What are the uses and dosages of Wellbutrin (bupropion)?

Wellbutrin (Bupropion) Uses and Dosages

Bupropion is FDA-approved for the treatment of major depressive disorder (MDD) and seasonal affective disorder (SAD), and is also effective for smoking cessation. 1, 2

Major Depressive Disorder (MDD)

• Starting dose: 150 mg once daily for Wellbutrin XL (extended-release) 1
• After 4 days, may increase to target dose of 300 mg once daily 1
• For Wellbutrin SR (sustained-release): Start with 150 mg once daily for 3 days, then increase to 150 mg twice daily 2
• Maximum dose: 450 mg/day for XL formulation, 400 mg/day for SR formulation 2, 1
• Onset of action typically occurs within 1-2 weeks, with full efficacy at 4-6 weeks 3
• Bupropion has comparable efficacy to other antidepressants but with less sexual dysfunction than SSRIs 4, 5

Smoking Cessation

• Standard dosing: 150 mg twice daily (300 mg total) of SR formulation 2, 6
• Treatment should begin 1-2 weeks before the target quit date 2
• Typical duration of treatment is 7-12 weeks 2
• Efficacy assessment should occur after 7-12 weeks of treatment 2
• Higher abstinence rates compared to placebo (OR, 2.07; 95% CI, 1.75–2.45) 6

Seasonal Affective Disorder (SAD)

• Initiate treatment in autumn prior to onset of seasonal depressive symptoms 1
• Starting dose: 150 mg once daily 1
• After one week, may increase to target dose of 300 mg once daily 1
• Continue treatment through the winter season 1

Special Population Considerations

Hepatic Impairment

• Moderate to severe impairment: 150 mg every other day 1
• Mild impairment: Consider reducing dose and/or frequency 1, 2
• Total daily dose should not exceed 150 mg in moderate to severe hepatic impairment 2

Renal Impairment

• Reduce total daily dose by half in moderate to severe renal impairment 2, 1
• Consider reducing frequency of dosing 1

Older Adults

• Start with lower doses (approximately 50% of standard dose) 2
• Recommended starting dose: 37.5 mg every morning, gradually increasing by 37.5 mg every 3 days as tolerated 2
• Maximum dose: 150 mg twice daily (300 mg total) 2
• Administer second dose before 3 p.m. to minimize insomnia 2

Contraindications and Precautions

• Seizure disorder or history of seizures (risk is dose-dependent, approximately 0.1% at doses up to 300 mg/day) 7, 1
• Current or prior diagnosis of bulimia or anorexia nervosa 7, 1
• Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs 1
• Use with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOIs 7, 1
• Known hypersensitivity to bupropion or other ingredients 1
• Uncontrolled hypertension 7
• Brain metastases (increased seizure risk) 6, 7
• Closed-angle glaucoma 7

Common Side Effects

• Dry mouth, nausea, insomnia, dizziness 1
• Headache, agitation, anxiety, tremor 1
• Less sexual dysfunction compared to SSRIs 4, 5
• May cause increased blood pressure (monitor before and during treatment) 1

Clinical Pearls

• Bupropion is particularly beneficial for patients with depression who also want to quit smoking 2, 6
• Unlike most antidepressants, bupropion has no appreciable activity on serotonin concentrations in the central nervous system 3
• May be effective as augmentation therapy for partial response to SSRIs 8
• Administer second daily dose before 3 p.m. to minimize insomnia 2
• Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years 2, 1