How to safely stop taking an extended-release (XL) medication?

How to Stop Wellbutrin XL 150 mg

Wellbutrin XL (bupropion extended-release) should be tapered gradually rather than stopped abruptly, as medications acting on the central nervous system can cause withdrawal symptoms when discontinued suddenly. 1

Why Gradual Tapering is Necessary

• Medications that act on the central nervous system, including antidepressants like bupropion, are known to cause withdrawal symptoms when stopped abruptly. 1
• Abrupt discontinuation can result in a rebound effect or discontinuation syndrome, which may include symptoms such as irritability, mood changes, dizziness, and flu-like symptoms. 2, 1
• Dose tapering is advisable to reduce the risk of a discontinuation syndrome whenever treatment must be stopped. 2

Recommended Tapering Approach

A gradual reduction over 4-8 weeks is the safest approach for discontinuing bupropion XL 150 mg:

• Reduce the dose gradually, stepping down by one dose level every 2-4 weeks. 3
• For Wellbutrin XL 150 mg, consider reducing to 100 mg daily for 2-4 weeks before complete discontinuation. 3
• Generally, medications should be stopped one at a time to allow proper monitoring of effects. 2
• The tapering schedule should employ small increments at intervals that allow adequate observation, usually at least a week at each dose level. 2

Monitoring During Discontinuation

Close monitoring is essential throughout the tapering process:

• Watch for discontinuation symptoms including mood changes, irritability, anxiety, dizziness, headache, and changes in energy levels. 3, 4
• Monitor for rebound symptoms that may occur during dose changes. 3
• Schedule follow-up appointments at 2 weeks, 1 month, and 3 months after complete discontinuation to assess for any delayed withdrawal effects or symptom recurrence. 3

Special Considerations

• If bupropion was prescribed for depression, monitor closely for return of depressive symptoms during and after discontinuation. 3
• If the medication was being used for smoking cessation, have a plan in place to manage nicotine cravings without the medication. 3
• Any decision to stop a medication needs a detailed plan for safe discontinuation, and the reasons for arriving at the decision should be documented. 2

When to Seek Immediate Medical Attention

• If severe withdrawal symptoms develop, contact your prescribing physician immediately rather than continuing the taper. 3
• If there is uncertainty about discontinuation, a time-limited withdrawal can clarify whether the medication was needed in the first place. 2
• Do not restart the medication without consulting your healthcare provider. 3

Important Caveats

• Never stop this medication abruptly without medical supervision, as stopping certain drug classes that act on the central nervous system requires caution. 2, 1
• Partnering with pharmacists and other clinicians can optimize medication management during the discontinuation process. 2
• The potential for a discontinuation syndrome underscores the importance of cautious patient selection and careful monitoring during dose reduction. 2