What is the recommended tapering schedule for Wellbutrin (bupropion)?

Wellbutrin (Bupropion) Tapering Recommendations

Taper Wellbutrin gradually over several months using 10% reductions of the previous dose every 2-4 weeks to minimize withdrawal symptoms, never stopping abruptly except in cases of serious medical toxicity. 1

Recommended Tapering Protocol

The FDA label explicitly states that bupropion should be tapered when discontinuing treatment. 1 While the specific schedule is not detailed in the FDA labeling, applying evidence-based principles from antidepressant discontinuation provides the most prudent approach:

Standard Tapering Schedule

• Reduce the dose by 10% of the previous dose every 2-4 weeks 2
• For patients on long-term bupropion therapy (months to years), slower tapers of 10% per month are more appropriate and better tolerated 2
• Monitor for withdrawal symptoms after each dose reduction before proceeding to the next step 2

Example Tapering Schedule

For a patient on 300mg daily:

• First reduction: 270mg daily (10% reduction) 2
• Second reduction: 243mg daily (10% of 270mg) 2
• Continue with 10% reductions of each new dose until reaching the lowest available formulation 2

Why Hyperbolic (Exponential) Tapering Matters

Linear tapering (reducing by the same absolute amount each time) is inadequate because it causes disproportionately large biological effects at lower doses. 3, 4 The 10% reduction method creates a hyperbolic taper that maintains consistent biological effect reduction throughout the discontinuation process 3, 4.

Critical Pitfalls to Avoid

Never Use Alternate-Day Dosing

Do not attempt to taper by dosing every other day—this creates severe fluctuations in drug levels and dramatically increases withdrawal risk. 5 Alternate-day dosing causes pronounced variation in receptor occupancy even at standard doses, making withdrawal symptoms highly likely 5.

Never Taper Too Quickly

Avoid arbitrary time limits for completing the taper. 2 The commonly recommended 2-4 week tapers show minimal benefit over abrupt discontinuation and are often not tolerated 3. Tapers over months are far more successful 3.

Managing Withdrawal Symptoms

Bupropion withdrawal can include irritability, anxiety, insomnia, headache, and generalized aches 6. If withdrawal symptoms emerge:

• Return to the previous well-tolerated dose and slow the taper further 2
• Use adjunctive medications for specific symptoms:
  • For insomnia: short-term trazodone 2
  • For muscle aches: acetaminophen or NSAIDs 2
  • For increased sympathetic activity: α2-adrenergic agonists like clonidine 2

Special Considerations

Patients on bupropion for years require much slower tapers than those on short-term therapy. 2 The taper may need to be paused and restarted when the patient is ready, and should be slowed further once reaching low doses 2.

Set clear expectations with patients about the tapering timeline and potential withdrawal symptoms before beginning. 2 Provide close monitoring and continued support throughout the entire process 2.

Practical Dosing Challenges

The major barrier to proper tapering is obtaining flexible doses, particularly at the final steps requiring very small amounts 4. Consider:

• Using immediate-release formulations if available for more flexible dosing
• Consulting a compounding pharmacy for custom doses
• Working with the patient's pharmacist to identify practical solutions for achieving 10% reductions