What is the recommended dosing of bupropion (Bupropion) for a 107kg male with severe Major Depressive Disorder (MDD)?

Bupropion Dosing for Severe MDD in a 107 Kg Male

For severe major depressive disorder in this patient, start bupropion XL at 150 mg once daily in the morning, then increase to the target dose of 300 mg once daily after 4 days, with a maximum dose of 450 mg daily if needed for adequate response. 1

Initial Dosing Strategy

• Start with bupropion XL 150 mg once daily in the morning to minimize seizure risk while establishing tolerability 1
• After 4 days at the starting dose, increase to the target dose of 300 mg once daily 1
• The XL formulation is preferred for once-daily dosing, improving adherence and providing steady drug levels throughout the day 2
• Administer in the morning to leverage bupropion's activating properties and minimize insomnia risk 2

Dose Escalation for Severe Depression

• If inadequate response after 4-6 weeks at 300 mg daily, the dose may be increased to the maximum of 450 mg once daily 1
• The FDA label specifies that 450 mg is the maximum daily dose for the XL formulation to minimize seizure risk 1
• Gradual dose titration is critical—never increase more rapidly than recommended, as seizure risk increases with higher doses and rapid escalation 1, 3

Weight Considerations

• Body weight does not require dose adjustment for this 107 kg male, as bupropion dosing is not weight-based 1
• Standard dosing applies regardless of body weight in patients without hepatic or renal impairment 1

Alternative Formulation (If XL Unavailable)

• Bupropion SR can be used as an alternative: start 150 mg once daily for 3 days, then increase to 150 mg twice daily (300 mg total) 2
• Maximum dose for SR formulation is 200 mg twice daily (400 mg total) 2
• If using SR twice daily, administer the second dose before 3 PM to prevent insomnia 2

Critical Safety Monitoring

• Absolute contraindications: seizure disorders, current/prior bulimia or anorexia nervosa, concurrent MAOI use or within 14 days of MAOI discontinuation 1
• Monitor for neuropsychiatric adverse effects, particularly in patients under 24 years old 2
• Watch for increased agitation, as bupropion has activating properties 2
• Monitor blood pressure, as bupropion should be avoided in uncontrolled hypertension 2

Expected Timeline for Response

• Initial improvement in depressive symptoms may be seen within 1-2 weeks 4
• Full therapeutic effect typically occurs at 4 weeks of treatment 4
• If no response after 6-8 weeks at an adequate dose, consider alternative treatment 2

Dose Adjustments for Special Circumstances

• Renal impairment (GFR <90 mL/min): Reduce dose and/or frequency by approximately 50% 2, 1
• Moderate to severe hepatic impairment: Maximum dose 150 mg daily (or 150 mg every other day for severe impairment) 2, 1
• Mild hepatic impairment: Consider reducing dose and/or frequency 1

Maintenance Treatment

• Acute depressive episodes require several months or longer of treatment beyond initial response 1
• The dose that provided initial response is typically continued for maintenance 1
• When discontinuing after treatment at 300 mg daily, taper to 150 mg once daily before complete discontinuation 1