600mg of Wellbutrin SR vs XL. Is taking 300mg of Wellbutrin XL 2x/day safe?

Patient

Q: I suffer very severe depression, and the pharmacies in my area are currently out of bupropion hydrochloride (Wellbutrin SR). My prescription for bupropion is 600mg in the form of a 200mg tablet 3 times a day, so I have the option of only taking 400mg in a day if my stomach is bothering me. I have my doctors permission to do this.

I have already missed a dose, and it's very important I get my medications regularly. My father has a prescription of 300mg Wellbutrin XL (the extended release version), and while I know I should never take medications that aren't prescribed to me I feel keeping my mental stability is more important. In the past I've been told never to take more than 300mg of bupropion at once, and was wondering about how I should take the extended release. Should I just take 300mg/day (half my prescribed dose), or would it be safe to take 300mg 2x/day (one in the morning and one at night).

My other medication is Cymbalta at 120mg/day. I receive rTMS 2x/week, so it's important my medications stay as constant as possible. I risk entering a state similar to catatonia without getting my medications, and I've already missed my morning dose. I am going to take 300mg of bupropion XL tonight, the question is if it's safe enough to take another 300mg in the morning - or would my risk of a side effect like a seizure be too great?

Doctor

A:   Thank you for your question. It is important to know the difference between the SR and XL formulations.

They are not interchangeable

SR is sustained release and releases the medication slowly over a 12 hour period into your body.

XL is extended release and releases the medication over a 24 hour period into your body.

From clinical experience, when switching from SR to XL, we should calculate your daily dose total on SR (400 to 600mg) and covert it to once a day dosing for XL.

In your example. You should start taking XL on a day you have not taken SR. Your starting dose should be 150 mg of XL and slowly over the course of 1 to weeks increased to 600mg XL.

XL should never be taken on the same day as SR and never be taken twice a day.

I hope this was helpfull. The above switch in medication formulation should never be done without consultation with your regular doctor and pharmacist.

Comments / Follow Ups

Patient: It's worth noting that my doctor and I are aware of and have discussed the increased risk of seizure at the dose I currently take. I have Ativan I can take in the event that I begin to experience seizure symptoms.

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