Bupropion 150mg Dosing Schedule
For smoking cessation, start bupropion 150 mg once daily in the morning for 3 days, then increase to 150 mg twice daily (maximum 300 mg/day) for 7-12 weeks, beginning 1-2 weeks before the target quit date. 1
Indication-Specific Dosing
Smoking Cessation (Most Common Use)
- Days 1-3: 150 mg once daily in the morning
- Day 4 onwards: 150 mg twice daily (if tolerated)
- Maximum dose: 300 mg per day
- Duration: 7-12 weeks initially, may extend to 6-12 months for continued cessation 1
- Timing: Initiate 1-2 weeks prior to target quit date 1
Key consideration: Give the second dose before 3 PM to minimize insomnia risk 2, 3
Major Depressive Disorder
- Starting dose: 150 mg once daily in the morning for 4 days
- Target dose: 300 mg once daily in the morning (after day 4)
- Duration: Several months or longer beyond acute response 4
Weight Management (Naltrexone/Bupropion Combination)
When used as naltrexone/bupropion ER (each tablet contains 90 mg bupropion):
- Week 1: 1 tablet daily (morning)
- Week 2: 1 tablet twice daily
- Week 3: 2 tablets morning, 1 tablet afternoon
- Week 4+: 2 tablets twice daily (maintenance = 360 mg bupropion total)
- Avoid second dose late in day to prevent insomnia 5
Critical Contraindications & Warnings
Absolute contraindications:
- Seizure disorders, history of seizures, or conditions increasing seizure risk (stroke, brain metastases, structural brain lesions) 1
- Concurrent MAO inhibitor use (allow 14 days washout) 4
- Eating disorders (bulimia, anorexia) - increases seizure risk
- Abrupt discontinuation of alcohol or benzodiazepines
- Closed-angle glaucoma 1
Use with extreme caution:
- Patients taking tamoxifen (bupropion inhibits CYP2D6, reducing tamoxifen efficacy) 1
- Uncontrolled hypertension 5
Dose Adjustments
Hepatic Impairment
- Moderate to severe (Child-Pugh 7-15): Maximum 150 mg every other day
- Mild (Child-Pugh 5-6): Consider reducing dose/frequency 4
Renal Impairment
- GFR <90 mL/min: Consider reduced dose and/or frequency
- Bupropion and metabolites accumulate with renal dysfunction 4
Elderly Patients
Monitor renal function closely; dose reduction may be necessary due to age-related decline in renal clearance 4
Common Side Effects & Management
Most frequent (from NCCN guidelines):
- Insomnia (dose-dependent): Give second dose before 3 PM 1, 2, 3
- Dry mouth (dose-dependent): Usually transient 6, 7
- Headache, nausea, anxiety (also nicotine withdrawal symptoms)
Serious but uncommon (<0.1% at 300 mg/day):
- Seizures (risk increases with doses >300 mg/day or in predisposed patients) 6, 7
- Neuropsychiatric events (depression, suicidal ideation) - monitor closely, though recent large RCT showed no increased risk vs placebo 1
Important Clinical Pearls
Neuropsychiatric safety: The 2016 EAGLES trial (n=8,058) found no significant increase in neuropsychiatric adverse events with bupropion compared to nicotine patches or placebo, in patients both with and without psychiatric disorders 1. However, monitor for worsening depression or suicidal ideation and discontinue if these occur.
Seizure risk minimization:
- Never exceed 300 mg/day for smoking cessation
- Screen carefully for risk factors
- Avoid in patients with eating disorders, brain lesions, or alcohol/benzodiazepine withdrawal 6, 7
Discontinuation: When stopping 300 mg daily dosing, taper to 150 mg once daily before complete discontinuation 4
Combination therapy: Bupropion can be safely combined with nicotine replacement therapy (NRT) for enhanced smoking cessation efficacy 1, 8