bupropion (Rx)
Brand and Other Names:Zyban, Budeprion SR, Aplenzin, Buproban, Wellbutrin SR, Wellbutrin XL, Forfivo XL
- Classes: Antidepressants, Dopamine Reuptake Inhibitors;
- Antidepressants, Other;
- Smoking Cessation Aids
Dosage Forms & Strengths
tablet (Wellbutrin - Discontinued)
- 75mg
- 100mg
tablet, sustained-release (Wellbutrin SR)
- 100mg
- 150mg
- 200mg
tablet, extended-release (Wellbutrin XL)
- 150mg
- 300mg
tablet, extended-release (Aplenzin)
- 174mg
- 348mg
- 522mg
tablet, extended-release (Forfivo XL)
- 450mg
tablet, extended-release (Zyban)
- 150mg
Major Depressive Disorder
Immediate-release
- Initial: 100 mg PO q12hr; may increase to 100 mg PO q8hr as early as day 4; may consider increasing dose up to maximum 150 mg q8hr after several weeks if no clinical improvement observed with 100 mg q8hr
- Alternatively, may initiate with 75 mg PO q8hr
Sustained-release
- Initial: 150 mg PO qDay; may increase to 150 mg q12hr after 3 days
- May increase to no more than 200 mg q12hr after more than 4 weeks if no clinical improvement observed with 150 mg q12hr
Extended-release
- Initial: 150 mg PO qDay; may increase to 300 mg qDay on day 4
- May increase not to exceed 450 mg qDay after more than 4 weeks if no clinical improvement observed with 300 mg qDay; Forfivo may be used only after titrating initially with other bupropion products
Aplenzin
- Initial: 174 mg PO qDay; after 4 days, may increase to usual adult target dose of 348 mg PO qDay
- May increase not to exceed 522 mg qDay after more than 4 weeks
Forfivo XL
- 450 mg PO qDay without regard to food
- Can be used in patients who have been receiving 300 mg/day of another bupropion formulation for at least 2 weeks and who require a dosage of 450 mg/day
- Patients who are currently being treated with other bupropion products at 450 mg/day can be switched to equivalent dose of Forfivo XL once daily
Dosing considerations (Depression)
- Extended-release: When switching to XL, give the same total daily dose at the indicated frequencies: 3 times daily for immediate-release, twice daily for sustained-release, and once daily for extended-release
- Forfivo XL: Do not initiate treatment with Forfivo XL; use another bupropion formulation for initial dose titration
- Switching from hydrochloride salt formulation to hydrobromide salt (Aplenzin): 150 mg/day hydrochloride salt = 174 mg/day hydrobromide salt; 300 mg/day hydrochloride salt = 348 mg/day hydrobromide salt; 450 mg/day hydrochloride salt = 522 mg/day hydrobromide salt
Seasonal Affective Disorder
Wellbutrin XL: 150 mg PO qDay; may increase to 300 mg qDay
Aplenzin (bupropion hydrobromide): 174 mg PO qDay initially (equivalent to 150 mg bupropion HCl); after 1 week, may increase to usual target dose of 348 mg/day (equivalent to 300 mg bupropion HCL)
Dosing considerations (SAD)
- Initiate treatment in the autumn prior to onset of seasonal depressive symptoms and continue through the winter season
Smoking Cessation
Zyban: 150 mg PO qDay for 3 days, THEN
Increase to 150 mg q12hr; should continue treatment for 7-12 weeks; if patient successfully quits after 7-12 weeks, consider ongoing maintenance therapy based on individual patient risk/benefit
Dosing considerations (Smoking Cessation)
- Begin therapy 1 week before target quit date (usually second week of treatment)
- May be used in combination with nicotine patch
ADHD (Off-label)
Initial: 150 mg/day PO
Titrate to 150-450 mg/day based on tolerability and efficacy; may administer in divided doses or in ER or SR formulations
Neuropathic Pain (Off-label)
150 mg bupropion SR PO twice daily for 6 weeks
Dosing Modifications
Hepatic impairment
- Mild to moderate: Use caution; consider reducing dose or frequency; Fortivo XL not recommended
- Moderate to severe (Buproban, Wellbutrin XL, Zyban): Not to exceed 150 mg every other day
- Moderate to severe (Aplenzin): Not to exceed 174 mg every other day
- Moderate to severe (Wellbutrin SR): 100 mg once daily or 150 mg every other day
- Moderate to severe (Zyban): 150 mg every other day
- Elderly: Lower dose/frequency may be required because of decreased renal/hepatic clearance
Renal impairment
- Use caution; consider dose reduction
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