Restarting Bupropion After a One-Week Gap
You do not need to re-titrate bupropion if you've only missed one week of treatment—you can resume at your previous maintenance dose. 1
Clinical Rationale
The standard titration protocol for bupropion exists primarily to minimize seizure risk during initial dose escalation, not because of physiological dependence or withdrawal requiring gradual reintroduction. 1, 2 The gradual titration schedule (starting at 150 mg once daily for 3 days, then increasing to 150 mg twice daily) is designed to assess tolerability and reduce adverse effects when first introducing the medication. 1
Key Considerations
One-week interruption is brief enough that your body has not undergone significant physiological changes requiring re-titration, unlike medications with longer washout periods or those requiring steady-state adjustments. 1
Seizure risk remains the primary concern with bupropion dosing, but this risk is dose-dependent and related to exceeding maximum daily doses (450 mg/day for IR, 400 mg/day for SR), not to restarting after brief interruptions. 2, 3
If you were tolerating your maintenance dose well before the gap, there is no pharmacological reason to restart at lower doses—the medication's mechanism (dopamine-norepinephrine reuptake inhibition) does not require gradual receptor adaptation after such a short break. 2, 4
Practical Approach
Resume your previous dose immediately (typically 150 mg twice daily for SR formulation or 300 mg once daily for XL formulation). 1
Monitor for side effects in the first few days after restarting, particularly agitation, insomnia, or tremor, though these are unlikely if you previously tolerated the dose. 1, 2
Take the first dose in the morning and if using SR formulation, take the second dose before 3 PM to minimize insomnia risk. 1
Important Caveats
If you experienced significant side effects before the gap (agitation, tremor, insomnia), consider discussing with your prescriber whether a brief period at a lower dose might be warranted. 1, 2
Longer interruptions (several weeks to months) would warrant a different approach and should prompt consultation with your prescriber about whether re-titration is needed. 1
Do not take extra doses to "make up" for missed time—this significantly increases adverse effect risk, including seizures. 5