Can a patient with difficulty swallowing cut a Wellbutrin (bupropion) sustained release tablet in half?

Can a Patient Cut Wellbutrin Sustained Release Tablets in Half?

No, patients should never cut, crush, or chew Wellbutrin (bupropion) sustained release tablets, even if they have difficulty swallowing. 1

Critical Safety Rationale

The FDA explicitly warns that cutting, crushing, or chewing bupropion extended-release or sustained-release formulations causes the entire dose to be released immediately into the body, significantly increasing seizure risk. 1

• The sustained-release mechanism is designed to release medication gradually over time, maintaining therapeutic levels while minimizing peak concentrations that trigger seizures 1
• When the tablet integrity is compromised, the controlled-release properties are destroyed, resulting in rapid absorption and potential overdose 2
• Bupropion already carries a baseline seizure risk of approximately 0.1% (1 in 1,000) at therapeutic doses; altering the formulation substantially increases this risk 3, 4

Alternative Solutions for Swallowing Difficulties

If a patient cannot swallow the sustained-release tablets whole, contact the prescriber to discuss alternative formulations or medications—never modify the tablet. 1

Specific alternatives to consider:

• Switch to immediate-release bupropion formulation if available, which comes in smaller tablets that may be easier to swallow (though this requires three-times-daily dosing) 5, 6
• Consider a different antidepressant available in liquid formulation or smaller tablets 2
• Evaluate swallowing techniques with speech therapy or use of thickened liquids to facilitate tablet swallowing 7

Additional Safety Concerns

Healthcare providers administering crushed medications expose themselves to drug particles that may be carcinogenic, teratogenic, or allergenic. 2

• The person crushing bupropion tablets risks direct exposure to active pharmaceutical ingredients 2
• This occupational hazard is particularly concerning with sustained-release formulations containing higher drug concentrations 2

Clinical Pearls

• Bupropion SR must be swallowed whole with or without food 1
• The tablets may have an odor, which is normal and does not indicate a problem 1
• Patients should be explicitly counseled at the time of prescribing that the tablets cannot be altered in any way 1
• If a patient reports difficulty swallowing after starting therapy, this requires immediate prescriber contact for formulation reassessment rather than patient-initiated tablet modification 2, 7