Missing a Single 150mg Daily Dose of Bupropion
Missing one day of bupropion 150mg is generally well-tolerated with minimal acute consequences, though patients may experience mild withdrawal symptoms or temporary return of depressive symptoms, particularly if they are sensitive to medication changes. 1
What Happens Physiologically
When a patient skips a single dose of bupropion 150mg daily:
- Plasma levels decline but do not disappear immediately due to bupropion's active metabolite (4-hydroxybupropion), which provides some pharmacological coverage even after missing a dose 2
- No acute medical emergency occurs from missing one dose, as bupropion does not cause dangerous withdrawal syndromes like those seen with benzodiazepines or alcohol 1
- The therapeutic effect may temporarily diminish, particularly for patients taking it for depression with low energy or apathy, as bupropion's activating properties wear off 1
Expected Symptoms (If Any)
Most patients experience no noticeable effects from missing a single dose, but some may notice:
- Mild return of depressive symptoms such as low energy, apathy, or reduced motivation, especially in patients who respond well to bupropion's activating properties 1
- Possible mild anxiety or irritability in some patients, though this is less common with a single missed dose 3
- No seizure risk from missing a dose - seizure risk is associated with excessive dosing or abrupt discontinuation of seizure-protective medications (like alcohol or benzodiazepines), not from missing therapeutic doses 1, 3
Clinical Management
The patient should simply resume their regular 150mg dose the next day at the usual time - do not double the dose to "make up" for the missed one 1
Key management points:
- Never take two doses at once to compensate for a missed dose, as this increases seizure risk unnecessarily 4, 5
- Resume the normal schedule immediately - taking the next scheduled dose at the regular time maintains steady-state levels 1
- Reassure the patient that occasional missed doses do not significantly impact overall treatment efficacy, though consistent adherence is important for optimal therapeutic benefit 1
Important Caveats
- For smoking cessation patients: Missing a dose during the critical quit period (first 7-12 weeks) may temporarily reduce craving control, but one missed dose is unlikely to derail cessation efforts 1, 3
- For patients on 150mg once daily: This is typically a starting dose, and missing it has less impact than missing doses in patients on higher maintenance dosing (150mg twice daily) 1
- Chronic non-adherence is different: While one missed dose is benign, frequent missed doses prevent achieving steady-state therapeutic levels and require 6-8 weeks at consistent dosing to properly assess efficacy 1