Tapering Schedule for Bupropion XL 150 mg Daily
For a patient taking bupropion XL 150 mg daily, no gradual taper is necessary—simply discontinue the medication. 1
FDA-Approved Discontinuation Protocol
The FDA label for bupropion XL explicitly states that tapering is only required when discontinuing from the 300 mg daily dose, not the 150 mg dose. 1
When discontinuing bupropion XL 300 mg daily, the FDA recommends decreasing to 150 mg once daily prior to complete discontinuation. 1 Since your patient is already at 150 mg daily, they are at the lowest therapeutic dose and can stop without further dose reduction. 1
Clinical Context and Monitoring
While abrupt discontinuation is FDA-approved at this dose, be aware that withdrawal symptoms have been reported in case reports, including irritable mood, anxiety, sleeplessness, headache, and generalized aches and pains. 2 However, these symptoms are uncommon and not severe enough to warrant mandatory tapering at the 150 mg dose. 2
Monitor the following during the first 1-2 weeks after discontinuation: 3, 4
- Mood changes or behavioral symptoms (particularly in patients under 24 years old, who have elevated risk for suicidal ideation during medication changes) 3, 4
- Blood pressure and heart rate (bupropion can affect cardiovascular parameters) 3, 5
- Withdrawal symptoms including irritability, anxiety, insomnia, headache, or body aches 2
Treatment Duration Considerations
Ensure the patient has completed adequate treatment duration before discontinuation. Treatment for a first episode of major depression should last at least 4 months beyond initial response. 4 Do not discontinue prematurely unless significant adverse effects occur. 4
Alternative Approach for Cautious Discontinuation
If you prefer a more conservative approach despite FDA guidance (for example, in patients with history of medication sensitivity or anxiety about withdrawal), you could use the hepatic impairment dosing as precedent: 150 mg every other day for 1-2 weeks before complete discontinuation. 5, 4 This schedule is established as safe in patients with moderate to severe hepatic impairment and provides a gentler transition. 5, 4
Critical Safety Considerations
If the patient is taking naltrexone-bupropion combination therapy (for weight management), discontinue before any procedure requiring opioid analgesia, as naltrexone will precipitate severe withdrawal in opioid-dependent patients. 5
Do not switch between formulations (SR to XL, brand to generic) during discontinuation, as historical bioequivalence issues may complicate the process and lead to unpredictable drug levels. 4