What is the starting dose of Wellbutrin (bupropion)?

Starting Dose of Wellbutrin (Bupropion)

The recommended starting dose for Wellbutrin (bupropion) is 150 mg once daily in the morning for the first 3-4 days, then increasing to the target dose of 150 mg twice daily (300 mg total daily dose) for most indications. 1, 2

Formulation-Specific Starting Doses

• For Bupropion SR (Sustained Release):

  • Start with 150 mg once daily in the morning for 3 days 1
  • Then increase to 150 mg twice daily (300 mg total daily) 1, 2
  • The second dose should be taken before 3 PM to minimize insomnia 1

• For Bupropion XL (Extended Release):

  • Start with 150 mg once daily in the morning 1, 2
  • After 4 days, may increase to 300 mg once daily in the morning 2
  • XL formulation is designed for once-daily dosing 1

Indication-Specific Considerations

• For Major Depressive Disorder (MDD):

  • Start with 150 mg once daily for 4 days 2
  • Then increase to target dose of 300 mg once daily (XL) or 150 mg twice daily (SR) 1, 2

• For Smoking Cessation:

  • Start with 150 mg once daily for 3 days 3
  • Then increase to 150 mg twice daily 3, 1
  • Begin treatment 1-2 weeks before the target quit date 1
  • Typical treatment duration is 7-12 weeks 1

Dose Adjustments for Special Populations

• For patients with moderate to severe hepatic impairment:

  • Maximum dose should not exceed 150 mg daily (one tablet) 3, 1, 2
  • For severe hepatic impairment, consider 150 mg every other day 2

• For patients with moderate to severe renal impairment:

  • Reduce the total daily dose by half 3, 1, 2
  • Consider 150 mg once daily instead of twice daily 1

• For older adults:

  • Consider starting with lower doses (approximately 50% of standard dose) 1
  • Gradually titrate to minimize adverse effects 1

Important Safety Considerations

• To minimize seizure risk, increase the dose gradually 2
• Bupropion tablets should be swallowed whole, not crushed, divided, or chewed 2
• Common side effects include insomnia, headache, dry mouth, and nausea 4
• Contraindicated in patients with seizure disorders or eating disorders 1
• Avoid use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 1, 2

Clinical Pearls

• If no clinical response is observed after 6-8 weeks at an adequate dose, consider alternative treatment 1
• When discontinuing treatment with bupropion 300 mg daily, taper to 150 mg once daily prior to discontinuation 2
• Bupropion may be taken with or without food 2
• Morning dosing is generally recommended to minimize insomnia 1, 4
• Bupropion has a lower incidence of sexual dysfunction and weight gain compared to many other antidepressants 5, 6