR) or 300 mg once daily (XL) 1, 2.