What is the typical dosage of bupropion (Wellbutrin) for Attention Deficit Hyperactivity Disorder (ADHD)?

Bupropion Dosing for ADHD

For ADHD treatment, start bupropion sustained-release (SR) at 100-150 mg once daily, then titrate to a maintenance dose of 100-150 mg twice daily (maximum 450 mg/day), or use extended-release (XL) formulation starting at 150 mg daily and increasing to 150-300 mg daily. 1

Formulation-Specific Dosing

Sustained-Release (SR) Formulation

• Initial dose: 100-150 mg once daily 1
• Maintenance dose: 100-150 mg twice daily 1
• Maximum dose: 450 mg per day 1
• Titrate weekly to target dose 2

Extended-Release (XL) Formulation

• Initial dose: 150 mg daily 1
• Maintenance dose: 150-300 mg daily 1
• Maximum dose: 450 mg per day 1
• This formulation provides sustained benefit throughout the day (morning, afternoon, and evening) 3

Clinical Context and Treatment Position

Bupropion is a second-line, off-label treatment for ADHD with moderate efficacy. 1 The American Academy of Child and Adolescent Psychiatry recommends trying all three stimulant classes before switching to bupropion 1. However, bupropion becomes a preferred first-line option in specific clinical scenarios:

• Active substance use disorder: Bupropion is preferred over stimulants in patients with comorbid substance use 1
• Comorbid depression: Consider bupropion for dual benefits in treating both ADHD and depression 1

Efficacy Evidence

The evidence supporting bupropion for ADHD shows:

• 43% reduction in ADHD symptom severity compared to placebo 4
• 53% responder rate (≥30% symptom reduction) versus 31% with placebo 3
• Response can be seen as early as week 2 of treatment 3
• Treatment effect size of 0.6 for ADHD Rating Scale total score 3

Critical Safety Considerations

Absolute Contraindication

Bupropion is absolutely contraindicated in patients with seizure disorders or conditions that increase seizure risk due to lowering of seizure threshold. 1

Common Adverse Effects

• Insomnia 1
• Decreased appetite 1
• Activation 1
• Headache (though less common than with methylphenidate) 5

Withdrawal rates due to adverse effects are similar to placebo, with only 5% drug-related study discontinuation. 1, 3

Special Populations

Comorbid Substance Use Disorder

• Bupropion SR at 200 mg twice daily produces clinically significant ADHD symptom reduction (43% decrease) in adults with active substance use disorders 2
• However, bupropion has minimal effect on substance use itself 2

Pediatric Dosing

• Weight-based dosing: 100 mg/day for patients <30 kg, 150 mg/day for patients >30 kg 5
• Efficacy comparable to methylphenidate in children and adolescents 5

Drug Interaction Considerations

If combining with atomoxetine (though this is uncommon):

• Start atomoxetine at lower doses (40 mg daily or less) if bupropion is already prescribed 6
• Monitor for serotonin syndrome symptoms within 24-48 hours: mental status changes, tremors, clonus, hyperreflexia, hypertension, tachycardia 6