What is the typical dosing for bupropion (Wellbutrin) in Attention Deficit Hyperactivity Disorder (ADHD)?

Bupropion Dosing for ADHD in Adults

For adult ADHD, start bupropion XL at 150 mg once daily in the morning, then increase to a maintenance dose of 150-300 mg daily, with a maximum of 450 mg per day. 1

Formulation-Specific Dosing Regimens

Bupropion XL (Extended-Release, Once Daily)

• Starting dose: 150 mg orally once daily in the morning 1
• Maintenance dose: 150-300 mg orally once daily 1
• Maximum dose: 450 mg per day 1
• Titration: Can increase to 300 mg after initial tolerability assessment, typically after 3-7 days 2

Bupropion SR (Sustained-Release, Twice Daily)

• Starting dose: 100-150 mg orally once daily 1
• Maintenance dose: 100-150 mg orally twice daily (total 200-300 mg/day) 1
• Maximum dose: 400 mg per day 3
• Critical timing: Second dose must be given before 3 PM to minimize insomnia risk 3

Evidence for Efficacy in ADHD

Bupropion demonstrates moderate efficacy for adult ADHD, with 53% of patients responding (≥30% symptom reduction) compared to 31% with placebo. 2 The treatment effect size is 0.6, indicating moderate clinical benefit 2. Response can be seen as early as week 2 of treatment 2.

• Bupropion provides sustained benefit throughout the day (morning, afternoon, and evening) 2
• Clinical improvement rates are significantly higher than placebo (RR 1.50-1.78) 4
• The medication reduces ADHD symptom severity by approximately 43% from baseline 5

Special Population Dosing Adjustments

Older Adults

• Starting dose: 37.5 mg every morning 3
• Titration: Increase by 37.5 mg every 3 days as tolerated 3
• Maximum dose: 150 mg twice daily (300 mg total daily) 3

Hepatic Impairment (Moderate to Severe)

• Maximum dose: 150 mg daily total (do not exceed) 3

Renal Impairment (Moderate to Severe, GFR <90 mL/min)

• Dose reduction: Reduce total daily dose by 50% 3
• Monitor closely for adverse reactions due to drug accumulation 3

Treatment Duration and Monitoring

• Assessment timeline: Allow 6-8 weeks at an adequate dose before determining treatment response 3
• Early response: Energy levels and apathy may improve within the first few weeks, earlier than full ADHD symptom response 3
• Long-term use: Evidence supports continued efficacy, though most clinical trials evaluated 6-10 weeks of treatment 4

Critical Safety Considerations

Absolute Contraindications

• Seizure disorders: Bupropion lowers seizure threshold and is contraindicated 1, 3
• Eating disorders: Increased seizure risk in patients with bulimia or anorexia nervosa 3
• MAOI use: Contraindicated within 14 days of MAOI discontinuation 3
• Abrupt withdrawal states: Contraindicated during abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs due to increased seizure risk 3

Monitoring Requirements

• Neuropsychiatric effects: Monitor closely, especially in patients under 24 years old 3
• Blood pressure: Monitor vital signs; avoid in uncontrolled hypertension 3
• Agitation: Watch for increased agitation, as bupropion has activating properties 3

Clinical Advantages for ADHD

Bupropion may be particularly beneficial for adults with ADHD who have comorbid depression, low energy, apathy, or concerns about sexual dysfunction. 3, 4

• Lower rates of sexual dysfunction compared to SSRIs 3
• Activating properties improve energy levels and reduce apathy 3
• Can address both ADHD and depression simultaneously through noradrenergic/dopaminergic mechanisms 3
• May be combined with SSRIs for complementary therapeutic effects 3

Common Pitfalls and How to Avoid Them

• Insomnia: Always administer the first dose in the morning and any second dose (SR formulation) before 3 PM 3
• Seizure risk: Never exceed maximum daily doses (450 mg for XL, 400 mg for SR) 1, 3
• Formulation switching: Monitor closely when switching between brand and generic or between SR and XL formulations due to historical bioequivalence issues 3
• Comorbid substance use: Bupropion effectively treats ADHD symptoms but has negligible effects on active substance use disorders 5
• Premature discontinuation: Ensure adequate trial duration (6-8 weeks) before concluding treatment failure 3