How can I taper off bupropion sustained-release 150 mg?

How to Taper Off Bupropion SR 150 mg

For bupropion SR 150 mg, taper by reducing to 150 mg once daily for at least several days before complete discontinuation; for patients on higher doses, step down to 150 mg daily before stopping. 1

FDA-Approved Tapering Protocol

The FDA drug label provides explicit guidance for discontinuing bupropion extended-release formulations:

• When discontinuing bupropion XL 300 mg once daily, decrease the dose to 150 mg once daily prior to complete discontinuation. 1
• This same principle applies to bupropion SR: if you are taking 150 mg twice daily (300 mg total), reduce to 150 mg once daily before stopping completely. 1
• If you are already on 150 mg once daily, you can reduce to 150 mg every other day for several days, then discontinue. 2

Why Tapering Matters

Although bupropion is not associated with the severe discontinuation syndromes seen with SSRIs or opioids, gradual dose reduction is still recommended:

• Abrupt discontinuation may unmask underlying symptoms or cause rebound effects, though bupropion has a relatively favorable discontinuation profile compared to serotonergic antidepressants. 3
• The FDA specifically instructs clinicians to taper the dose when discontinuing treatment, particularly for patients on 300 mg daily. 1

Practical Tapering Schedule

For bupropion SR 150 mg twice daily (300 mg total):

• Week 1–2: Reduce to 150 mg once daily (morning dose only). 1
• Week 3: Discontinue completely, or optionally take 150 mg every other day for 3–4 days before stopping. 2, 1

For bupropion SR 150 mg once daily:

• Days 1–4: Take 150 mg every other day. 2
• Day 5 onward: Discontinue completely. 2

Special Populations Requiring Slower Tapers

• Patients with hepatic impairment (moderate to severe) should taper even more gradually, as bupropion clearance is reduced and the maximum dose is already limited to 150 mg every other day. 2, 1
• Patients with renal impairment (GFR <90 mL/min) should also taper slowly, as bupropion and its active metabolites accumulate. 2, 1
• Older adults may benefit from a more gradual taper (e.g., reducing by 37.5 mg increments every 3–7 days) due to increased sensitivity to medication changes. 2

Monitoring During Discontinuation

• Watch for re-emergence of depressive symptoms, irritability, or mood changes during the taper, especially in the first 1–2 weeks after dose reduction. 3
• If you were taking bupropion for smoking cessation, be prepared for nicotine withdrawal symptoms to re-emerge; consider nicotine replacement therapy if needed. 2, 4
• Unlike SSRIs, bupropion does not typically cause dizziness, "brain zaps," or severe flu-like discontinuation symptoms, but monitor for insomnia, headache, or irritability. 4, 3

Common Pitfalls to Avoid

• Do not stop bupropion abruptly if you are on 300 mg daily—this violates FDA guidance and may increase the risk of symptom recurrence. 1
• Do not confuse bupropion SR (sustained-release, dosed twice daily) with bupropion XL (extended-release, dosed once daily); the tapering schedule is similar, but the formulations are not interchangeable without dose adjustment. 2, 1
• If you are switching to another antidepressant, coordinate the taper with your prescriber; bupropion does not require a washout period before starting most other antidepressants (except MAOIs, which require a 14-day gap). 1

When to Seek Medical Guidance

• If depressive symptoms worsen significantly during the taper, contact your prescriber immediately—you may need to resume the previous dose or switch to an alternative antidepressant. 3
• If you experience new-onset agitation, suicidal thoughts, or severe mood changes, seek urgent evaluation, especially if you are under 24 years old. 2, 1