Tapering Wellbutrin (Bupropion): Recommended Protocol
When discontinuing bupropion XL 300 mg once daily, decrease the dose to 150 mg once daily prior to complete discontinuation. 1
FDA-Approved Tapering Protocol
The FDA label provides explicit guidance for discontinuing bupropion extended-release formulations:
- For patients on 300 mg daily: Reduce to 150 mg once daily before stopping completely 1
- Timing: The FDA does not specify a minimum duration at the reduced dose, but the taper should be gradual to minimize seizure risk 1
This represents the only evidence-based tapering protocol specifically outlined in official prescribing information for bupropion.
Formulation-Specific Considerations
Bupropion SR (sustained-release): If tapering from 300 mg daily (150 mg twice daily), reduce to 150 mg once daily before discontinuation 2
Bupropion XL (extended-release): Reduce from 300 mg once daily to 150 mg once daily before stopping 1
The key principle is to avoid abrupt discontinuation, particularly from higher doses, as bupropion lowers seizure threshold and gradual dose reduction minimizes this risk 1
Special Population Adjustments During Tapering
Hepatic impairment: Patients with moderate to severe hepatic impairment (Child-Pugh score 7-15) should not exceed 150 mg every other day, making the taper even more gradual 1
Renal impairment: Consider reducing dose and/or frequency more gradually in patients with GFR <90 mL/min 1
Older adults: May require slower tapering with smaller dose reductions (consider 37.5 mg decrements) due to increased risk of adverse reactions 2
Clinical Monitoring During Taper
Withdrawal symptoms to monitor: While bupropion is not associated with the same withdrawal syndrome as SSRIs or opioids, monitor for:
- Return of depressive symptoms 1
- Changes in mood or behavior, particularly in patients under 24 years old 3
- Vital signs, especially blood pressure 3
Duration at reduced dose: Although not specified in FDA labeling, maintaining the reduced dose (150 mg) for at least 1-2 weeks before complete discontinuation is reasonable based on the drug's elimination half-life of 11-14 hours and the need to allow neuroadaptations to resolve 4
Critical Safety Considerations
Do not abruptly discontinue: The gradual taper is essential to minimize seizure risk, which is dose-dependent with bupropion 1
MAOI interactions: Allow at least 14 days after stopping bupropion before starting an MAOI antidepressant 1
Opioid considerations: If bupropion is part of naltrexone-bupropion combination therapy for weight management, discontinue before any procedure requiring opioid analgesia 3
Common Pitfalls to Avoid
- Stopping too quickly from 300 mg: Always step down to 150 mg first rather than stopping abruptly 1
- Ignoring formulation differences: SR formulations require twice-daily dosing adjustments, while XL is once daily 2
- Inadequate monitoring period: Observe patients for at least several weeks after complete discontinuation for emergence of depressive symptoms 1