How do I switch from Wellbutrin (bupropion) 200mg sustained release (SR) twice daily (BID) to Adderall (amphetamine and dextroamphetamine)?

Switching from Wellbutrin 200mg SR BID to Adderall

You should taper Wellbutrin gradually over 1-2 weeks while simultaneously initiating Adderall at a low starting dose, as bupropion does not require an extended washout period and this cross-taper approach minimizes the risk of symptom exacerbation during the transition. 1, 2

Rationale for Cross-Tapering

• Bupropion can be safely discontinued while starting stimulant therapy because it works through noradrenergic/dopaminergic pathways and does not pose significant drug interaction risks with amphetamines. 1
• Cross-tapering is generally the most acceptable method of switching psychiatric medications, as it avoids prolonged periods without treatment and reduces the risk of symptom exacerbation. 2, 3
• Conservative switching strategies that involve complete washout periods can take a long time and include periods of no treatment with the risk of potentially life-threatening exacerbations of illness. 2

Specific Tapering Protocol for Wellbutrin

Week 1:

• Reduce Wellbutrin SR from 200mg BID (400mg total daily) to 150mg BID (300mg total daily). 1
• Administer doses in the morning and before 3 PM to minimize insomnia risk during the taper. 1

Week 2:

• Further reduce to 150mg once daily in the morning. 1
• Gradual dose reduction over days to weeks reduces the risk and severity of withdrawal complications. 2

Week 3:

• Discontinue Wellbutrin completely after the 1-2 week taper. 2

Initiating Adderall

• Start Adderall at a low dose (typically 5-10mg once or twice daily) while tapering Wellbutrin, rather than waiting for complete discontinuation. 2
• Stimulants have a rapid effect, allowing for quick assessment of tolerability and efficacy. 4
• Monitor closely for increased agitation or activation, as both medications have activating properties. 1

Critical Monitoring Parameters

During the transition (weeks 1-3):

• Watch for withdrawal symptoms from bupropion, including mood changes, irritability, or return of depressive symptoms. 2
• Monitor blood pressure, as both medications can increase blood pressure, though this is more pronounced with stimulants. 1
• Assess for excessive activation, anxiety, or insomnia from the combination during cross-taper. 1

After completing the switch:

• Recognize that approximately 41% of medication-naive adults with ADHD require switching from their initially prescribed stimulant family due to poor tolerability within 90 days. 5
• If Adderall is not well-tolerated, consider switching to methylphenidate-based products rather than returning to bupropion. 5

Important Caveats

• Bupropion is not as efficacious as stimulants for ADHD treatment, so patients should understand this is a switch to more effective therapy if ADHD is the primary indication. 4
• If depression is a co-occurring condition requiring ongoing treatment, consider adding an SSRI rather than relying solely on Adderall, as stimulants are not primary treatments for depression. 4
• Avoid abrupt discontinuation of Wellbutrin after prolonged use, as this can cause withdrawal syndromes and relapse of depression. 2
• Ensure the patient does not have seizure disorders or uncontrolled hypertension before initiating either medication, though this is particularly critical for Wellbutrin. 1

Timeline Expectations

• The entire switching process should take 2-3 weeks from initiation of taper to full transition to Adderall monotherapy. 2
• Stimulant effects are typically apparent within days, allowing rapid assessment of whether the switch is beneficial. 4
• Allow adequate time (at least 6-8 weeks at therapeutic Adderall doses) to fully assess treatment response before making further medication changes. 1