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Usual Adult Dose for:
Usual Geriatric Dose for:
Usual Pediatric Dose for:
Additional dosage information:
Usual Adult Dose for Depression
Immediate release tablets:
Initial dose: 100 mg orally twice a day.
Maintenance dose: The dosage may be increased in 75 to 100 mg/day increments not more often than every 3 days up to the usual maintenance dose of 100 mg orally 3 times a day. The maximum dose is 450 mg/day, given in 4 divided doses; bupropion should be discontinued if there is not an adequate response to this dose. Single doses should not exceed 150 mg.
Sustained release tablets:
Initial dose: 150 mg orally once a day in the morning.
Maintenance dose: After at least 4 days, the dose may be increased to 100 to 150 mg twice a day. If there is not adequate improvement after several weeks, the dose may be increased to a maximum of 200 mg twice a day.
Extended release tablets (Wellbutrin XL):
Initial dose: 150 mg orally once a day in the morning.
Maintenance dose: After at least 4 days, the dose may be increased to 300 mg once a day. If there is not adequate improvement after several weeks, the dose may be increased to a maximum of 450 mg once a day in the morning.
Extended release tablets (Aplenzin):
Initial dose: 174 mg orally once a day in the morning (equivalent to 150 mg bupropion HCl).
Maintenance dose: After at least 4 days, the dose may be increased to 348 mg once a day (equivalent to 300 mg bupropion HCl). If there is not adequate improvement after several weeks, the dose may be increased to a maximum of 522 mg once a day in the morning (equivalent to 450 mg bupropion HCl).
Usual Adult Dose for Smoking Cessation
Initial Dose: 150 mg orally once a day.
Maintenance: Based on clinical response, this dosage may be increased to 300 mg/day, given as 150 mg twice a day, no sooner than 3 days after beginning therapy.
Usual Adult Dose for Seasonal Affective Disorder
Initiate treatment for seasonal affective disorder in the autumn prior to onset of symptoms.
Wellbutrin XL (R):
Initial: 150 mg orally once a day in the morning
Titration: If tolerated, after 7 days dose may be increased to maximum dose of 300 mg once a day administered in the morning. Patients who are unable to tolerate this increase in dose should be reduced back to 150 mg orally once a day.
Initial: 174 mg once daily (equivalent to 150 mg bupropion) in the morning
Titration: If tolerated, after 7 days dose may be increased to 348 mg once daily (equivalent to 300 mg bupropion) in the morning through the winter season.
Usual Geriatric Dose for Depression
Initial dose: 75 mg orally twice a day.
Maintenance dose: 75 mg orally 3 times a day.
Immediate Release: 150 mg orally 3 times a day.
Sustained Release: 400 mg given as 200 mg twice a day.
Usual Pediatric Dose for Attention Deficit Disorder
Immediate release tablets:
6 to 18 years:
20 to 30 kg: 50 to 150 mg/day in 2 divided doses (investigational).
31 to 40 kg: 75 to 200 mg/day in 2 divided doses (investigational).
Greater than 40 kg: 100 to 250 mg/day in 2 divided doses (investigational).
Extended release tablets:
Less than 11 years: Safety and effectiveness have not been established.
11 to 18 years: 150 to 300 mg/day in 2 divided doses (investigational).
Usual Pediatric Dose for Smoking Cessation
14 years of age or older and greater than 40.5 Kg:
150 mg orally twice a day of sustained release for seven weeks with cessation counseling
Renal Dose Adjustments
Caution should be used in patients with renal impairment. Reduced frequencies and/or doses may be necessary.
Liver Dose Adjustments
Immediate release tablets (adults): Do not exceed 75 mg daily in patients with severe hepatic cirrhosis. Reduced frequencies and/or doses are recommended for patients with mild to moderate liver disease.
Sustained release tablets (adults): Do not exceed 100 mg daily or 150 mg every other day in patients with severe hepatic cirrhosis. Reduced frequencies and/or doses are recommended for patients with mild to moderate liver disease.
Extended release tablets (adults): Do not exceed 150 mg (Wellbutrin XL) or 174 mg (Aplenzin) every other day in patients with severe hepatic cirrhosis. Reduced frequency and or dose should be considered in patients with mild to moderate hepatic dysfunction (including mild to moderate cirrhosis).
Dose adjustments should be made gradually to minimize the risk of seizure.
Adults: For the prevention of seasonal major depressive episodes associated with seasonal affective disorder, the timing and duration of treatment should be individualized. In general, treatment should be initiated in autumn prior to the onset of depressive symptoms, continue throughout the winter season, and be tapered and discontinued in early spring. For patients receiving a dose of 300 mg per day during the autumn- winter season, it is recommended to taper the dose to 150 mg per day for approximately 2 weeks prior to discontinuation of treatment.
The concurrent use of bupropion and MAO inhibitors is contraindicated. At least 14 days should elapse between discontinuation of bupropion and initiation of an MAO inhibitor, or vice versa.
The risk of seizure may be minimized if:
1) Maximum recommended daily doses are not exceeded (in adults, 450 mg for immediate or extended release tablets and 400 mg for sustained release tablets).
2) Maximum recommended single doses are not exceeded (in adults, 150 mg for immediate release tablets, 200 mg for sustained release tablets, and 450 mg for extended release tablets).
3) The rate of dosage increase is very gradual.
4) Extreme caution should be used when bupropion is administered to patients with a history of seizure, cranial trauma, or other predisposition(s) toward seizure; prescribed with other agents (e.g., antipsychotics, other antidepressants, etc.) or treatment regimens (e.g., abrupt discontinuation of a benzodiazepine) that lower seizure threshold.
Safety and efficacy in pediatric patients (under 18 years old) have not been established.
Bupropion is recommended for use in pediatric patients (under 18 years old) only if the potential benefit outweighs the risk.
Children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders may be at an increased risk of suicidal thinking and suicidality with antidepressant use, particularly during the first few months of treatment. Medical evidence has not shown this increased risk to exist in adults older than 24 years of age, but adults 65 years of age and older taking antidepressants appear to have a decreased risk of suicidality. The results of a meta-analysis indicate an overall favorable risk-to-benefit profile for the use of antidepressants (i.e., selective serotonin and/or norepinephrine reuptake inhibitors) in the treatment of pediatric patients (less than 19 years old) with major depressive disorders (MDD), obsessive-compulsive disorder (OCD), or non-OCD anxiety disorders. Although this study also reports an overall increased risk of suicidal ideation/suicide attempt associated with the use of antidepressants in pediatric patients, the risk may be less than originally estimated. Additional prospective studies are warranted in order to confirm these findings.
Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications, particularly those being treated for depression. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. It is unknown if these symptoms are a precursor to either worsening of depression or the emergence of suicidal impulses; however, there is concern that patients who experience one or more of these symptoms may be at increased risk for worsening depression or suicidality. Although the FDA has not concluded that antidepressant drugs cause worsening depression or suicidality, health care providers should be aware that worsening of symptoms could be due to the underlying disease or might be a result of drug therapy.
Health care providers should carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. If symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms, the health care provider will need to determine what intervention, including discontinuing or modifying the current drug therapy, is indicated. Prescriptions should be written for small quantities of drug to reduce the risk of an attempt to overdose. Health care providers should instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider.
Because antidepressants are believed to have the potential for inducing manic episodes in patients with bipolar disorder, there is a concern about using antidepressants alone in this population. Therefore, patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.
Healthcare providers should instruct patients not to chew, divide, or crush extended-release tablets as this may lead to an increased risk of adverse effects, including seizures.
Initial dose: 150 mg orally every 3 days (suggested).
In patients with end-stage renal failure who undergo hemodialysis, a reduction in the dosing frequency has been suggested.
Bupropion may be taken without regard to meals. The sustained- or extended-release formulations should be swallowed whole and not crushed, divided, or chewed.
Bupropion, bupropion SR, and bupropion XL are considered bioequivalent. Patients may be given the same daily dose they are currently receiving when being converted from one formulation to another.
The full antidepressant effect may not be evident for 4 weeks or longer.
More about bupropion
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