Do I need to taper (titrate off) bupropion rather than stop it abruptly when discontinuing it in an adult on a therapeutic dose or extended‑release formulation?

Bupropion Discontinuation: Tapering Is Recommended

You should taper bupropion rather than stop it abruptly when discontinuing treatment. The FDA label explicitly states: "When discontinuing treatment in patients treated with bupropion hydrochloride extended-release tablets (XL) 300 mg once daily, decrease the dose to 150 mg once daily prior to discontinuation" 1. For seasonal affective disorder specifically, the FDA recommends: "For patients treated with 300 mg per day, decrease the dose to 150 mg once daily before discontinuing" 1.

Why Tapering Matters

Gradual tapering minimizes the risk of withdrawal symptoms and potential relapse. 2 Although bupropion is not classified as physically addictive in the same way as opioids or benzodiazepines, abrupt discontinuation can trigger uncomfortable withdrawal phenomena.

Withdrawal Symptoms to Monitor

During tapering, watch for:

• Irritability and mood changes 2
• Sleep disturbances and anxiety 2
• Fatigue 2

These symptoms signal that the taper may be proceeding too quickly and should prompt you to slow the dose reduction 2.

Recommended Tapering Protocol

For patients on 300 mg daily: Reduce to 150 mg once daily and maintain this dose for at least 1–2 weeks before complete discontinuation 1. If moderate-to-severe withdrawal symptoms emerge at any point, hold the current dose for 1–2 weeks before resuming the taper 3.

For patients on 150 mg daily: The FDA label does not specify a mandatory taper below 150 mg, but clinical guidelines suggest that patients on long-term therapy (>1 year) or those with a history of difficult medication discontinuation may benefit from a more cautious approach 4.

Individualization Based on Treatment Duration

• Short-term use (<6 months): A single dose reduction from 300 mg to 150 mg for 1–2 weeks, then stop, is typically sufficient 1
• Long-term use (>1 year): Consider extending the 150 mg phase to 2–4 weeks and monitor closely for symptom re-emergence 4

Special Considerations for Combination Products

If bupropion is part of naltrexone-bupropion ER for weight management, the same tapering principles apply 2. The combination formulation does not alter the need for gradual discontinuation.

Monitoring for Symptom Recurrence

Watch for the return of the original condition (depression, seasonal affective disorder, or nicotine cravings) during and after tapering. 4 Symptoms may not return immediately but can emerge weeks to months after complete discontinuation 4. If depressive symptoms re-emerge during the taper, transitioning to an alternative antidepressant (such as an SSRI) is preferable to abruptly stopping all treatment 3.

Common Pitfall: Premature Complete Discontinuation

Do not skip the intermediate 150 mg dose when stopping 300 mg daily therapy. The FDA explicitly requires this step-down 1. Patients who abruptly stop 300 mg risk more severe withdrawal symptoms and higher relapse rates compared to those who taper properly.

Contrast with Historical Practice

Older literature from 1990 suggested that "bupropion should be discontinued after several months of therapy" without specific tapering guidance 5, but this predates the FDA's current labeling requirements. Modern FDA-approved labeling supersedes older recommendations and mandates tapering for doses ≥300 mg daily 1.

Pause and Adjust Strategy

If withdrawal symptoms develop during tapering, pause at the current dose rather than pushing forward. 2 Maintain the dose for 1–2 weeks until symptoms resolve, then resume a slower taper 3. This "pause-and-hold" approach prevents psychiatric destabilization and improves the likelihood of successful discontinuation.