Recommended Dosing for Bupropion (Wellbutrin) for Smoking Cessation
For smoking cessation, bupropion should be dosed at 150 mg once daily for the first 3 days, then increased to 150 mg twice daily (300 mg total daily) for 7-12 weeks, starting 1-2 weeks before the target quit date. 1
Dosing Schedule and Duration
- Initial dose: 150 mg once daily for 3 days
- Maintenance dose: 150 mg twice daily (300 mg total)
- Starting time: Begin 1-2 weeks before planned quit date
- Standard duration: 7-12 weeks
- Extended use: May be extended up to 6 months to 1 year to promote continued cessation if needed 1
Clinical Efficacy
Bupropion significantly improves smoking cessation rates compared to placebo. Evidence from randomized controlled trials shows that it improves success at staying off cigarettes for at least 12 months by 9-10 percentage points 2. In a head-to-head comparison with varenicline, bupropion demonstrated higher efficacy than placebo but lower efficacy than varenicline for cessation at both 3 and 12 months 3.
Combination Therapy
Bupropion can be used in combination with nicotine replacement therapy (NRT). One study showed that the 12-month abstinence rates were:
- 15.6% for placebo
- 16.4% for nicotine patch alone
- 30.3% for bupropion alone
- 35.5% for bupropion plus nicotine patch 4
While the combination showed higher abstinence rates than bupropion alone, the difference was not statistically significant. However, the combination therapy was significantly more effective than placebo or nicotine patch alone 4.
Contraindications and Precautions
Bupropion is contraindicated in patients with:
- Seizure disorders or risk factors for seizures
- Patients taking MAO inhibitors
- Patients taking tamoxifen
- Closed-angle glaucoma
- History of eating disorders 1
Side Effects
- Common side effects: Insomnia, dry mouth, headache, and nausea
- Serious but rare side effects: Seizures (estimated at 1 in 1,000), hypersensitivity reactions, and neuropsychiatric symptoms such as depression, hostility, and suicidal behavior 1, 2
Special Considerations
- Dose adjustments: Consider dose reduction for patients with moderate to severe hepatic or renal impairment 1
- Weight management benefit: Bupropion may help reduce weight gain associated with smoking cessation 1, 4
- Monitoring: Regular monitoring for neuropsychiatric symptoms is recommended, particularly in patients with a history of psychiatric disorders 1
Clinical Pearl
Starting bupropion 1-2 weeks before the quit date is crucial for achieving therapeutic blood levels by the time the patient stops smoking, which significantly increases the chances of successful cessation 1.