Tapering Wellbutrin at 150mg Daily
For patients taking Wellbutrin (bupropion) 150mg daily, tapering is recommended rather than abrupt discontinuation to minimize withdrawal symptoms and monitor for re-emergence of depression. 1, 2
Recommended Tapering Approach
The FDA-approved drug label specifically states that when discontinuing bupropion extended-release 300mg daily, the dose should be decreased to 150mg once daily prior to discontinuation. 2 For patients already on 150mg daily, this principle of gradual reduction still applies.
Specific Tapering Protocol
- Maintain the 150mg dose for at least 1-2 weeks before complete cessation to allow monitoring for withdrawal effects or depressive symptom re-emergence 1
- Schedule follow-up within 2-4 weeks after complete discontinuation, as depressive symptoms may re-emerge weeks to months later 1
- The general guideline for antidepressant discontinuation recommends tapering over 10-14 days to limit withdrawal symptoms 3
Withdrawal Symptoms to Monitor
Watch for these specific withdrawal manifestations during and after tapering:
- Gastrointestinal symptoms including nausea 1
- Mood changes including anxiety, irritability, or worsening depression 1
- Physical symptoms that may emerge during the discontinuation period 3
Why Tapering Matters
While bupropion is generally well-tolerated with low discontinuation rates (6-12% in clinical trials) 4, abrupt cessation can precipitate problems:
- Withdrawal symptoms are preventable with careful dose tapering, though some patients tolerate abrupt discontinuation without issues 5
- The first dose reduction is critical - it must go well to predict tolerance of complete discontinuation 5
- Research shows that only 8.9% of patients receive evidence of deliberate tapering in routine practice, suggesting this important step is often overlooked 5
Clinical Pitfalls to Avoid
Do not confuse withdrawal symptoms with depression relapse. Both can present with mood changes, anxiety, and physical symptoms 1. The timing helps differentiate: withdrawal symptoms typically emerge within days to 2 weeks of dose reduction, while true depression relapse may take weeks to months 1.
For patients on 150mg daily, consider whether they can tolerate every-other-day dosing as an intermediate step before complete cessation, similar to the approach used in hepatic impairment 2. This provides an even gentler taper than immediate discontinuation.