What is the recommended tapering schedule for an adult taking bupropion extended‑release (XR) 300 mg daily?

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Tapering Bupropion XR 300 mg

For patients taking bupropion XR 300 mg daily, reduce the dose to 150 mg once daily for at least 1–2 weeks before complete discontinuation. 1, 2

Recommended Taper Schedule

Step 1: Reduce to 150 mg once daily

  • Decrease from 300 mg to 150 mg XR once daily in the morning 2
  • Maintain this dose for a minimum of 1–2 weeks before stopping completely 1
  • This gradual reduction minimizes withdrawal symptoms and relapse risk 1

Step 2: Monitor for withdrawal symptoms

  • Watch for irritability, mood changes, and anxiety during the taper 1, 3
  • Sleep disturbances are common withdrawal symptoms 1
  • Fatigue may emerge as the dose is reduced 1
  • Headache and generalized aches have been reported with abrupt discontinuation 3

Step 3: Adjust taper speed based on tolerance

  • If moderate-to-severe withdrawal symptoms develop, pause the taper and maintain the current dose for 1–2 additional weeks before resuming 4
  • Slowing the taper rate is appropriate when withdrawal symptoms emerge 1
  • The taper speed should be individualized according to symptom tolerance 4

Critical Safety Considerations

Do not stop abruptly

  • Abrupt discontinuation increases the risk of withdrawal symptoms including irritable mood, anxiety, sleeplessness, headache, and generalized aches 3
  • Gradual dose reduction is recommended for all antidepressant discontinuation 3

Monitor for mood destabilization

  • If depressive symptoms re-emerge during the taper, consider transitioning to an alternative antidepressant rather than completing abrupt discontinuation 4
  • Weekly assessment for mood changes is warranted during any antidepressant taper 4

Special Populations

Patients with hepatic impairment

  • In moderate-to-severe hepatic impairment, the maximum dose is already 150 mg every other day, so further tapering may require extending the interval between doses 2

Patients with renal impairment

  • Consider a slower taper in patients with reduced kidney function (GFR <90 mL/min), as bupropion metabolites accumulate 4

Common Pitfalls to Avoid

  • Stopping too quickly: The FDA label explicitly states to taper when discontinuing 300 mg daily 2
  • Ignoring withdrawal symptoms: Patients should be educated about potential withdrawal effects before starting the taper 3
  • Failing to monitor mood: Depression relapse can occur during discontinuation, requiring resumption of treatment or switch to another agent 4

References

1
Guideline

Bupropion ER Discontinuation Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Research

Bupropion-Associated Withdrawal Symptoms: A Case Report.

Primary care companion to the Journal of clinical psychiatry, 1999

4
Guideline

Bupropion Dosing and Administration

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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