What is the efficacy of bupropion (Wellbutrin) 150 mg extended release (ER) 24 hour taken twice daily for depression or smoking cessation?

Efficacy of Bupropion 150 mg Extended Release Taken Twice Daily

Bupropion 150 mg extended release taken twice daily (300 mg total daily dose) is effective for both smoking cessation and depression, with smoking cessation rates of 32-60% and significant improvement in depressive symptoms, though it should be used with caution in patients with seizure risk factors. 1

Dosing and Administration

• Standard dosing protocol for smoking cessation:

  • Days 1-3: 150 mg once daily
  • Day 4-12 weeks: 150 mg twice daily (300 mg total)
  • Maximum dose: 300 mg per day
  • Treatment duration: 7-12 weeks 1

• Initiate dosing 1-2 weeks prior to the target quit date for smoking cessation 1

• Morning and afternoon dosing is preferred (avoid evening doses to prevent insomnia) 1

• The medication should be discontinued if:

  • For smoking cessation: Patient has not achieved adequate progress by week 12 1
  • For depression: Reassess after 9 months with potential dose reduction 1

Efficacy Data

For Smoking Cessation:

• Clinical trials show 32-60% of patients achieve smoking cessation with bupropion SR 300 mg/day 2, 3
• At 6-month follow-up, approximately 40% of patients maintain smoking cessation 3
• Bupropion is listed as a subsequent therapy option after first-line treatments (combination NRT or varenicline) in smoking cessation guidelines 1

For Depression:

• Significantly reduces depressive symptoms compared to placebo by treatment day 56 4
• Effective for long-term treatment of recurrent major depression at 300 mg daily dose 1
• Can be used as an activating antidepressant for patients with low energy levels 1

Safety and Adverse Effects

Common Adverse Effects:

• Insomnia (most common, especially with evening dosing)
• Dry mouth
• Headache
• Nausea
• Anxiety 5, 6

Most adverse effects are transient and often resolve without intervention; they can be managed if necessary by dose reduction 5.

Important Precautions:

• Contraindications:

  • Seizure disorders or factors that lower seizure threshold
  • Patients taking MAO inhibitors (increased risk of hypertensive reactions)
  • Patients taking tamoxifen
  • Closed-angle glaucoma 1

• Monitoring requirements:

  • Blood pressure (avoid in uncontrolled hypertension)
  • Neuropsychiatric symptoms (depression, suicidal ideation)
  • Weight (typically causes modest weight loss) 1

Special Considerations

• Dual benefits: May be particularly beneficial for patients with both depression and need for smoking cessation 2, 3
• Weight effects: Associated with modest weight loss (0.5-1.0 kg), which can be advantageous compared to other antidepressants 4
• Sexual function: Lower incidence of sexual dysfunction compared to other antidepressants 6
• Activating properties: May be preferred for patients with fatigue or apathy 1

Common Pitfalls to Avoid

1. Seizure risk: Carefully screen patients for seizure risk factors before prescribing
2. Drug interactions: Avoid use within 14 days of MAO inhibitors
3. Evening dosing: Avoid late-day dosing to minimize insomnia
4. Opioid therapy: If using with naltrexone-bupropion combination, discontinue before procedures requiring opioids 1
5. Monitoring: Regular follow-up to assess both efficacy and side effects is essential

Bupropion SR 150 mg twice daily provides a well-established treatment option with demonstrated efficacy for both smoking cessation and depression, with the additional benefits of minimal sexual side effects and potential weight loss rather than weight gain.