What is the recommended dosage and regimen for using bupropion (Wellbutrin) for smoking cessation?

Bupropion (Wellbutrin) for Smoking Cessation: Dosage and Regimen

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) 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
• Target dose: 150 mg twice daily (300 mg total)
• Start timing: Begin 1-2 weeks before your planned quit date
• Standard duration: 7-12 weeks
• Extended therapy: May be extended up to 6 months to 1 year to promote continued cessation if needed 1

The medication works by reducing nicotine withdrawal symptoms through modulation of dopamine and norepinephrine reuptake, which helps manage cravings and withdrawal symptoms during the quit attempt 2.

Efficacy

Bupropion significantly improves smoking cessation rates compared to placebo. Studies show that bupropion can increase long-term (12-month) abstinence rates by approximately 9-10 percentage points compared to placebo 3. In direct comparison studies, bupropion has demonstrated a 30.3% abstinence rate at 12 months versus 15.6% with placebo 4.

Contraindications

Bupropion should NOT be used in patients with:

• Seizure disorders or risk factors for seizures
• Current use of MAO inhibitors
• History of eating disorders
• Closed-angle glaucoma
• Patients taking tamoxifen 1

Side Effects to Monitor

• Common: Insomnia, dry mouth, headache, nausea 1, 3
• Serious but rare:
  • Seizures (risk approximately 1 in 1,000)
  • Hypersensitivity reactions
  • Neuropsychiatric symptoms (depression, hostility, suicidal behavior) 1

Special Considerations

1. Dose adjustments: Consider reduced dosing for patients with moderate to severe hepatic or renal impairment 1

2. Weight management benefit: Bupropion may help reduce weight gain commonly associated with smoking cessation 1, 4

3. Combination therapy options:

   • Combining bupropion with nicotine replacement therapy (NRT) may enhance efficacy for some patients who have difficulty quitting with monotherapy 2, 1
   • One study showed 35.5% abstinence at 12 months with bupropion plus nicotine patch versus 30.3% with bupropion alone 4

4. Monitoring requirements:

   • Watch for neuropsychiatric symptoms, particularly in patients with history of psychiatric disorders
   • Monitor for seizure risk factors

Practical Implementation

1. Set a quit date 1-2 weeks after starting medication
2. Begin with 150 mg daily for 3 days
3. Increase to 150 mg twice daily on day 4
4. Quit smoking on the target quit date (usually around day 8)
5. Continue medication for at least 7-12 weeks
6. Consider extending treatment up to 6 months if needed to maintain abstinence

For optimal results, combining bupropion with behavioral support is recommended to boost chances of successful smoking cessation 3.