What is the maximum recommended dose of Auvelity (dextromethorphan hydrobromide/bupropion hydrochloride) for adults (≥18 years)?

Maximum Dose for Auvelity

The maximum recommended dose of Auvelity (dextromethorphan 45 mg/bupropion 105 mg) is 2 tablets twice daily, for a total daily dose of dextromethorphan 90 mg/bupropion 210 mg. 1, 2

Standard Dosing Protocol

• Initial titration: Start with 1 tablet (dextromethorphan 45 mg/bupropion 105 mg) once daily in the morning for the first 3 days. 3

• Maintenance dose: Increase to 1 tablet twice daily (morning and afternoon/early evening) from day 4 onward. 3

• Maximum dose: Do not exceed 2 tablets twice daily (total daily: dextromethorphan 90 mg/bupropion 210 mg). 1, 2

Critical Timing Considerations

• Administer the second daily dose before 3 PM to minimize insomnia risk, as bupropion has activating properties. 4

• The fixed-dose combination cannot be split or adjusted independently—each tablet contains both dextromethorphan 45 mg and bupropion 105 mg. 5

Seizure Risk and Dose Limits

• Seizure risk increases at higher doses of bupropion—the bupropion component in the maximum Auvelity dose (210 mg/day) is well below the 450 mg/day threshold where seizure risk rises markedly. 4, 1

• Do not combine Auvelity with other bupropion-containing products, as this would exceed safe bupropion dosing limits. 4

• Absolute contraindications include seizure disorders, eating disorders (bulimia/anorexia), and abrupt discontinuation of alcohol, benzodiazepines, or antiepileptic drugs. 4, 6

Special Population Adjustments

• Hepatic impairment (moderate to severe): Maximum dose is 1 tablet once daily (dextromethorphan 45 mg/bupropion 105 mg). 4

• Renal impairment (GFR <90 mL/min): Reduce dose by approximately 50%—maximum 1 tablet once daily. 4, 6

• Older adults: Consider starting at lower doses and titrating more slowly, though specific Auvelity geriatric dosing is not established; apply bupropion dose-reduction principles. 4

Common Pitfalls to Avoid

• Do not exceed 2 tablets twice daily under any circumstances—higher doses increase seizure risk without additional efficacy. 1, 2

• Do not take late in the day—the second dose must be before 3 PM to prevent insomnia. 4

• Do not combine with MAOIs or use within 14 days of MAOI discontinuation—this can precipitate hypertensive crisis. 4

• Screen for uncontrolled hypertension before initiating, as bupropion can elevate blood pressure and heart rate. 4

Monitoring Parameters

• Assess for suicidal ideation weekly during the first month, especially in patients under 24 years old. 4, 1

• Monitor blood pressure and heart rate, particularly during the first 12 weeks of treatment. 4

• Evaluate for neuropsychiatric adverse effects including agitation, anxiety, and insomnia. 1, 2