Is Wellbutrin (bupropion) indicated for alcohol use cessation?

Bupropion (Wellbutrin) for Alcohol Use Cessation

Bupropion (generic name for Wellbutrin) is not FDA-indicated for alcohol use cessation, though it is approved for smoking cessation and depression treatment. 1

Indications for Bupropion

Bupropion is FDA-approved for:

• Major depressive disorder (as Wellbutrin)
• Seasonal affective disorder
• Smoking cessation (as Zyban) 1, 2

Off-label uses include:

• ADHD treatment 3
• Depression in patients with comorbid conditions 4

Evidence for Smoking Cessation

Bupropion has strong evidence for tobacco cessation:

• The European Society of Cardiology guidelines note that bupropion aids long-term smoking cessation with an odds ratio of 1.69 (95% CI 1.53-1.85) compared to placebo 1
• It is considered a first-line pharmacotherapy for smoking cessation alongside nicotine replacement therapy and varenicline 1, 2
• Typical dosing for smoking cessation is 150 mg twice daily (300 mg total) 4

Evidence for Alcohol Use Cessation

The evidence for bupropion in alcohol use cessation is limited:

• No major clinical guidelines recommend bupropion as a first-line treatment for alcohol use disorder
• Some naturalistic studies suggest potential benefits:
  • One open-label study found that bupropion-SR may help recently abstinent alcohol-dependent individuals reduce smoking 5
  • However, a double-blind placebo-controlled study found that bupropion when added to nicotine patch did not improve smoking outcomes in alcoholics 6

Formulations and Administration

Bupropion is available in multiple formulations:

• Immediate-release (IR)
• Sustained-release (SR)
• Extended-release (XL) 3

Safety Considerations

Important safety considerations include:

• Contraindicated in patients with seizure disorders (seizure risk approximately 0.1%) 2
• Avoid in patients with:
  • History of seizures or conditions lowering seizure threshold
  • Current use of MAO inhibitors
  • Uncontrolled hypertension 1, 4
• Common side effects: insomnia, dry mouth, anxiety/jitteriness, headache, decreased appetite 4, 2
• Bupropion carries a black box warning related to potential increase in suicidal thoughts in young adults 1

Special Populations

For patients with liver disease:

• Pharmacokinetic studies show the morpholinol metabolite of bupropion has a significantly prolonged half-life in patients with alcoholic liver disease 7
• Dose adjustment may be necessary in patients with moderate to severe hepatic impairment 4

Bottom Line

While bupropion is effective for smoking cessation and depression treatment, it is not specifically indicated for alcohol use cessation. For patients with comorbid alcohol use disorder and tobacco dependence, bupropion may be considered primarily for its smoking cessation benefits, with careful monitoring for seizure risk and other adverse effects.