Switching from Bupropion to SSNRI

Recommended SSNRI Options

The American Geriatrics Society recommends duloxetine as the preferred first-line SSNRI when switching from bupropion due to its established efficacy and favorable safety profile compared to other options 1, 2
Venlafaxine is an alternative option, starting at 37.5mg once or twice daily and increasing by 75mg each week to a maximum of 225mg daily 3, 4
Desvenlafaxine or milnacipran are other possible alternatives but have less robust evidence for efficacy compared to duloxetine 1

After one week on 30mg, increase duloxetine to 60mg daily if tolerated 3
An adequate trial requires at least 4 weeks at therapeutic dosage 3
Begin duloxetine 30mg while reducing bupropion to 300mg for 3-4 days 4
Increase duloxetine to 60mg while reducing bupropion to 200mg for another 3-4 days 4

SSNRIs may cause more nausea, dizziness, and potential blood pressure increases 3
Cardiac monitoring may be necessary when switching to venlafaxine, as it can cause cardiac conduction abnormalities and blood pressure increases 3

Avoid abrupt discontinuation of either medication; always taper to prevent withdrawal symptoms 1, 2
Use caution when prescribing SSNRIs to patients with cardiac disease due to potential blood pressure effects and cardiac conduction issues 3
Consider renal function when dosing SSNRIs; both duloxetine and venlafaxine may require dose adjustments in patients with renal impairment 4
Be cautious about drug interactions, particularly with medications that affect the cytochrome P450 system 5