Starting Dose of Wellbutrin (Bupropion)
For major depressive disorder, start bupropion SR at 150 mg once daily in the morning for the first 3 days, then increase to 150 mg twice daily (300 mg total daily) starting on day 4. 1, 2, 3
Standard Dosing by Formulation
Bupropion SR (Sustained Release)
- Initial dose: 150 mg once daily in the morning for days 1-3 1, 2
- Target dose: 150 mg twice daily (300 mg total daily) starting day 4 1, 2
- Timing: Take the second dose before 3 PM to minimize insomnia risk 1, 2
- Maximum dose: 400 mg per day 1, 2
Bupropion XL (Extended Release)
- Initial dose: 150 mg once daily in the morning 1
- Target dose: 300 mg once daily after 4 days 3
- Maximum dose: 450 mg per day 1, 2
- Administration: Take in the morning, may be taken with or without food 3
Special Population Adjustments
Older Adults (≥55 years)
- Start lower: 37.5 mg once daily in the morning 1, 2
- Titration: Increase by 37.5 mg every 3 days as tolerated 1, 2
- Maximum dose: 150 mg twice daily (300 mg total daily) 2
- Rationale: Approximately 50% of standard adult starting doses due to increased risk of adverse reactions 2
Hepatic Impairment
- Moderate to severe (Child-Pugh 7-15): Maximum 150 mg every other day 2, 3
- Mild (Child-Pugh 5-6): Consider reducing dose and/or frequency 3
Renal Impairment
- GFR <90 mL/min: Reduce total daily dose by half 1, 2, 3
- Monitoring: Close observation for adverse reactions due to drug accumulation 1
Indication-Specific Dosing
Smoking Cessation
- Days 1-3: 150 mg once daily 1, 2
- Day 4 onward: 150 mg twice daily (300 mg total) 1, 2
- Maximum dose: 300 mg per day for smoking cessation 2
- Timing: Start 1-2 weeks before target quit date 1, 2
- Duration: 7-12 weeks, with possible extension to 6 months-1 year 2
Seasonal Affective Disorder (SAD)
- Initial dose: 150 mg once daily 3
- Target dose: 300 mg once daily after 7 days 3
- Timing: Initiate in autumn before symptom onset, continue through winter 3
- Discontinuation: Taper to 150 mg before stopping in early spring 3
Critical Safety Considerations
Absolute Contraindications
- Seizure disorders or conditions lowering seizure threshold 1, 2
- Concurrent MAOI use or within 14 days of discontinuation 2, 3
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs 1, 2
- Brain metastases (due to seizure risk) 2
Seizure Risk Management
- Maximum dose limit: Never exceed 450 mg per day 1, 2
- Gradual titration: Essential to minimize seizure risk (approximately 0.4% at doses up to 450 mg/day) 2
- Tablet integrity: Must be swallowed whole, never crushed, divided, or chewed 3
Monitoring Requirements
- Neuropsychiatric symptoms: Monitor for depression worsening, suicidal ideation, agitation, anxiety, especially in patients <24 years 1, 2, 3
- Blood pressure: Check at baseline and during titration, as bupropion can cause elevations 1, 2
- Early follow-up: Begin monitoring within 1-2 weeks of initiation for adverse effects 1
- Efficacy assessment: Allow 6-8 weeks at adequate dose before determining treatment response 1, 2
Clinical Advantages
- Lower sexual dysfunction rates compared to SSRIs 2, 4, 5
- Less somnolence than many antidepressants 2, 4, 5
- Potential for weight loss rather than weight gain 2
- Activating properties: Particularly beneficial for patients with low energy, apathy, or hypersomnia 1, 2
- Dual benefit: Addresses both depression and smoking cessation 1
Common Pitfalls to Avoid
- Late-day dosing: Always give second SR dose before 3 PM to prevent insomnia 1, 2
- Premature discontinuation: Do not stop before 6-8 weeks unless significant adverse effects occur 1
- Crushing tablets: Never crush, divide, or chew extended-release formulations 3
- Uncontrolled hypertension: Requires close blood pressure monitoring or alternative treatment 1, 2