Bupropion Dosing and Monitoring Considerations Based on Pharmacokinetic Variability

Dose Adjustment in Organ Impairment

• Dose reduction is recommended for patients with hepatic or renal dysfunction to avoid drug accumulation (Obesity Reviews) 1.

Age‑Related Pharmacokinetic Changes

• In older adults, hepatic phase‑I metabolism via CYP enzymes declines by approximately 20–50%, liver mass falls 20–30%, and hepatic blood flow is reduced, leading to higher peak concentrations and prolonged half‑life of bupropion; consequently, dose adjustments are advised for this population (European Heart Journal) 3.

Drug Interaction with MAO Inhibitors

• Co‑administration of bupropion with monoamine‑oxidase inhibitors (MAOIs) is contraindicated; a wash‑out period of at least 14 days is required when switching between these agents (Obesity Reviews) 1.

Safety Monitoring Recommendations

• Clinicians should monitor patients for seizure risk because bupropion lowers the seizure threshold (Obesity Reviews) 1.
• Renal function should be evaluated before initiating bupropion therapy, especially in elderly individuals (European Heart Journal) 3.
• When transitioning to or from MAOIs, an extended wash‑out period of ≥14 days should be observed to prevent adverse interactions (Obesity Reviews) 1.