What is a recommended taper schedule for discontinuing Wellbutrin (bupropion) from 300 mg?

Wellbutrin Taper from 300 mg

When discontinuing Wellbutrin (bupropion) 300 mg daily, reduce to 150 mg once daily for a period before complete discontinuation. 1, 2

Standard Tapering Protocol

For patients on bupropion XL 300 mg once daily:

• Decrease to 150 mg once daily before stopping completely 2
• The FDA label specifically recommends this single-step reduction for the XL formulation 2

For patients on bupropion SR 300 mg daily (150 mg twice daily):

• Reduce to 150 mg once daily before discontinuation 1
• This represents a 50% dose reduction before complete cessation 1

Duration of Taper

The evidence does not specify an exact duration for how long to remain at the reduced 150 mg dose before complete discontinuation. However, based on general principles:

• Allow at least 1-2 weeks at the reduced dose to assess tolerability and monitor for withdrawal symptoms 1
• Older adults may require slower tapering with smaller dose reductions (37.5 mg decrements) due to increased risk of adverse reactions 1

Critical Monitoring During Taper

Monitor closely for:

• Changes in mood or behavior, particularly in patients under 24 years old 1
• Vital signs, especially blood pressure 1
• Emergence of depressive symptoms that may indicate need for alternative treatment 1

Special Population Considerations

Older adults require modified approach:

• Consider tapering in 37.5 mg decrements rather than the standard 150 mg reduction 1
• This slower approach minimizes risk of adverse reactions in this vulnerable population 1

Patients on naltrexone-bupropion combination therapy:

• Must discontinue before any procedure requiring opioid analgesia 1
• This is a critical safety consideration often overlooked 1

Common Pitfalls to Avoid

Do not ignore formulation differences:

• SR formulations require twice-daily dosing adjustments 1
• XL formulations are once daily 1
• These are not interchangeable without dose adjustment 1

Do not abruptly discontinue:

• While bupropion is not associated with the severe withdrawal syndromes seen with SSRIs or opioids, gradual reduction is still recommended by the FDA 2
• The single-step taper (300 mg to 150 mg to zero) is the minimum recommended approach 2

Clinical Context

Unlike SSRIs, which may require hyperbolic tapering over months to minimize withdrawal symptoms 3, bupropion has a more straightforward discontinuation profile. The FDA-approved label provides clear guidance for a simple one-step dose reduction before complete cessation 2. This reflects bupropion's unique mechanism of action (norepinephrine-dopamine reuptake inhibition) which does not produce the same withdrawal phenomena as serotonergic agents 2.

The timing of initiation and duration at the reduced dose should be individualized based on patient response and tolerability, but the dose reduction itself (300 mg to 150 mg) is standardized 2.