Can I restart bupropion (Wellbutrin) at 150 mg daily after a two‑month break?

Restarting Bupropion at 150 mg After a Two‑Month Break

Yes, you can restart bupropion at 150 mg daily after a two‑month break, but you must use the same gradual titration schedule as a new start: 150 mg once daily for 3 days, then increase to 150 mg twice daily (300 mg total) if tolerated. 1

Standard Restart Protocol

After any treatment interruption, bupropion should be reintroduced using the initial titration schedule rather than resuming at your previous maintenance dose. 1 The two‑month gap is long enough that your body has cleared the medication and its metabolites, so you are effectively starting fresh from a safety standpoint.

The recommended restart sequence is:

• Days 1–3: 150 mg once daily in the morning 1
• Day 4 onward: 150 mg twice daily (300 mg total) if the initial dose is well tolerated 1
• Second dose timing: Take the second 150 mg dose before 3 PM to minimize insomnia risk 1

This gradual approach minimizes seizure risk while allowing you to assess tolerability. 1 The seizure threshold is dose‑dependent, and abrupt reintroduction at higher doses increases risk unnecessarily.

Critical Safety Screening Before Restart

Before restarting bupropion, verify that you do not have any new contraindications that may have developed during the two‑month break:

• Seizure history or new conditions lowering seizure threshold (head trauma, stroke, brain tumor, eating disorder) 1
• Uncontrolled hypertension (check baseline blood pressure, as bupropion can elevate it) 1
• Current MAOI use or use within the past 14 days 1
• Abrupt discontinuation of alcohol, benzodiazepines, or antiepileptic drugs (all increase seizure risk) 1
• Moderate to severe hepatic or renal impairment (requires dose reduction by 50% or more) 1

Monitoring During Restart

• Week 1–2: Assess for suicidal ideation, agitation, anxiety, or mood changes—especially if you are under 24 years old, as this period carries the highest risk for emergent suicidal thoughts 1
• Blood pressure: Check at baseline and during the first few weeks, as bupropion can cause modest elevations 1
• Efficacy assessment: Allow 6–8 weeks at the therapeutic dose (300 mg/day) before determining whether the medication is working adequately 1

Common Pitfalls to Avoid

• Do not skip the 3‑day lead‑in at 150 mg once daily. Jumping directly to 300 mg increases seizure risk unnecessarily. 1
• Do not take the second dose after 3 PM. Late dosing is the most common cause of bupropion‑related insomnia. 1
• Do not exceed 450 mg/day total (the maximum for extended‑release formulations), as seizure risk rises sharply above this threshold. 1

Special Population Adjustments

• Older adults (≥55 years): Start at 37.5 mg once daily and increase by 37.5 mg every 3 days, with a maximum of 300 mg/day total 1
• Renal impairment (GFR <90 mL/min): Reduce the total daily dose by 50% (e.g., 150 mg once daily instead of 300 mg) 1
• Moderate to severe hepatic impairment: Maximum dose is 150 mg once daily 1

Why the Gradual Restart Matters

The FDA‑approved prescribing information and consensus guidelines emphasize gradual titration because bupropion lowers the seizure threshold in a dose‑dependent manner. 2 Even though you tolerated 150 mg (or higher) previously, restarting at that dose after a two‑month gap does not allow your system to re‑adapt and increases the risk of adverse effects—particularly seizures, which occur in approximately 0.1% of patients at 300 mg/day when proper titration is followed. 3