Discontinuing Wellbutrin (Bupropion) 150 mg
For patients on bupropion 150 mg daily, the FDA-approved discontinuation protocol is straightforward: simply stop the medication without tapering, as this dose does not require a dose reduction step. 1
FDA-Approved Discontinuation Protocol
The FDA label explicitly states that tapering is only required for patients on 300 mg daily—these patients should decrease to 150 mg once daily before complete discontinuation. 1 Since your patient is already at 150 mg, no taper is necessary according to the official prescribing information.
Clinical Context and Withdrawal Considerations
However, the FDA guidance does not specifically address antidepressant discontinuation syndrome, which is a recognized clinical phenomenon:
Bupropion has a relatively low risk of discontinuation symptoms compared to SSRIs, as it primarily affects norepinephrine and dopamine rather than serotonin. 2
Common discontinuation symptoms when they occur include insomnia, mood disturbances, dizziness, and flu-like symptoms, though these are less frequent with bupropion than with serotonergic antidepressants. 2
Symptoms can last from days to months if they develop, with different symptoms having different durations. 2
Conservative Approach for High-Risk Patients
If the patient has a history of severe withdrawal symptoms from other antidepressants, has been on bupropion for years, or has anxiety about stopping, consider a brief taper despite FDA guidance:
Reduce to 150 mg every other day for 1-2 weeks, then discontinue completely. This approach is not FDA-specified but aligns with clinical practice for minimizing discontinuation symptoms in vulnerable patients. 2
Alternatively, if using SR formulation (which comes in smaller increments), could taper from 150 mg to 100 mg daily for 1-2 weeks before stopping. 3
Patient Education and Monitoring
Educate the patient that if withdrawal symptoms develop, they should restart the medication at the prior dose and then taper more slowly. 2
Monitor for mood changes, energy level changes, and sleep disturbances in the first 2-4 weeks after discontinuation, as these could represent either withdrawal or recurrence of depression. 2
Distinguish between withdrawal symptoms (typically peak within 1 week and resolve within 2-4 weeks) and depression recurrence (typically emerges more gradually over weeks to months). 4, 2
Critical Safety Points
Do not abruptly discontinue if the patient is also stopping alcohol, benzodiazepines, or antiepileptic drugs, as this increases seizure risk. 3
Ensure the patient is not planning to start an MAOI within 14 days of stopping bupropion. 1
For patients with renal impairment (GFR <90 mL/min) or hepatic impairment, the medication may take longer to clear, potentially prolonging any withdrawal symptoms. 3, 1
When Taper Is NOT Needed
Most patients on 150 mg can stop abruptly without problems—the evidence suggests that 89-95% of patients discontinuing antidepressants do not receive or require a formal taper through the lowest dose. 5 Bupropion's pharmacology (affecting dopamine/norepinephrine rather than serotonin) makes it less prone to withdrawal than SSRIs. 2