From the Guidelines
Bupropion is contraindicated in those with a past medical history of seizure disorder or any condition that increases seizure risks. This is a crucial consideration when prescribing bupropion for smoking cessation, as it reduces the seizure threshold and meta-analyses of trial data have found a 0.1% seizure risk among those receiving the drug for smoking cessation 1.
When considering bupropion therapy for smoking cessation in a patient like Ms. KM, who has a history of chronic pain and diabetes, it is essential to weigh the benefits and risks. Bupropion has been shown to be effective in aiding long-term smoking cessation, with a similar efficacy to nicotine replacement therapy (NRT) 1. The standard dosing regimen for smoking cessation is Wellbutrin SR 150 mg once daily for 3 days, then 150 mg twice daily for 7-12 weeks.
Some key points to consider when prescribing bupropion for smoking cessation include:
- Setting a target quit date within the first 1-2 weeks of starting the medication to maximize effectiveness
- Monitoring blood pressure, as bupropion can cause mild elevations, which may be relevant for diabetic patients who often have comorbid hypertension
- Being aware of common side effects, such as insomnia, dry mouth, and headache
- Avoiding use in patients with seizure disorders, eating disorders, or those taking MAO inhibitors
It is also important to note that bupropion may be particularly beneficial as a smoking cessation agent for persons with depression, and longer duration of bupropion treatment may help prevent relapse in those who have successfully quit 1. However, the primary concern in this case is the potential increased risk of seizures, which must be carefully evaluated before initiating bupropion therapy.
From the FDA Drug Label
Instruct patients to discontinue and not restart bupropion hydrochloride extended-release tablets (XL) if they experience a seizure while on treatment Advise patients that the excessive use or the abrupt discontinuation of alcohol, benzodiazepines, antiepileptic drugs, or sedatives/hypnotics can increase the risk of seizure. Seizure is a contraindication for bupropion therapy, and it is also contraindicated in those with a past medical history of seizure disorder or any condition that increases seizure risks
The correct answer is A: It is contraindicated in those with a past medical history of seizure disorder or any condition that increases seizure risks 2.
From the Research
Bupropion for Smoking Cessation
- Bupropion is a pharmacologic agent approved by the U.S. Food and Drug Administration as an antidepressant and to support smoking cessation 3, 4, 5.
- It is contraindicated in patients with a past medical history of seizure disorder or any condition that increases seizure risks, as it can lower the seizure threshold 3, 4, 5, 6.
- The correct statement regarding bupropion for smoking cessation is that it is contraindicated in those with a past medical history of seizure disorder or any condition that increases seizure risks.
- Bupropion can be started before the patient has quit smoking, typically 1-2 weeks before the quit date, to allow the medication to reach a steady state 7, 5.
- Treatment with bupropion for smoking cessation typically lasts for 12 weeks, but it can be continued for a longer period if needed 7, 5.
- Weight gain can occur during treatment with bupropion, but it is also known to reduce cessation-related weight gain 5.