What is the recommended tapering schedule for discontinuing Wellbutrin (bupropion)?

Wellbutrin (Bupropion) Tapering Recommendations

For patients on bupropion 300 mg daily, taper to 150 mg once daily before complete discontinuation; no specific taper duration is mandated by the FDA label, but a gradual reduction over 1-2 weeks is reasonable to minimize potential withdrawal symptoms. 1

FDA-Approved Tapering Protocol

The FDA label for bupropion extended-release provides explicit guidance: 1

• For patients on 300 mg daily: Decrease to 150 mg once daily before stopping completely 1
• For patients on 150 mg daily: The label does not specify a required taper step, suggesting direct discontinuation may be acceptable 1
• Timing: The label does not mandate a specific duration between dose reduction and complete cessation 1

Practical Tapering Approach

While the FDA label is brief, a conservative approach based on general antidepressant principles includes: 1, 2

• Week 1-2: Reduce from 300 mg to 150 mg daily 1
• Week 3-4: Continue 150 mg daily to assess tolerance 1
• After Week 4: Discontinue if patient tolerates the 150 mg dose well 1

For patients experiencing withdrawal symptoms (anxiety, irritability, insomnia, mood changes), consider: 2, 3

• Extending the 150 mg phase to 4-6 weeks before discontinuation 2
• For severe symptoms, some patients may benefit from alternating 150 mg daily with 150 mg every other day for 1-2 weeks before stopping 4, 2

Key Differences from Other Antidepressants

Bupropion requires less aggressive tapering than SSRIs because: 1, 2

• The FDA label only mandates one dose reduction step (300 mg → 150 mg) 1
• Bupropion's mechanism (dopamine/norepinephrine reuptake inhibition) produces less severe withdrawal than serotonergic agents 5, 1
• Research on hyperbolic tapering focuses primarily on SSRIs due to their serotonin transporter occupancy curves, which is less relevant for bupropion 2, 6

Monitoring During Discontinuation

Watch for these withdrawal symptoms: 2, 3

• Mood changes: Irritability, anxiety, depressed mood 2
• Physical symptoms: Headache, fatigue, dizziness 2
• Sleep disturbances: Insomnia or vivid dreams 2
• Cognitive symptoms: Difficulty concentrating 3

If significant symptoms emerge, return to the previous dose and slow the taper further. 2, 3

Critical Pitfalls to Avoid

• Do not abruptly stop 300 mg daily dosing without first reducing to 150 mg, as this violates FDA guidance and increases withdrawal risk 1
• Do not confuse withdrawal symptoms with depression relapse in the first 2-4 weeks after discontinuation; withdrawal symptoms typically emerge within days and resolve within 2-3 weeks, while relapse develops more gradually 2, 3
• Do not use the same aggressive hyperbolic tapering strategies designed for SSRIs, as bupropion's pharmacology differs substantially 2, 6

Special Populations

Hepatic impairment: 1

• Moderate to severe (Child-Pugh 7-15): Maximum dose is 150 mg every other day; taper by extending dosing interval further (every 3-4 days, then weekly, then stop) 1
• Mild impairment (Child-Pugh 5-6): Consider slower taper with extended time at 150 mg daily 1

Renal impairment (GFR <90 mL/min): Consider extending the taper duration and monitoring more closely for withdrawal symptoms 1