Bupropion Dosing for ADHD

Introduction to Bupropion Dosing

• The American College of Obstetricians and Gynecologists recommends starting with sustained-release (SR) formulation at 100-150 mg daily, titrate to a maintenance dose of 100-150 mg twice daily, or use extended-release (XL) formulation starting at 150 mg daily with maintenance dosing of 150-300 mg daily, not exceeding a maximum of 450 mg per day 1, 2, 3

Important Context: Off-Label Use

• The American Academy of Pediatrics and other medical societies suggest that stimulants should be used as first-line therapy, with non-stimulants like atomoxetine, guanfacine, or clonidine as second-line options before considering bupropion 4

Dosing Regimens

• The sustained-release (SR) formulation starting dose is 100-150 mg orally once daily 1, 2, 3
• The sustained-release (SR) formulation maintenance dose is 100-150 mg orally twice daily (BID) 1, 2, 3
• The extended-release (XL) formulation starting dose is 150 mg orally once daily 1, 2, 3
• The extended-release (XL) formulation maintenance dose is 150-300 mg orally once daily 1, 2, 3
• The maximum dose for both formulations is 450 mg per day 1, 2, 3

Special Populations

• In pregnancy, bupropion does not appear to increase major congenital malformations, though some studies suggest possible small increases in specific cardiac defects (left ventricular outflow tract obstruction, ventricular septal defects) 1, 2, 3
• When breastfeeding, caution is advised as bupropion is present in breast milk with two case reports of seizures in breastfed infants 1, 2, 3

Bupropion Daily Dosing for ADHD

Introduction to Bupropion Dosing

• Stimulants can be used intermittently because they have rapid onset and offset, working only as long as they are given, according to the Journal of the American Academy of Child and Adolescent Psychiatry 5
• The American College of Obstetricians and Gynecologists guideline notes that stimulants have a rapid effect and suggests intermittent use on an as-needed basis is possible for stimulants to maximize functioning while reducing exposure 6

Contrast with Stimulants

• This as-needed approach does NOT apply to bupropion, which requires daily dosing to build and maintain therapeutic levels, as stated by the American College of Obstetricians and Gynecologists 6

Position in Treatment Algorithm

• Bupropion is less efficacious than stimulants for ADHD treatment, according to the American College of Obstetricians and Gynecologists 6
• Bupropion may be particularly useful when treating co-occurring depression or in patients who cannot tolerate stimulants, as suggested by the American College of Obstetricians and Gynecologists 6

Safety and Combination Therapy

• There are no studies on combining bupropion with stimulants, so clinicians should proceed with caution if considering combination therapy, as noted by the Journal of the American Academy of Child and Adolescent Psychiatry 5, 7