Bupropion ER Tapering Schedule for Discontinuation
When discontinuing bupropion extended-release (ER), a gradual tapering approach is recommended to minimize withdrawal symptoms. For patients taking bupropion ER 300 mg daily, decrease the dose to 150 mg once daily prior to discontinuation. 1
Recommended Tapering Protocol for Bupropion ER
- For patients on bupropion ER 300 mg daily, reduce to 150 mg daily for at least 1-2 weeks before complete discontinuation 1
- For patients already on 150 mg daily, consider taking 150 mg every other day for 1-2 weeks before stopping completely 1
- Patients with moderate to severe hepatic impairment should already be on reduced dosing (150 mg every other day), and can discontinue after 1-2 weeks at this frequency 1
Rationale for Gradual Tapering
- Abrupt discontinuation of antidepressants, including bupropion, may lead to withdrawal symptoms 2
- Gradual tapering helps minimize the risk of withdrawal symptoms and potential relapse 3
- While bupropion has a lower risk of discontinuation syndrome compared to SSRIs, tapering is still recommended 4
Monitoring During Tapering
- Watch for potential withdrawal symptoms during the tapering process, which may include: 2, 5
- Irritability or mood changes
- Sleep disturbances
- Fatigue
- Headaches
- Anxiety
Special Considerations
- For patients with renal impairment, consider an even more gradual taper due to altered drug clearance 1
- Patients with a history of seizures require careful monitoring during the tapering process, as bupropion may lower the seizure threshold 1
- If the patient is taking bupropion as part of a combination therapy (e.g., naltrexone-bupropion ER for weight management), the same tapering principles apply 3
Important Caveats
- If withdrawal symptoms emerge during tapering, consider slowing the taper rate 3
- Distinguish between withdrawal symptoms and recurrence of the original condition (depression, anxiety) that was being treated 2
- Most studies on antidepressant tapering suggest that slower tapers (over months rather than weeks) may be more successful in preventing withdrawal symptoms 5, 6, 7
- For patients at high risk of relapse, consider implementing additional supportive interventions during the tapering process 2
When to Seek Additional Medical Attention
- If severe symptoms develop during tapering, such as significant mood changes, suicidal thoughts, or severe physical symptoms, immediate medical attention should be sought 2
- If withdrawal symptoms are intolerable, temporarily returning to the previous dose and attempting a slower taper may be necessary 6