Does a patient with Attention Deficit Hyperactivity Disorder (ADHD) need to taper off bupropion (Wellbutrin) when discontinuing the medication?

Bupropion Tapering for ADHD Discontinuation

Yes, patients with ADHD should taper bupropion when discontinuing, reducing from 300 mg to 150 mg daily before complete cessation. 1

FDA-Mandated Tapering Protocol

The FDA drug label explicitly states that when discontinuing bupropion extended-release 300 mg once daily, the dose must be decreased to 150 mg once daily prior to complete discontinuation. 1 This is the only FDA-approved tapering protocol for bupropion and should be followed for all patients, including those taking it for ADHD.

Rationale for Tapering

Bupropion requires tapering to prevent withdrawal symptoms, which have been documented in clinical case reports. 2 Withdrawal symptoms from abrupt bupropion discontinuation include:

• Irritable mood 2
• Anxiety 2
• Sleeplessness 2
• Headache 2
• Generalized aches and pains 2

Specific Tapering Schedule

For patients on 300 mg daily:

• Step 1: Reduce to 150 mg once daily in the morning 1
• Step 2: Continue 150 mg for at least several days to weeks before complete discontinuation 1
• Step 3: Discontinue completely 1

The FDA label does not specify the exact duration to remain at 150 mg before stopping, but based on general antidepressant tapering principles and the documented withdrawal case, maintaining the 150 mg dose for 1-2 weeks before complete cessation is prudent. 2

Special Considerations for ADHD Patients

Monitor closely for return of ADHD symptoms during and after tapering, as symptom recurrence may take weeks to months to emerge after dose reduction. 3 Schedule more frequent follow-up appointments during the tapering period to assess for:

• Return of inattention, impulsivity, or hyperactivity 4, 5
• Emergence of withdrawal symptoms 2
• Need for alternative ADHD treatment 4

Common Pitfalls to Avoid

Never discontinue bupropion abruptly, even though it is not a controlled substance and lacks the abuse potential of stimulants. 2 The case report literature demonstrates that abrupt cessation can produce clinically significant withdrawal symptoms that may be mistaken for ADHD symptom recurrence. 2

Do not assume bupropion can be stopped without tapering simply because the patient is taking it for ADHD rather than depression. The FDA tapering requirement applies regardless of the indication for use. 1

Patient Education

Educate patients about the benefits of gradual discontinuation and the potential for withdrawal symptoms if bupropion is stopped abruptly. 2 Emphasize the importance of compliance with the tapering schedule to minimize discomfort and distinguish true ADHD symptom return from withdrawal effects. 2