Bupropion Elimination and Metabolism

Special Populations with Delayed Clearance

In patients with moderate to severe renal impairment, dose reduction by half is recommended, as exposure to bupropion is approximately 2-fold higher after a single dose, and hydroxybupropion and threohydrobupropion metabolites show 2.3-fold and 2.8-fold increases in AUC, respectively, in end-stage renal failure 1, 2
In patients with moderate to severe hepatic impairment, the maximum daily dose should not exceed 150 mg, as bupropion AUC increases 3.12-fold and half-life increases 1.43-fold, and hydroxybupropion shows a 3.88-fold increase in half-life 1, 2

The seizure risk associated with bupropion may theoretically persist until metabolites are cleared, which can take approximately 7-9 days after discontinuation 3
For procedures requiring opioid analgesia in patients taking naltrexone-bupropion combinations, the medication should be discontinued well in advance to allow complete clearance, which can take approximately 7-9 days after discontinuation 1