Bupropion Dosing and Administration

Standard Dosing by Formulation

The American Academy of Family Physicians recommends starting bupropion SR at 150 mg once daily for 3 days, then increasing to 150 mg twice daily (300 mg total daily) if tolerated, with a maximum dose of 400 mg/day for SR formulation or 450 mg/day for XL formulation 1, 2
The initial dose of bupropion SR is 150 mg once daily in the morning for days 1-3, then increased to 150 mg twice daily (300 mg total) starting day 4, with a maximum dose of 400 mg per day 3, 1, 2
The American Academy of Family Physicians recommends taking the second dose of bupropion SR before 3 PM to minimize insomnia risk 2, 4

For smoking cessation, the dose is 150 mg once daily for days 1-3, then 150 mg twice daily (300 mg total) with a maximum of 300 mg per day, starting 1-2 weeks before the target quit date and lasting 7-12 weeks, with possible extension to 6 months-1 year 3, 2

The American Academy of Family Physicians recommends approximately 50% of standard adult starting doses for older adults (≥55 years) due to increased risk of adverse reactions, with an initial dose of 37.5 mg once daily and titration by 37.5 mg every 3 days as tolerated, to a maximum dose of 150 mg twice daily (300 mg total) 1, 2, 4
For patients with moderate to severe hepatic impairment, the maximum dose is 150 mg daily (one tablet) 2
For patients with renal impairment (GFR <90 mL/min), the total daily dose should be reduced by half 2, 4

The National Comprehensive Cancer Network guidelines note that bupropion is contraindicated in patients with brain metastases due to seizure risk, and also in patients with seizure disorders or conditions that lower seizure threshold, concurrent MAOI use, or abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs 3, 2, 4
Uncontrolled hypertension requires close blood pressure monitoring 2, 4
The maximum dose must not exceed 450 mg per day to minimize seizure risk, which occurs in approximately 0.4% of patients at doses up to 450 mg/day 2

Patients should be monitored for neuropsychiatric symptoms, including depression worsening, suicidal ideation, agitation, anxiety, and mood changes, especially in patients <24 years 3, 2, 4
Blood pressure should be checked at baseline and during titration, as bupropion can cause elevations 4
Efficacy assessment should allow 6-8 weeks at adequate dose before determining treatment response 2

Bupropion offers distinct advantages over SSRIs, including lower rates of sexual dysfunction, less somnolence, and potential for weight loss rather than weight gain 1, 2
The medication may be particularly beneficial for patients with depression characterized by low energy, apathy, or hypersomnia due to its activating properties 2
Common side effects include insomnia, agitation, dry mouth, nausea, headache, and tremor, with insomnia being the most common and manageable by proper timing of doses 3, 2, 4