Prescription Labeling for Naltrexone-Bupropion ER Titration
Write the prescription as 90 capsules for a 30-day supply. 1
Rationale for 30-Day Supply Designation
The prescription should reflect the intended treatment period rather than the mathematical duration if all capsules were consumed at the maintenance dose. 1 Here's why:
- Naltrexone-bupropion ER requires a 4-week titration schedule before reaching the maintenance dose of 2 tablets twice daily (4 capsules/day). 1
- During the 30-day titration period, patients use 69 capsules total following the manufacturer's recommended escalation: Week 1 (7 capsules), Week 2 (14 capsules), Week 3 (21 capsules), and Week 4 (28 capsules). 1
- Providing 90 capsules ensures adequate supply for the complete titration plus a small buffer for the transition to maintenance dosing. 1
Standard Prescribing Practice
- Insurance and pharmacy systems recognize "days' supply" as the treatment duration, not the theoretical duration if maximum daily dosing were used from day one. 2
- Labeling this as "37 days" would be clinically misleading because it implies the patient should stretch 90 capsules over 37 days, which contradicts the required titration schedule. 1
- The 30-day designation accurately reflects that this prescription covers one month of therapy during the dose-escalation phase. 1
Clinical Considerations
- After completing this initial 30-day titration, subsequent prescriptions should provide 120 capsules for 30 days (4 capsules daily at maintenance dose). 1
- Clear dosing instructions are critical for medication adherence, particularly with complex titration schedules—explicit instructions reduce dosing errors. 3
- The second dose should not be taken late in the day to minimize insomnia risk. 1