Adult Dosing
Major depressive disorder
Bupropion hydrochloride extended-release, Wellbutrin XL
- Initial treatment
- Start 150 mg PO qd qam
- If adequately tolerated, may increase after 4 days to 300 mg PO qd qam
- Max: 450 mg/day given as a single dose in patients with no clinical improvement after several wks of treatment
- Note: Keep interval of at least 24 hrs between successive doses
- Maintenance treatment
- Periodically reassess the patients to determine the need for maintenance treatment and the appropriate dose for such treatment
Seasonal affective disorder
Bupropion hydrochloride extended-release, Wellbutrin XL
- Start 150 mg PO qd qam
- If adequately tolerated, may increase after 7 days to 300 mg PO qd qam
- If dose is not tolerated, reduce the dosage to 150 mg/day
- Usual dose: 300 mg PO qd qam
- Taper the dose to 150 mg/day x 2 wks prior to discontinuation in patients taking 300 mg/day during the autumn-winter season
- Notes:
- Initiate in autumn prior to the onset of depressive symptoms
- Continue treatment through the winter season and taper and discontinue in early spring
- Individualize timing of initiation and duration of treatment based on the patient's historical pattern of seasonal major depressive episodes
- Avoid prophylactically treating patients whose seasonal depressive episodes are infrequent or not associated with significant impairment
Major depressive disorder, Seasonal affective disorder
Switching patients from Wellbutrin (bupropion hydrochloride tablets) or from Wellbutrin SR (bupropion hydrochloride extended-release tablets (SR)
- Give the same total daily dose when possible
Major depressive disorder
Bupropion hydrochloride sustained-release
- Initial treatment
- 150 mg PO bid
- Start 150 mg PO qd qam
- If adequately tolerated, may increase after 4 days to 300 mg PO qd (in the morning)
- Max: 400 mg/day given as 200 mg PO bid in patients with no clinical improvement after several wks of treatment
- Note: Keep interval of at least 8 hrs between successive doses
- Maintenance treatment
- Periodically reassessed patients to determine the need for maintenance treatment and the appropriate dose for such treatment
Major depressive disorder
Aplenzin
- Initial treatment
- Start 174 mg PO qd qam
- If adequately tolerated, may increase after 4 days to 348 mg PO qd qam
- Max: 522 mg/day given as a single dose in patients with no clinical improvement after 4 wks of treatment or longer
Note:
- Keep interval of at least 24 hrs between successive doses
- 174 mg bupropion HBr are equivalent to 150 mg bupropion HCl
- 348 mg bupropion HBr are equivalent to 300 mg bupropion HCl
- 522 mg bupropion HBr are equivalent to 450 mg bupropion HCl
- Maintenance treatment
- Periodically reassess the patients to determine the need for maintenance treatment and the appropriate dose for such treatment
Major depressive disorder
Switching Patients from Wellbutrin, Wellbutrin SR or Wellbutrin XL
- Give the equivalent total daily dose when possible
Major depressive disorder
Wellbutrin
- Initial treatment
- Start with 100 mg PO bid
- Based on clinical response, increase to 100 mg PO tid 3 days after initiation of therapy
- Usual dose: 300 mg/day PO, given as tid
- Max: 450 mg/day given in divided doses of not more than 150 mg each in patients with no clinical improvement after 4 wks of treatment or longer
- Accomplish dosing >300 mg/day using the 75 mg or 100 mg tablets
- Administer 100 mg tablet as 100 mg PO qid with atleast 4 hrs interval between successive doses
- Notes:
- Discontinue therapy on no adequate response at dose of 450 mg/day
- Increase in dose should not exceed 100 mg/day in a 3-day period
- Gradual escalation in dosage is necessary
- No single dose of Wellbutrin should exceed 150 mg
- Administer tid, preferably with at least 6 hrs between successive doses
- Maintenance treatment
- Use lowest dose that maintains remission
- Acute episodes of depression require several months or longer of antidepressant drug treatment
Major depressive disorder
Wellbutrin SR
- Usual dose: 150 mg PO bid
- Initial treatment
- Start 150 mg PO as a single dose qam
- If adequately tolerated, may increase after 4 days to 150 mg bid
- Keep interval of at least 8 hrs between successive doses
- Max: 400 mg/day given as 200 mg PO bid in patients with no clinical improvement after 4 wks of treatment
- Maintenance treatment
- Periodically reassess the patients to determine the need for maintenance treatment and the appropriate dose for such treatment
Notes:- Do not crush/divide/chew the formulation
Major depressive disorder
Forfivo XL
- 450 mg PO qd without regard to food
Note:
- Forvivo XL should not be used as initial treatment; use another bupropion formulation for initial dose titration
- Patients treated with other bupropion products at 450 mg/day can be switched to equivalent dose of Forfivo XL once daily
- Do not crush/divide/chew the formulation
Smoking cessation
Zyban
- Start 150 mg qd (in the morning) for 3 days
- Increase to 150 mg PO bid; continue treatment for 7-12 wks
- Max: 300 mg/day
Notes:- Individualize therapy
- Keep interval of at least 8 hrs between successive doses
- Do not crush/divide/chew the formulation
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Bupropion hydrochloride extended release and bupropion hydrochloride sustained release tablets, Aplenzin, Wellbutrin, Wellbutrin SR, Forfivo XL, Wellbutrin XL
- Major depressive disorder
Aplenzin, Wellbutrin XL
- Seasonal affective disorder
Zyban
- Aid to smoking cessation treatment
See Supplemental Patient Information
- Increases risk of suicide in children, adolescents, and young adults; assess potential benefits/risk before considering the use. In short-term studies of antidepressants vs. placebo, suicide risk did not increase in patients >24 yrs of age, and risk decreased in patients >65 yrs of age [US black box warning]
- Depression and other psychiatric disorders are associated with an increase in the risk of suicide [US black box warning]
- Monitor and closely observe patients for clinical worsening of depression, suicide risk, or unusual changes in behavior following initiation of therapy [US black box warning]
- Advise families and caregivers of the need for close observation and communication with the prescriber [US black box warning]
- Unapproved for use in pediatrics [US black box warning]
- Unapproved for smoking cessation treatment with the exception of Zyban, which is approved for use in smoking cessation; Zyban is not indicated for treatment of depression [US black box warning]
- Serious neuropsychiatric events, not limited to depression, suicidal ideation, suicide attempt, and suicide have occurred in patients taking bupropion for smoking cessation; nicotine withdrawal symptoms may complicate some of these symptoms [US black box warning]
- Depression, with rare suicidal ideation, have occurred in smokers undergoing a attempt to cease smoking without medication; symptoms have also occurred in patients treated with bupropion continuing to smoke [US black box warning]
- Closely observe patients treated with bupropion for smoking cessation for neuropsychiatric symptoms including changes in behavior, hostility, agitation, depressed mood, and suicide-related events, including ideation, behavior, and attempted suicide; these symptoms, as well as worsening of pre-existing psychiatric illness and suicide have occurred in patients attempting to cease smoking while taking Zyban; these symptoms have mostly occurred during treatment, while some were on discontinuation of therapy with Zyban [US black box warning]
- Advise patients treated for smoking cessation or caregivers to stop therapy and immediately contact a clinician on occurrence of agitation, hostility, depressed mood, or changes in thinking or behavior or if the patient develops suicidal ideation or suicidal behavior. Monitor and provide supportive care until symptoms are resolved [US black box warning]
- Assess potential benefit/risk while using the drug for cessation of smoking [US black box warning]
- Increases the likelihood of abstinence from smoking for as long as 6 months compared to treatment with placebo [US black box warning]
- Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have occurred in adults and pediatric patients
- Consider changing the therapeutic regimen or discontinuation of therapy on persistent worsening of depression, on experiencing emergent suicidality or abrupt onset of severe symptoms, suggesting worsening of depression or suicidality or symptoms that were not part of the patient's presenting symptoms
- Prescribe smallest quantity of tablets to reduce the risk of overdose
- Only bupropion under the name Zyban is approved for cessation of smoking; serious neuropsychiatric symptoms have occurred; nicotine withdrawal symptoms may complicate some of these symptoms (US Black Box Warning)
- Depression, with rare suicidal ideation, have occurred in smokers undergoing an attempt to cease smoking without medication; symptoms have also occurred in patients treated with bupropion who continued to smoke
- Monitor and provide supportive care until symptoms are resolved
- Assess potential benefit/risk while using the drug for cessation of smoking. Increases the likelihood of abstinence from smoking for as long as 6 months compared to treatment with placebo (US Black Box Warning)
- Ask for a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression before initiating therapy
- Extended-release tablets (XL) are unapproved for treatment in bipolar depression
- Avoid concomitant use of formulations containing bupropion
- Dose related risk of seizures exists; permanently discontinue therapy on occurrence of seizures
- Consider caution in dosing due to disproportionate increase in seizure incidence with dose incrimination have occurred. Avoid doses in excess of 450 mg/day and 200 mg as a single dose for extended release formulations and sustained release formulations respectively; doses of Zyban should not exceed 300 mg/day; no single dose should be >150 mg; rate of increment in dosing should be gradual. Seizure threshold increases almost tenfold between 450-600 mg/day
- Avoid doses in excess of 150 mg every other day in patients with severe hepatic cirrhosis
- Anaphylactoid/anaphylactic reactions requiring medical treatment have occurred
- Advise patients to discontinue therapy and consult clinician on occurrence of allergic or anaphylactoid/anaphylactic reactions
- Symptoms resembling serum sickness have occurred
- Hypertension has occurred in patients receiving combination of bupropion and nicotine replacement therapy; monitor blood pressure
- Closely monitor patients with hepatic impairment
- Altered appetite and weight can occur
Cautions: Use cautiously in:
- Mild-moderate hepatic impairment
- Severe hepatic cirrhosis
- Renal impairment
- Lowered seizure threshold
- History of head trauma
- Intracranial lesion
- Prior seizure
- CNS tumor
- Concomitant use of medications that lower seizure threshold
- Bipolar disorder
- Psychiatric disorder
- Suicidal ideation
- History of suicidality
- Excessive use of alcohol
- Excessive use of sedatives (including benzodiazepines)
- Addiction to opiates
- Addiction to cocaine
- Addiction to stimulants
- Use of OTC stimulants and anorectics
- Alcohol or drug abuse
- Hypertension
- Diabetes treated with oral hypoglycemic or insulin
- Recent history of myocardial infarction
- Unstable heart disease
- <24yrs patients
- Geriatrics
Supplemental Patient Information
- Advise families and caregivers of the need for close observation and communication with the prescriber
- Advise patients treated for smoking cessation or caregivers to stop therapy and immediately contact a clinician on occurrence of agitation, hostility, depressed mood, or changes in thinking or behavior or if the patient develops suicidal ideation or suicidal behavior.
- Inform patients/caregivers about the benefits and risks associated with therapy and counsel them in its appropriate use
- Instruct patients/caregivers to read the medication guide and assist them in understanding its contents
- Advise caregivers to remain alert to clinical worsening of symptoms and risk of suicidality
- Advise patients to refrain from activities requiring mental alertness such as operating a hazardous machinery or driving an automobile
- Advise patients to avoid consumption of alcohol or abrupt discontinuation of alcohol or sedatives
- Advise patients to notify their physicians if they become pregnant or intend to become pregnant during therapy
- Instruct to avoid chewing/dividing/crushing of the tablets
Pregnancy Category:C
Breastfeeding: Likely unsafe; if bupropion is used during lactation, monitor infants for adverse events including development of seizures, serum levels to rule out toxicity should be monitored. Other drugs may be preferred, especially if breastfeeding a newborn or a preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 01 August 2013). Manufacturer advises to make a decision whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
- Aplenzin
- Wellbutrin
- Wellbutrin SR
- Wellbutrin XL
- Zyban
- Forfivo XL
US Availability
bupropion hydrochloride (generic)
- TABS: 75, 100, 150 mg
- ETABS: 100, 150, 200, 300 mg
Aplenzin (bupropion hydrobromide)
- ETABS (extended release): 174, 348, 522 mg
Wellbutrin (bupropion hydrochloride)
Wellbutrin SR (bupropion hydrochloride)
- ETABS: 100, 150, 200 mg (12 hrs dosing)
Wellbutrin XL (bupropion hydrochloride)
- ETABS: 150, 300 mg (24 hrs dosing)
Zyban (bupropion hydrochloride)
- ETABS (sustained release): 150 mg
Forfivo XL (bupropion hydrochloride)
Canadian Trade Name(s)
- Ava-bupropion SR
- Bupropion SR
- Novo-bupropion SR
- PMS-bupropion SR
- Ratio-bupropion SR
- Sandoz bupropion SR
- Wellbutrin SR
- Wellbutrin XL
- Zyban
Canadian Availability
bupropion hydrochloride (generic)
Ava-bupropion SR
Bupropion SR
Novo-bupropion SR
PMS-bupropion SR
Ratio-bupropion SR
Sandoz bupropion SR
Wellbutrin SR
Wellbutrin XL
Zyban
UK Trade Name(s)
UK Availability
Zyban (bupropion hydrochloride)
Australian Trade Name(s)
Australian Availability
bupropion hydrochloride (generic)
Clorprax, Prexaton, Zyban SR (bupropion hydrochloride)
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Wellbutrin SR 150 MG TB12 [Bottle] (GLAXO SMITH KLINE)
60 mg = $229.98
180 mg = $662.96 - Aplenzin 522 MG TB24 [Bottle] (SANOFI-AVENTIS U.S.)
30 mg = $560
90 mg = $1629.99 - Wellbutrin XL 300 MG TB24 [Bottle] (VALEANT)
30 mg = $290
90 mg = $825.99 - Wellbutrin 100 MG TABS [Bottle] (GLAXO SMITH KLINE)
90 mg = $311.29
270 mg = $904.92 - Wellbutrin SR 200 MG TB12 [Bottle] (GLAXO SMITH KLINE)
60 mg = $441.01
180 mg = $1279.02 - Zyban 150 MG TB12 [Bottle] (GLAXO SMITH KLINE)
60 mg = $209.99
180 mg = $579.95 - BuPROPion HCl 75 MG TABS [Bottle] (MYLAN)
90 mg = $74.99
270 mg = $210.98 - Wellbutrin 75 MG TABS [Bottle] (GLAXO SMITH KLINE)
90 mg = $235.28
270 mg = $682.93 - BuPROPion HCl 100 MG TABS [Bottle] (MYLAN)
30 mg = $29.99
90 mg = $79.97 - Wellbutrin SR 100 MG TB12 [Bottle] (GLAXO SMITH KLINE)
60 mg = $227.99
180 mg = $648.97 - Wellbutrin XL 150 MG TB24 [Bottle] (VALEANT)
30 mg = $230.97
90 mg = $629.94 - Aplenzin 348 MG TB24 [Bottle] (SANOFI-AVENTIS U.S.)
30 mg = $245.99
90 mg = $706 - Aplenzin 174 MG TB24 [Bottle] (SANOFI-AVENTIS U.S.)
30 mg = $155.98
90 mg = $445.95
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
