From the Guidelines
Bupropion SR (Sustained Release) is the recommended formulation for smoking cessation, as it has been specifically studied and proven effective in this context, unlike the XL (Extended Release) formulation which is more commonly used for depression treatment. The standard regimen begins with 150 mg once daily for the first three days, then increases to 150 mg twice daily for the remainder of the treatment course, which usually lasts 7-12 weeks, as supported by studies such as 1. Patients should set a target quit date within the first two weeks of treatment, ideally during the second week. The medication works by affecting dopamine and norepinephrine levels in the brain, reducing nicotine cravings and withdrawal symptoms.
Some key points to consider when prescribing bupropion SR for smoking cessation include:
- Common side effects, such as insomnia, dry mouth, and headache, as noted in 1
- Contraindications, including seizure disorders, eating disorders, or those taking MAO inhibitors, as mentioned in 1
- The importance of combining bupropion SR with behavioral counseling to significantly improve quit rates compared to medication alone, as highlighted in 1 and 1
It's also worth noting that while the XL formulation is available, the SR formulation is specifically recommended for smoking cessation due to its proven efficacy in clinical trials, such as those referenced in 1 and 1. Additionally, studies like 1 provide further evidence on the safety and efficacy of bupropion SR for smoking cessation, including its potential benefits and risks.
From the Research
Formulation Options for Bupropion in Smoking Cessation
The recommended formulation for bupropion (Wellbutrin) in smoking cessation is either SR (Sustained Release) or XL (Extended Release). However, based on the provided studies, the focus is on the SR formulation.
Key Findings
- Bupropion SR is licensed in many countries to aid smoking cessation, with a usual recommended dose of 150 mg twice daily taken for 7-14 days prior to the quit date, and then 6-8 weeks afterwards 2.
- The SR formulation has been extensively evaluated for smoking cessation and has shown continuous smoking abstinence rates at one year of around 20% across many clinical groups 3.
- Pharmacokinetic and metabolism studies reveal that bupropion SR is metabolised by multiple pathways, and the optimal daily dose for the majority of patients is 300mg to maximise efficacy with an acceptable safety profile 4.
Comparison with Other Formulations
- While there is no direct comparison between SR and XL formulations in the provided studies, bupropion SR has been compared to other smoking cessation therapies, such as varenicline and nicotine replacement therapy 5.
- Bupropion SR has also been evaluated in specific patient populations, such as those with chronic posttraumatic stress disorder (PTSD), and has shown promise in helping patients quit smoking 6.
Safety and Efficacy
- Bupropion SR is generally well-tolerated, with common side effects including dry mouth and sleep disturbance, and rare but serious side effects such as anaphylactic/hypersensitivity reaction and seizure 2, 3.
- The efficacy of bupropion SR in smoking cessation is directly related to dose, and the incidence of side effects is related to bupropion plasma concentrations 4.