From the Guidelines
Wellbutrin XL (bupropion hydrochloride extended-release) is typically prescribed at 150 mg once daily for the first 3 days, then increased to 150 mg orally, twice daily, if tolerated, for smoking cessation, as recommended by the NCCN clinical practice guidelines in oncology 1. The dosage is initiated 1-2 weeks prior to quitting and continues for 7-12 weeks. Key points to consider when prescribing Wellbutrin XL for smoking cessation include:
- The medication should be taken in the morning to minimize insomnia, and tablets must be swallowed whole, not crushed or chewed.
- Patients should set a specific quit date and may use nicotine replacement therapy alongside Wellbutrin XL if needed.
- The medication works by affecting brain chemicals like dopamine and norepinephrine, which helps reduce nicotine cravings and withdrawal symptoms.
- Common side effects include dry mouth, insomnia, and headache.
- Wellbutrin XL should be avoided by those with seizure disorders, eating disorders, or those taking MAO inhibitors, as stated in the guidelines 1. Regular follow-up with a healthcare provider is important to monitor progress and manage any side effects, with follow-up recommended within 2 weeks after starting pharmacotherapy, and additional periodic follow-up during therapy, as indicated 2.
From the Research
Dosage of Wellbutrin XL for Smoking Cessation
- The studies provided do not specifically mention the dosage of Wellbutrin XL for smoking cessation 3, 4, 5, 6, 7.
- However, it is known that bupropion, the active ingredient in Wellbutrin XL, is effective for smoking cessation and is typically prescribed in a sustained-release formulation 3, 4, 5.
- One study mentions that bupropion SR was titrated to 150 mg by mouth twice daily for a total of 12 weeks, in combination with varenicline, for the treatment of tobacco dependence 5.
- Another study notes that bupropion is classified as an atypical antidepressant and is actually a norepinephrine and dopamine reuptake inhibitor, but does not specify the dosage for smoking cessation 6.
Efficacy of Wellbutrin XL for Smoking Cessation
- The studies suggest that bupropion, in combination with other medications such as varenicline, may be effective for increasing smoking abstinence rates above that observed with monotherapy 4, 5.
- One study found that combination therapy with varenicline and bupropion SR yielded greater efficacy than varenicline monotherapy in two randomized controlled trials and one retrospective outcomes study 4.
- Another study found that varenicline seems to be more effective in maintaining abstinence and reducing craving than bupropion and NRT 6.
- A comparative effectiveness trial found that varenicline and combination nicotine replacement therapy (C-NRT) were more effective than nicotine patch monotherapy in achieving biochemically verified 7-day point-prevalence abstinence 4 weeks post-target quit day (TQD) 7.