Starting Dose of Wellbutrin for a 526-Pound Patient
Start with bupropion XL 150 mg once daily in the morning, as weight-based dosing is not required or recommended for bupropion—standard dosing applies regardless of body weight. 1, 2
Standard Dosing Protocol
The FDA-approved starting dose for major depressive disorder is 150 mg once daily in the morning, which can be increased to the target dose of 300 mg once daily after 4 days of dosing if tolerated. 2 This dosing strategy applies universally and is not adjusted based on patient weight. 1
- Initial dose: 150 mg once daily in the morning 2
- Titration timeline: After 4 days, may increase to 300 mg once daily 2
- Maximum dose: 450 mg per day for XL formulation 1
Critical Safety Screening Required Before Initiation
Before prescribing bupropion to any patient, regardless of weight, screen for absolute contraindications:
- Seizure history or conditions predisposing to seizures (brain metastases, head trauma, stroke) 1, 2
- Current or recent MAOI use (within 14 days) 2
- Eating disorders (bulimia or anorexia nervosa) due to increased seizure risk 1
- Abrupt discontinuation of alcohol, benzodiazepines, or antiepileptic drugs 1
- Uncontrolled hypertension 1
Special Considerations for Obesity
While the patient's weight of 526 pounds does not require dose adjustment for bupropion itself, consider the following:
- Hepatic function: If moderate to severe hepatic impairment is present (which can occur with obesity-related fatty liver disease), the maximum dose is 150 mg every other day 1, 2
- Renal function: If moderate to severe renal impairment exists (GFR <90 mL/min), reduce the total daily dose by 50% 1
- Blood pressure monitoring: Bupropion can elevate blood pressure and heart rate, requiring monitoring especially in the first 12 weeks 1
Administration Guidelines
- Swallow tablets whole—do not crush, divide, or chew 2
- Take in the morning to minimize insomnia risk 1
- May be taken with or without food 2
Monitoring Timeline
- Week 1-2: Monitor for neuropsychiatric adverse effects, suicidal ideation (especially in patients <24 years), and tolerability 1
- First 12 weeks: Monitor blood pressure and heart rate periodically 1
- 6-8 weeks: Assess for adequate therapeutic response before considering dose modification 1
Common Pitfalls to Avoid
Do not exceed 450 mg per day to maintain seizure risk at 0.1% (1 in 1,000). 1, 3 The seizure risk increases with higher doses, and this maximum applies regardless of patient weight. 4, 3
Do not assume weight-based dosing is needed—bupropion pharmacokinetics do not require weight-based adjustments in the absence of hepatic or renal impairment. 1, 2