What is the equivalent dose of Wellbutrin (bupropion) for a patient taking 10mg of Lexapro (escitalopram)?

Bupropion Equivalent Dosing for 10mg Escitalopram

The equivalent dose of Wellbutrin (bupropion) for a patient taking 10mg of Lexapro (escitalopram) is approximately 175-200mg daily of bupropion SR (sustained release). 1

Dosing Considerations

• Bupropion SR is typically started at 150mg once daily for 3 days, then increased to 150mg twice daily (300mg total daily dose) for depression treatment 2
• For patients transitioning from escitalopram 10mg, starting with 150mg daily of bupropion SR and titrating based on response is appropriate 2, 1
• The dose equivalence research indicates that bupropion 348.5mg is equivalent to fluoxetine 40mg, which would make approximately 175-200mg of bupropion roughly equivalent to escitalopram 10mg in antidepressant effect 1

Formulation Differences

• Bupropion is available in multiple formulations:
  • Immediate Release (IR): Maximum dose 450mg/day
  • Sustained Release (SR): Maximum dose 400mg/day
  • Extended Release (XL): Maximum dose 450mg/day 2
• For most patients, the SR formulation dosed at 150mg twice daily provides optimal therapeutic effect with manageable side effects 2

Titration Schedule

• Begin with 150mg once daily of bupropion SR for the first 3-7 days 3, 2
• If well tolerated, increase to 150mg twice daily (300mg total) 2
• To minimize risk of insomnia, administer the second dose before 3 p.m. 3
• Maximum recommended dose is 400mg daily for SR formulation 2

Special Population Considerations

• For older adults: Start with 37.5mg every morning, then increase by 37.5mg every 3 days as tolerated 3
• For patients with moderate to severe hepatic impairment: Total daily dose should not exceed 150mg daily 2
• For patients with moderate to severe renal impairment: Total daily dose should be reduced by half 2

Safety Considerations

• Bupropion should be avoided in patients with:
  • Seizure disorders (lowers seizure threshold)
  • Patients taking MAOIs or within 14 days of discontinuing MAOIs
  • Uncontrolled hypertension 2
• Common side effects include:
  • Agitation, dry mouth, insomnia, headaches, nausea, constipation, and tremor 4
  • Activating effects (increased energy, reduced apathy) 3

Monitoring

• Assess for neuropsychiatric adverse effects, especially in individuals younger than 24 years 2
• Monitor vital signs, particularly blood pressure 2
• Efficacy should be evaluated after 4-6 weeks of treatment at therapeutic dose 4
• If no response is seen after 6-8 weeks at an adequate dose, consider alternative treatment 2

Clinical Advantages of Bupropion

• Bupropion is the only antidepressant with no appreciable activity on serotonin concentrations, acting primarily on norepinephrine and dopamine neurotransmitters 4
• May be particularly beneficial for patients with depression who also want to quit smoking 2
• Generally causes less sexual dysfunction and weight gain than SSRIs like escitalopram 4

Combination Therapy Considerations

• If considering combination therapy rather than switching, studies show that escitalopram 10mg plus bupropion SR (mean dose 327mg/day) resulted in 50% remission rates, which is higher than typical SSRI monotherapy 5
• The combination was well-tolerated with only 6% discontinuation due to side effects 5