Recommended Dosing of Bupropion for Smoking Cessation
The recommended dose of bupropion (Wellbutrin/Zyban) for smoking cessation is 150 mg once daily for the first 3 days, then 150 mg twice daily (300 mg total per day) for 7-12 weeks, starting 1-2 weeks before the target quit date. 1
Dosing Schedule and Administration
Initiation phase: Begin 1-2 weeks prior to the target quit date
- Days 1-3: 150 mg orally once daily
- Day 4 through end of treatment: 150 mg orally twice daily (if tolerated)
- Maximum dose: 300 mg per day 1
Treatment duration: 7-12 weeks total 1
- Treatment may be extended to promote continued cessation (up to 6 months-1 year) if needed 1
Patient Selection and Contraindications
Bupropion is contraindicated in patients with:
- Seizure disorders or risk factors for seizures (stroke, brain metastases) 1
- Patients taking MAO inhibitors (increased risk of hypertensive reactions) 1
- Patients taking tamoxifen 1
- Patients with closed-angle glaucoma 1
- History of eating disorders 1, 2
- Severe hepatic cirrhosis 2
- History of bipolar disorder 2
Efficacy and Outcomes
Bupropion has been shown to significantly improve smoking cessation rates compared to placebo:
- In clinical trials, 12-month abstinence rates were approximately 23% with bupropion 300 mg/day versus 12.4% with placebo 3
- When combined with behavioral support, bupropion can improve success at staying off cigarettes for at least 12 months by 9-10 percentage points 2
Side Effects and Monitoring
Common side effects:
Serious but rare side effects:
- Seizures (risk approximately 0.1% at recommended doses) 4
- Hypersensitivity reactions (approximately 0.1%) 4
- Neuropsychiatric symptoms (monitor for depression and suicidal ideation/behavior) 1, 5
Practical Considerations
- Dose adjustments may be considered if clinically indicated 1
- Combining bupropion with nicotine replacement therapy (NRT) is an option for enhanced efficacy 1, 6
- Bupropion may help reduce weight gain associated with smoking cessation 3, 6
- For optimal results, combine with behavioral support/counseling 1, 2
- Monitor patients for neuropsychiatric symptoms, particularly those with a history of psychiatric disorders 1, 5
Special Populations
- For patients with moderate to severe hepatic or renal impairment, consider dose reduction 5
- Limited evidence exists for use in light smokers (less than 10 cigarettes per day) 1
- May be particularly beneficial for smokers with a history of depression 5, 7
By following this dosing regimen and monitoring protocol, bupropion can be an effective pharmacological aid for smoking cessation, significantly improving long-term abstinence rates and reducing the health risks associated with continued smoking.