Bupropion Initiation and Dosing Guidelines

Special Populations and Dosing Considerations

The American College of Cardiology is not mentioned, however, Praxis Medical Insights recommends starting older adults (≥55 years) with 37.5 mg once daily in the morning, increasing by 37.5 mg every 3 days as tolerated, with a maximum dose of 150 mg twice daily (300 mg total daily) to minimize adverse reactions 1
For patients with renal impairment (GFR <90 mL/min), the dose should be reduced by half and/or frequency reduced, as bupropion and metabolites accumulate with renal dysfunction, requiring close monitoring 1
The American Heart Association is not mentioned, however, Praxis Medical Insights suggests that patients with bulimia or anorexia nervosa should not start bupropion due to increased seizure risk 1
Patients taking CYP2D6 inhibitors require caution due to potential drug interactions, as stated by the American Heart Association in the journal Circulation 2

Uncontrolled hypertension requires close monitoring of blood pressure, as stated by Praxis Medical Insights 1
Concurrent use with tamoxifen may reduce tamoxifen efficacy, according to Praxis Medical Insights 1
Monitoring for suicidal ideation, especially in patients <24 years old, and assessing for neuropsychiatric symptoms, such as agitation, anxiety, and mood changes, is crucial, as recommended by Praxis Medical Insights 1
Checking blood pressure at baseline and during titration is necessary, as stated by Praxis Medical Insights 1

Insomnia, the most common side effect, can be managed by ensuring the second dose (if using SR formulation) is before 3 PM, and XL formulation is taken in the morning only, as suggested by Praxis Medical Insights 1