Bupropion (Wellbutrin)

 

Half-life: 21 hours
starting dose:
> IR: 100mg PO BID
> SR: 150mg PO QAM
> ER: 150mg PO QAM
target dosing range: 150mg-450mg
best time to dose: Morning
how to dose:
> IR: Initial 100mg PO BID for 5-7 days then increase to 100mg PO TID.
Max daily dose is 450mg. Each dose should be administered at least 6
hours apart with no more than 150mg per dose.
> SR: Initial 150mg PO QAM for 5-7 days then increase to 150mg PO BID.
Max daily dose is 400mg. Each dose should be administered at least 8
hours apart with no more than 200mg per dose.
> ER: Initial 150mg PO QAM for 5-7 days then increase to 300mg PO
QAM. Max daily dose is 450mg PO QAM.
PREGNANCY: Minimal data on safety. Not a contraindication.
breastfeeding: Minimal data on safety. Not a contraindication.

 

FDA INDICATIONS:
1) Major Depressive Disorder
2) Seasonal Affective Disorder
3) Smoking Cessation

 

Additional Information

 

  • Rare risk of seizures at high doses and/or rapid increases in doses
  • Elevated seizure risk in patients who snort high doses of crushed bupropion, Patients with preexisting seizure disorders, Patients with eating disorders, and Patients withdrawing from alcohol or benzodiazepines
  • Bupropion has no sexual side effects and is often used to minimize psychotropic induced sexual dysfunction
  • Bupropion has actions at nicotine receptors which may explain its use as a smoking cessation agent

 

References

  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.

(Note: the diagrams were created by me, but the theories behind them were taken from numerous textbooks and articles. For more information, I recommend Dr. Stephen Stahl’s Textbook “Stahl’s Essential Psychopharmacology” 4th edition).

Mechanism of Bupropion: