Stopping Wellbutrin (Bupropion) 300mg Daily
For patients taking bupropion 300mg daily, taper to 150mg once daily before complete discontinuation. 1, 2
Recommended Tapering Protocol
Standard Taper for Most Patients
- Reduce from 300mg to 150mg once daily and maintain this dose for at least 1-2 weeks before stopping completely 1, 2
- The FDA label explicitly states: "When discontinuing treatment in patients treated with bupropion hydrochloride extended-release tablets (XL) 300 mg once daily, decrease the dose to 150 mg once daily prior to discontinuation" 2
- This applies to both XL (once daily) and SR (twice daily) formulations, though SR requires adjustment from 150mg twice daily to 150mg once daily 1
Special Population Considerations
- Older adults may require slower tapering with smaller dose reductions (37.5mg decrements) due to increased risk of adverse reactions 1
- For patients under 24 years old, monitor closely for changes in mood or behavior during the taper, as this age group has increased risk of suicidal ideation 1
Critical Monitoring During Discontinuation
Vital Signs and Symptoms to Track
- Monitor blood pressure throughout the taper, as bupropion can elevate blood pressure and withdrawal may cause fluctuations 1
- Watch for potential withdrawal symptoms including irritable mood, anxiety, sleeplessness, headache, and generalized aches and pains 3
- While withdrawal symptoms with bupropion are less common than with SSRIs, they can occur, particularly with abrupt discontinuation 3
Timeline Considerations
- Maintain the 150mg dose for 1-2 weeks minimum before complete cessation to allow neuroadaptations to resolve 1, 2
- Some patients may benefit from an even slower taper (maintaining 150mg for several weeks) if withdrawal symptoms emerge 3
Important Clinical Caveats
Formulation-Specific Adjustments
- Do not ignore formulation differences: SR formulations require twice-daily dosing adjustments (from 150mg BID to 150mg once daily), while XL is already once daily (from 300mg to 150mg) 1
- When switching between formulations during taper, ensure equivalent total daily dosing 2
Special Circumstances Requiring Immediate Discontinuation
- If bupropion is part of naltrexone-bupropion combination therapy, discontinue before any procedure requiring opioid analgesia to avoid precipitating withdrawal or blocking opioid effectiveness 1
- For serious adverse effects (seizures, severe hypersensitivity reactions), immediate discontinuation may be necessary despite withdrawal risk 4
Why Tapering Matters
The evidence for bupropion withdrawal is less robust than for SSRIs, but case reports document withdrawal syndromes with abrupt cessation 3. The FDA's explicit recommendation to taper suggests regulatory recognition of this risk 2. While many patients may tolerate abrupt discontinuation, a standardized taper approach prevents unnecessary suffering in those who would experience withdrawal 5.
The key principle: the first dose reduction (from 300mg to 150mg) must go well - if withdrawal symptoms emerge, slow the taper further before attempting complete cessation 5.