Auvelity Dosing Compared to Standard Wellbutrin
Auvelity contains only 105 mg of bupropion per tablet—substantially less than the typical 150–300 mg daily doses used in standard Wellbutrin therapy for depression. 1
Standard Auvelity Dosing Regimen
The FDA-approved dosing for Auvelity is one tablet (45 mg dextromethorphan/105 mg bupropion) twice daily, providing a total daily bupropion dose of 210 mg. 2, 3, 4 This represents approximately 70% of the standard 300 mg daily bupropion dose used for major depressive disorder. 1
- No titration is required—patients start directly at the maintenance dose of one tablet twice daily. 3, 4
- Therapeutic effects appear within 1–2 weeks, significantly faster than the 6–8 weeks typically required for standard antidepressants including bupropion monotherapy. 3
Comparison to Standard Wellbutrin Dosing
Wellbutrin SR (Sustained Release)
- Initial dose: 150 mg once daily for 3 days, then increase to 150 mg twice daily (300 mg total). 1
- Maximum dose: 400 mg per day. 1
- Requires gradual titration to minimize seizure risk and assess tolerability. 1
Wellbutrin XL (Extended Release)
- Initial dose: 150 mg once daily, with maintenance at 150–300 mg once daily. 1
- Maximum dose: 450 mg per day. 1
Why the Lower Bupropion Dose in Auvelity Works
In Auvelity, bupropion serves a dual role: it provides antidepressant effects through noradrenergic/dopaminergic pathways AND inhibits CYP2D6 to increase dextromethorphan bioavailability by approximately 20-fold. 3, 4 The dextromethorphan component—an NMDA receptor antagonist and sigma-1 receptor agonist—provides the primary rapid antidepressant mechanism, allowing for lower bupropion dosing than traditional monotherapy. 2, 3, 4
Critical Safety Considerations
- Seizure risk remains present despite the lower bupropion dose; all standard bupropion contraindications apply (seizure disorders, eating disorders, abrupt alcohol/benzodiazepine withdrawal, MAOI use within 14 days). 1, 5
- Black box warning for suicidal ideation applies to all patients, especially those under 24 years, with highest risk in the first 1–2 months. 1, 5
- Most common adverse effects include dizziness, nausea, headache, diarrhea, somnolence, dry mouth, sexual dysfunction, and insomnia—similar to bupropion but with additional dextromethorphan-related effects. 5
Clinical Use Patterns
Real-world data show that 28.8% of patients initiate Auvelity as monotherapy, while 71.2% use it as add-on therapy, most commonly added to SSRIs (10.7%) or SNRIs (6.5%). 6 Notably, 10.1% of patients were treatment-naïve, suggesting clinicians are comfortable using Auvelity as first-line therapy despite its novelty. 6
Patients previously treated with standard bupropion (40.4% in real-world cohorts) can safely transition to Auvelity, though the lower total bupropion dose (210 mg vs. typical 300 mg) should be considered when making this switch. 6