Maximum Dose of Bupropion
For a patient currently taking bupropion 150 mg daily, the maximum recommended dose depends on the formulation: 400 mg/day for sustained-release (SR) and 450 mg/day for extended-release (XL). 1
Formulation-Specific Maximum Doses
The maximum daily dose varies by formulation and must not be exceeded to minimize seizure risk:
- Bupropion SR (sustained-release): Maximum 400 mg per day 1, 2
- Bupropion XL (extended-release): Maximum 450 mg per day 1, 3
- Immediate-release formulation: Maximum 450 mg per day 2
Standard Therapeutic Dosing
For most indications, the typical therapeutic approach is:
- Initial dose: 150 mg once daily for 3 days 1
- Standard maintenance dose: 150 mg twice daily (300 mg total daily) for SR formulation 1
- XL formulation: 150-300 mg once daily, with maximum of 450 mg once daily 1
Critical Safety Considerations
The seizure risk at recommended doses (≤450 mg/day) is approximately 0.1% (1 in 1,000 patients), but this risk increases substantially with higher doses or rapid titration. 1, 3, 4
Key safety parameters include:
- Gradual titration is mandatory to reduce seizure risk—increase by no more than 37.5-150 mg every 3 days as tolerated 1
- Never exceed maximum dose for the specific formulation being used 1, 3
- Screen for seizure risk factors before any dose escalation, including history of seizures, eating disorders, head trauma, brain tumors, or abrupt discontinuation of alcohol/benzodiazepines 1, 4
Special Population Dose Adjustments
Maximum doses must be reduced in certain populations:
- Moderate to severe hepatic impairment: Maximum 150 mg daily (one tablet) 1
- Moderate to severe renal impairment (GFR <90 mL/min): Reduce total daily dose by 50% 1
- Older adults: Maximum 300 mg total daily dose (150 mg twice daily) 1
Indication-Specific Dosing
- Smoking cessation: Maximum 300 mg per day (150 mg twice daily SR formulation) to maintain seizure risk at 0.1% 1, 4
- Major depressive disorder: Up to 400 mg/day (SR) or 450 mg/day (XL) 1, 2
Common Pitfall to Avoid
Do not confuse the maximum dose for smoking cessation (300 mg/day) with the maximum dose for depression treatment (400-450 mg/day depending on formulation). The lower maximum for smoking cessation reflects the specific risk-benefit profile for that indication. 1, 4