From the Guidelines
Bupropion therapy in smoking cessation requires dose reduction in patients with CrCl < 60 ml/min, making option A the correct statement. According to the evidence, bupropion is effective for treating both depression and smoking cessation simultaneously, making it particularly beneficial for patients with comorbid depression who want to quit smoking 1. It can be safely used alongside nicotine replacement therapy (NRT), and this combination may actually enhance smoking cessation outcomes compared to either treatment alone. The dose adjustment in renal impairment is necessary because bupropion and its metabolites are primarily eliminated through the kidneys, and reduced clearance can lead to drug accumulation and increased risk of adverse effects, particularly seizures.
Some key points to consider when using bupropion for smoking cessation include:
- Dose reduction is necessary in patients with CrCl < 60 ml/min to 150 mg once daily 1
- Bupropion can be safely used in patients with depression, and may be particularly beneficial for those with comorbid depression who want to quit smoking 1
- Combination with NRT may enhance smoking cessation outcomes compared to either treatment alone 1
- Monitor patients closely for side effects such as insomnia, dry mouth, and agitation when initiating treatment with bupropion.
Overall, bupropion is a useful medication for smoking cessation, particularly in patients with comorbid depression, and can be safely used in combination with NRT. However, dose adjustment is necessary in patients with impaired renal function to minimize the risk of adverse effects.
From the FDA Drug Label
Bupropion and its metabolites are cleared renally and may accumulate in such patients to a greater extent than usual Monitor closely for adverse reactions that could indicate high bupropion or metabolite exposures [see Dosage and Administration (2.7)and Clinical Pharmacology (12.3)]. Consider a reduced dose and/or dosing frequency of bupropion hydrochloride extended-release tablets (XL) in patients with renal impairment (glomerular filtration rate: <90 mL/min).
The correct statement regarding bupropion therapy for smoking cessation is:
- A: Dose reduction is necessary in patients with CrCl < 60 ml/min, however the label states to consider a reduced dose for CrCl < 90 mL/min. The most accurate answer choice given is A, but with the clarification that the CrCl threshold is < 90 mL/min, not < 60 ml/min as stated in option A. 2
From the Research
Bupropion Therapy in Smoking Cessation
- The correct statement regarding bupropion therapy for smoking cessation is related to its use in patients with impaired renal function, depression, or those using nicotine replacement therapy.
- Dose Reduction in Renal Impairment: A study 3 investigated the pharmacokinetics of bupropion in haemodialysis patients who smoke, suggesting that a dose reduction may be necessary in patients with severe renal impairment, as the metabolites of bupropion accumulate in renal failure.
- Concomitant Use with Nicotine Patch: Research 4, 5 indicates that bupropion can be used concurrently with nicotine replacement therapy, including nicotine patches, and may even be more beneficial for certain subgroups of smokers, such as those with a history of depression.
- Use in Patients with Depression: Studies 4, 6 show that bupropion is safe and effective for smoking cessation in patients with depression, including those maintained on treatment with selective serotonin reuptake inhibitor antidepressants, and may even offer additional benefits such as minimal weight gain and improvement in SSRI-associated sexual dysfunction.
- Quit Date: There is no requirement that the patient must quit smoking immediately upon starting bupropion therapy; typically, bupropion is started while the patient is still smoking, and a quit date is set within a week or two after starting treatment 7.