Bupropion (Wellbutrin) Titration Schedule
The recommended titration schedule for Wellbutrin (bupropion) depends on the formulation, with the standard approach for Wellbutrin SR being to start at 150 mg once daily for 3 days, then increase to the target dose of 150 mg twice daily (300 mg total daily dose). 1
Formulation-Specific Titration Schedules
Sustained Release (SR) Formulation
- Start with 150 mg once daily for 3 days, then increase to 150 mg twice daily 1
- Maximum recommended dose is 400 mg per day (200 mg twice daily) 1
- For patients with hepatic or renal impairment, the maximum dose should not exceed 150 mg daily 1
- To minimize insomnia, administer the second daily dose before 3 PM 1
Extended Release (XL) Formulation
- Start with 150 mg once daily in the morning 1
- After 1 week, may increase to 300 mg once daily 1
- Maximum recommended dose is 450 mg once daily 1
- Morning administration is recommended to minimize insomnia 1
Special Population Considerations
Older Adults
- Start with lower doses (approximately 50% of standard dose) 1
- Begin with 37.5 mg every morning, then gradually increase by 37.5 mg every 3 days as tolerated 1
- Maximum recommended dose for older adults is 150 mg twice daily (300 mg total) 1
Patients with Hepatic or Renal Impairment
- For moderate to severe hepatic impairment: Total daily dose should not exceed 150 mg 1
- For moderate to severe renal impairment: Total daily dose should be reduced by 50% 1
Indication-Specific Titration
Major Depressive Disorder
- For SR formulation: Start with 150 mg once daily for 3 days, then increase to 150 mg twice daily 1
- For XL formulation: Start with 150 mg once daily, may increase to 300 mg once daily after 1 week 1, 2
- Efficacy has been demonstrated at doses ranging from 300-450 mg per day 2
Smoking Cessation
- Begin with 150 mg once daily for 3 days, then increase to 150 mg twice daily 1
- Start treatment 1-2 weeks before the target quit date 1
- Typical duration of treatment is 7-12 weeks 1
Safety Considerations and Monitoring
- Allow at least 8 hours between doses to minimize seizure risk 1
- Titrate slowly to minimize risk of adverse effects such as insomnia, headache, dry mouth, and anxiety 3
- Most common adverse events (insomnia and dry mouth) are generally transient and often resolve quickly 3
- Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years 1
- Monitor blood pressure as bupropion should be avoided in patients with uncontrolled hypertension 1
Important Contraindications
- Seizure disorders (bupropion lowers seizure threshold) 1
- Current or prior diagnosis of bulimia or anorexia nervosa 1
- Use of monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 1
- Abrupt discontinuation of alcohol, benzodiazepines, or antiepileptic drugs 1
By following these titration guidelines, the risk of adverse effects can be minimized while achieving therapeutic efficacy. The most important aspect is to start with a low dose and gradually increase to the target dose based on tolerability and response.