From the Guidelines
Bupropion (Zyban) can be used for smoking cessation in patients with schizophrenia, but requires careful monitoring. The decision to use bupropion in this population is supported by the most recent and highest quality study available, which suggests that bupropion is effective for smoking cessation and does not significantly increase the risk of neuropsychiatric adverse events, even in patients with mental illness 1.
Key Considerations
- The typical dosing regimen for bupropion starts with 150 mg once daily for 3 days, then increases to 150 mg twice daily for 7-12 weeks.
- Treatment should begin 1-2 weeks before the target quit date.
- Coordination between psychiatric and primary care providers is essential to monitor for potential worsening of psychiatric symptoms or medication interactions.
- Bupropion works by inhibiting the reuptake of dopamine and norepinephrine, which helps reduce nicotine cravings and withdrawal symptoms.
- Close monitoring is necessary as some patients might experience agitation, anxiety, or insomnia, and lower doses or slower titration may be needed for patients taking antipsychotics that affect the same neurotransmitter systems.
Benefits and Risks
- Bupropion has been shown to be effective for smoking cessation, with a similar efficacy to nicotine replacement therapy (NRT) 1.
- The risk of serious adverse cardiovascular effects is not elevated with bupropion use for smoking cessation, according to recent meta-analyses 1.
- Neuropsychiatric effects have been identified as a safety concern with bupropion, but recent systematic reviews have found that serious neuropsychiatric adverse events are rarely associated with bupropion prescribed for smoking cessation, including in patients with mental illness 1.
Monitoring and Follow-up
- Regular follow-up appointments should be scheduled to assess both smoking cessation progress and psychiatric stability.
- Patients should be monitored for potential worsening of psychiatric symptoms or medication interactions, and adjustments to the treatment plan should be made as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Bupropion for Smoking Cessation in Schizophrenia
- Bupropion (Zyban) has been studied as a potential aid for smoking cessation in patients with schizophrenia, with several trials demonstrating its efficacy and safety in this population 2, 3, 4.
- A 2002 study published in Biological Psychiatry found that bupropion significantly increased 7-day point prevalence smoking abstinence rates compared to placebo in patients with schizophrenia or schizoaffective disorder 2.
- A 2005 study published in the Journal of Clinical Psychopharmacology also found that bupropion was effective for smoking cessation in patients with schizophrenia, with a significant increase in 7-day point prevalence abstinence rates compared to placebo 3.
- Reviews of the evidence have concluded that bupropion, often used in combination with behavioral treatment, is a safe and effective option for smoking cessation in patients with schizophrenia 5, 6.
- A 2010 meta-analysis published in the British Journal of Psychiatry found that bupropion increased biochemically verified self-reported smoking cessation rates in smokers with schizophrenia, without worsening their mental state 4.
- The use of bupropion for smoking cessation in schizophrenia is supported by clinical practice guidelines, which recommend its use in combination with behavioral treatment for at least 12 weeks, with maintenance pharmacotherapy considered to reduce relapse and improve sustained abstinence rates 5, 6.