From the Guidelines
Yes, nicotine patches can be used together with bupropion as a combination therapy for smoking cessation, as this combination has been found to be more effective than using either treatment alone 1.
Combination Therapy
The combination of nicotine patches and bupropion works well because the medications act through different mechanisms - nicotine patches provide a steady dose of nicotine to reduce withdrawal symptoms, while bupropion affects brain chemicals like dopamine and norepinephrine that are involved in nicotine addiction.
- Nicotine patches are usually started on the quit date, with a standard regimen beginning with 21 mg/day for 4-6 weeks, followed by 14 mg/day for 2 weeks, and then 7 mg/day for 2 weeks.
- Bupropion is typically started 1-2 weeks before the quit date, with a dosing regimen of 150 mg once daily for 3 days, then increased to 150 mg twice daily 1.
Efficacy and Safety
Some studies suggest that NRT in combination with bupropion SR may be more efficacious than bupropion SR alone but not necessarily NRT alone 1. However, it is essential to consult with a healthcare provider before combining these medications, as they can monitor for side effects such as insomnia, dry mouth, or increased blood pressure that may occur with either medication.
- The combination of nicotine patches and bupropion has been found to increase cessation rates compared to using either treatment alone 1.
- Healthcare providers should monitor for the development or worsening of serious neuropsychiatric issues, such as depression and suicidal ideation/behavior, when using bupropion, and discontinue use if these signs occur 1.
From the Research
Mixing Nicotine Patches with Bupropion
- The study 2 found that the combination of nicotine replacement therapy (NRT) and bupropion did not significantly improve smoking cessation rates compared to either treatment alone.
- However, another study 3 suggests that combination pharmacotherapy, including NRT and bupropion, may be beneficial for highly nicotine-dependent smokers or those who have failed with monotherapy.
- A systematic review and meta-analysis 4 compared the effects of high-dose and combination NRT, varenicline, and bupropion on smoking abstinence, but did not find consistent benefits of combination NRT over other interventions.
- A more recent review 5 discusses the pharmacological approaches to smoking cessation, including NRT, bupropion, and varenicline, and emphasizes the importance of customizing the smoking cessation strategy based on patient preferences and comorbidities.
Safety and Efficacy
- The study 2 reported that several unwanted symptoms were more common with bupropion, but did not specifically address the safety of combining nicotine patches with bupropion.
- Another study 6 notes that bupropion is effective for smoking cessation and its effectiveness is improved by a moderate level of counseling, but does not discuss the combination with nicotine patches.
- The review 5 states that smoking cessation drugs, including NRT and bupropion, are effective and safe in real-world settings, even in patients with chronic cardiovascular disease.
Clinical Practice
- The study 3 recommends that smokers be provided with counseling and pharmacologic smoking cessation aids, unless contraindicated, and suggests that combination pharmacotherapy may be indicated for highly nicotine-dependent smokers.
- The review 5 aims to provide practical indications for physicians on the pharmacological strategies for smoking cessation, including the use of NRT, bupropion, and varenicline, and emphasizes the importance of customizing the approach based on patient characteristics and preferences.