Safely Switching from Lexapro (Escitalopram) to Wellbutrin (Bupropion)

Cross-Tapering Approach

The safest way to switch from Lexapro to Wellbutrin is through a cross-taper approach, gradually reducing Lexapro while simultaneously introducing Wellbutrin SR at 150 mg once daily for 3 days, then increasing to 150 mg twice daily, as recommended by Praxis Medical Insights 1
Begin Wellbutrin SR at 150 mg once daily while maintaining your current Lexapro dose, as suggested by Praxis Medical Insights 1
After 3 days, increase Wellbutrin to the target dose of 150 mg twice daily (300 mg total daily), according to Praxis Medical Insights 1

Common Wellbutrin side effects include insomnia, dry mouth, headache, and nausea, as reported by the American Family Physician 2
Take the second Wellbutrin dose before 3 PM to minimize risk of insomnia, as recommended by Praxis Medical Insights 1

For older adults, start Wellbutrin at a lower dose (approximately 50% of standard dose), as suggested by Praxis Medical Insights 1
For patients with moderate to severe hepatic impairment, total daily Wellbutrin dose should not exceed 150 mg, according to Praxis Medical Insights 1
For patients with moderate to severe renal impairment, reduce total daily Wellbutrin dose by half, as recommended by Praxis Medical Insights 1

Avoid this switch if you have a seizure disorder, as Wellbutrin lowers seizure threshold, as warned by Praxis Medical Insights 1
Do not combine with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs, as cautioned by Praxis Medical Insights 1
Use caution if you have uncontrolled hypertension, as Wellbutrin can raise blood pressure, as advised by Praxis Medical Insights 1

Schedule follow-up within 2 weeks of initiating the switch to assess efficacy and side effects, as recommended by the Journal of the National Comprehensive Cancer Network 3
Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years, as suggested by Praxis Medical Insights 1
Check vital signs, particularly blood pressure, during follow-up visits, as advised by Praxis Medical Insights 1
Assess for improvement in depressive symptoms after 4-6 weeks on the target dose of Wellbutrin, as reported by the American Family Physician 2

If no response is seen after 6-8 weeks at an adequate Wellbutrin dose, consider alternative treatment, as recommended by Praxis Medical Insights 1

Taking Wellbutrin late in the day increases risk of insomnia, as warned by Praxis Medical Insights 1
Exceeding recommended Wellbutrin doses increases seizure risk, as cautioned by Praxis Medical Insights 1