What is the next dosing step for a patient taking 150mg of Wellbutrin (bupropion)?

Next Dosing Step for Wellbutrin 150mg

For a 45-year-old female currently taking 150mg Wellbutrin, the next dosing step is to increase to 300mg daily, which can be achieved by either taking 150mg twice daily (if using the SR formulation) or 300mg once daily in the morning (if using the XL formulation). 1, 2

Formulation-Specific Titration

If Using Wellbutrin SR (Sustained-Release):

• Increase to 150mg twice daily (300mg total daily dose) 1, 2
• Take the first dose in the morning and the second dose before 3 PM to minimize insomnia risk 1
• This represents the standard maintenance dose for major depressive disorder 1, 2

If Using Wellbutrin XL (Extended-Release):

• Increase to 300mg once daily in the morning 1, 2
• After 4 days at 150mg, the dose may be increased to the target dose of 300mg 2
• The XL formulation offers once-daily convenience with similar efficacy 1

Timing Considerations

The dose increase should occur after at least 3-4 days at the current 150mg dose to assess tolerability and minimize seizure risk, though the FDA label for XL formulation specifies 4 days. 1, 2 This gradual titration is critical because bupropion lowers the seizure threshold in a dose-dependent manner. 1, 2

Maximum Dosing Limits

• For SR formulation: Maximum 400mg per day 1
• For XL formulation: Maximum 450mg per day 1, 2
• The 300mg daily dose represents the standard therapeutic target for most patients with major depressive disorder 1, 2

Critical Safety Considerations

Do not exceed 450mg per day total to minimize seizure risk, which is the most serious adverse effect of bupropion. 1, 2 The risk of seizures increases with:

• Higher doses 2
• Rapid dose escalation 2
• History of seizure disorder (absolute contraindication) 1, 2
• Eating disorders (bulimia/anorexia) due to increased seizure risk 1

Special Population Adjustments

For this 45-year-old patient, standard dosing applies unless she has:

• Hepatic impairment (moderate to severe): Maximum 150mg daily total 1, 2
• Renal impairment (GFR <90 mL/min): Reduce total daily dose by half 1
• Uncontrolled hypertension: Avoid bupropion entirely 1

Expected Timeline for Response

• Initial energy improvement may occur within 1-2 weeks 1
• Full antidepressant effect typically requires 4-6 weeks at therapeutic dose 1, 3
• Allow 6-8 weeks at 300mg before determining treatment response 1

Common Pitfalls to Avoid

Never administer the second SR dose after 3 PM, as this significantly increases insomnia risk due to bupropion's activating properties. 1 Other important considerations:

• Monitor for increased agitation, as bupropion is an activating medication 1
• Watch for neuropsychiatric adverse effects, particularly in younger patients 1
• Check blood pressure, as bupropion should be avoided in uncontrolled hypertension 1