Bupropion Dosing for Depression Treatment
The recommended starting dose of bupropion for depression is 150 mg once daily for 3 days, then increasing to 150 mg twice daily (300 mg total daily dose) for the sustained-release (SR) formulation. 1
Initial Dosing and Titration
- For Bupropion SR (sustained-release), start with 150 mg once daily for 3 days, then increase to 150 mg twice daily (300 mg total daily dose) 2, 1
- The second dose should not be taken late in the day to minimize the risk of insomnia 1, 3
- For immediate-release formulations, the starting dose is typically lower at 100 mg twice daily 4
- For extended-release (XL) formulations, start with 150 mg once daily in the morning, which can be increased to 300 mg once daily after several days 1
Dose Adjustments for Special Populations
- For older adults (>65 years), start with a lower dose of 37.5 mg every morning, then increase by 37.5 mg every 3 days as tolerated, to a maximum of 150 mg twice daily 2, 1
- For patients with moderate to severe hepatic impairment, the total daily dose should not exceed 150 mg daily 1, 3
- For patients with moderate to severe renal impairment, reduce the total daily dose by half 1, 3
Maximum Dosing
- The maximum recommended dose for bupropion SR is 400 mg per day 1
- The maximum recommended dose for bupropion XL is 450 mg per day 1
- Doses exceeding these limits increase the risk of seizures significantly 5
Efficacy Assessment and Monitoring
- Clinical response should be assessed after 4-8 weeks of treatment at an adequate dose 6
- If no response is seen after 6-8 weeks at an adequate dose, consider alternative treatment 1
- Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years 1, 4
- Monitor vital signs, particularly blood pressure, as bupropion should be avoided in patients with uncontrolled hypertension 3
Clinical Considerations
- Bupropion SR at both 150 mg/day and 300 mg/day has been shown to be more effective than placebo in treating depression 7
- Once-daily dosing appears to be at least as effective as twice-daily dosing for some patients, offering greater convenience and potentially improved adherence 7
- Bupropion may be particularly beneficial for patients with depression who also want to quit smoking 1, 2
- Bupropion has shown particular benefit in bipolar and atypical depression compared to "typical" depression 8
Safety Considerations
- Avoid in patients with seizure disorders, as bupropion lowers the seizure threshold 2, 5
- The risk of seizures is dose-dependent and significantly increases at doses above the recommended maximum 5
- Avoid use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 2, 1
- Common side effects include dry mouth, insomnia, headache, nausea, and agitation 6
- Unlike many other antidepressants, bupropion has minimal sexual side effects and is less likely to cause weight gain 6
Formulation Differences
- SR (sustained-release): Typically dosed twice daily (morning and afternoon) 1
- XL (extended-release): Typically dosed once daily in the morning 1
- The bioavailability between immediate-, sustained-, and extended-release formulations is similar under steady-state conditions 4
Following these dosing guidelines will help optimize treatment outcomes while minimizing the risk of adverse effects in patients with depression.