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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by gdog on September 18, 2001, at 15:25:05
does anyone know what the maximum daily dose of wellbutrin sr is? i've been prescribed 150mg 2xd, but feel like i need to up the dose. is 450 too much (i've been told not to cut the sr pills. . . ) thanks, gdog.
Posted by SalArmy4me on September 18, 2001, at 17:28:13
In reply to max wellbutrin dose, posted by gdog on September 18, 2001, at 15:25:05
I know quite a few people who take 450 mg. They often take 300 in the morning and 150 in the afternoon to minimize insomnia.
My view on Wellbutrin and seizures: I think that the risk of seizures associated with Wellbutrin is exaggerated. In the early studies, the rate of occurence was about 0.30 percent in general patient populations at dosages as high as 900mg. This is about equal to the tricyclics. More recent studies indicate that the SR (sustained release) version of Wellbutrin at dosages up to 300mg carries no greater risk to produce seizures than most other antidepressants; the rate being about 0.10 percent. However, the rate of seizure increases significantly in people with a pre-existing seizure disorder. It is also increased when treating people who have an imbalance of electrolytes such is seen in eating disorders like bulemia. The rate of seizure also increases at dosages greater than 300mg. Even so, the rate at 450mg is no greater than that of the tricyclics. I would not want to speculate at dosages exceeding 450mg. More frequent dosing helps to minimize risk. It was during a pre-marketing investigation designed to study the efficacy of Wellbutrin in treating bulimia that seizures emerged. I think most of the bad reputation this drug has was born of that study.
Posted by Cam W. on September 18, 2001, at 20:26:29
In reply to max wellbutrin dose, posted by gdog on September 18, 2001, at 15:25:05
Gdog - I have personally been involved in 2 cases of Wellbutrin™ (bupropion)-induced seizures, and have heard of 2 more in our area. All four cases were drug-induced, with the two people taking low doses of traditional antipsychotics (Case #1 - taking 100mg of Largactil™ - clorpromazine; Case #2 - taking 50mg of Mellaril™ - thioridazine).
In both of cases I was involved in, the psychiatrists had figured that the doses of the traditional antipsychotics were too small to decrease the seizure threshold by a significant amount. Indeed, both of these docs had used similar combinations uneventfully (and with higher doses of the traditional antipsychotics).
I would expect of drugs that lower seizure threshold (esp. TCAs) would have a propensity to induce seizures, when taken together. I have never seen a combination of Wellbutrin and a TCA causing a seizure, but I have heard of it happening (so I don't know if there were other extenuating circumstances in these cases). I cannot remember what the drugs were in the other 2 cases in our area.
Even though the risk of seizures caused by Wellbutrin may be exaggerated, the relative risk of having a seizure at the 450mg/day dose is 4x greater than at the 300mg/day dose. Any risk is still a risk, and needs to be respected.
My 2˘ - Cam
Posted by gdog on September 19, 2001, at 14:26:18
In reply to Re: max wellbutrin dose » gdog, posted by Cam W. on September 18, 2001, at 20:26:29
thanks sal and cam for the information - its all very helpful. cam, do you remember what doses of wellbutrin the 4 folks you know of who seized were taking? i'm asking because wb worked really well for me for about three months, and then i felt the symptoms of depression sneaking in with increasingly in the last 3 weeks(sneaky little bastards!) i would ask my pdoc - that is, if i could get an appointment or even a phone consultation sometime in the next 4 months. but i cant. i dont like the idea of messing around with doses, etc, but since i've been feeling so. . . normal. . .this summer, i just cant bear the thought of going back into that darkness. so i think i'm gonna take the risk and take 150mg each at 6am, 1pm, and 8pm. anyone know of anything (outside of wb dosage) that seems to prevent seizures in general? thanks, gdog.
Posted by Cam W. on September 19, 2001, at 23:59:35
In reply to Re: max wellbutrin dose, posted by gdog on September 19, 2001, at 14:26:18
Gdog - The two cases I worked on were taking 150mg Wellbutrin SR twice daily. I can't honestly say what the other two were taking, but our clinic docs, for the most part, are fairly conservative. I would say that the other two were at 300mg/ day, or even lower, if the Wellbutrin was being used as an augmenting agent. - Cam
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