What is the recommended dose of Bupropion (Zyban) for smoking cessation?

From the Guidelines

Bupropion (Zyban) is recommended for smoking cessation at a dose of 150 mg once daily for the first 3 days, then increased to 150 mg twice daily for the remainder of the treatment course, with a total treatment duration of 7-12 weeks, as supported by the most recent and highest quality study 1.

Key Points

• The treatment should be initiated 1-2 weeks before the quit date to allow the medication to reach effective levels in the body.
• The pills should be taken at least 8 hours apart to minimize the risk of seizures, which is a rare but serious side effect.
• Bupropion works by affecting brain chemicals (dopamine and norepinephrine) that are linked to nicotine addiction, reducing cravings and withdrawal symptoms.
• Common side effects include dry mouth, insomnia, headache, and nausea.
• Bupropion is contraindicated in patients with seizure disorders, eating disorders, or those taking MAO inhibitors.

Recommendations

• For best results, bupropion should be used as part of a comprehensive smoking cessation program that includes behavioral support and counseling.
• Patients should be monitored for the development or worsening of serious neuropsychiatric issues, such as depression and suicidal ideation/behavior, and the medication should be discontinued if these signs occur.
• The use of bupropion in combination with other pharmacotherapy, such as nicotine replacement therapy (NRT), may be more effective than using a single type of medication, as suggested by studies 1.

Important Considerations

• The evidence from studies 1 suggests that bupropion is effective in helping patients quit smoking, with abstinence rates ranging from 19% to 28% compared to placebo.
• However, the most recent and highest quality study 1 provides the most up-to-date guidance on the recommended dose and treatment duration for bupropion.

From the Research

Recommended Dose of Bupropion (Zyban) for Smoking Cessation

The recommended dose of Bupropion (Zyban) for smoking cessation is:

• 150 mg twice daily, taken for 7 - 14 days prior to the quit date, and then 6 - 8 weeks afterwards 2
• The maximum daily dose is 300mg, and smokers should be screened for predisposing risk factors to avoid a risk of seizure of greater than 0.1% 3
• Treatment typically consists of nine weeks of bupropion (150 mg a day for the first three days, and then 150 mg twice daily) 4

Efficacy of Bupropion for Smoking Cessation

Bupropion has been shown to be effective in aiding smoking cessation, with:

• Abstinence rates at 12 months of 15.6 percent in the placebo group, as compared with 16.4 percent in the nicotine-patch group, 30.3 percent in the bupropion group, and 35.5 percent in the group given bupropion and the nicotine patch 4
• Continuous abstinence rates at 12 months of 18.4% with bupropion and 5.6% with placebo 5
• Point prevalence rates at 12 months of 23.1 and 30.3% with bupropion, whereas values for placebo were 12.4 and 15.6% 5

Safety and Tolerability of Bupropion

Bupropion is generally well tolerated, with:

• Common adverse events including insomnia, headache, dry mouth, nausea, and anxiety 3, 4
• Rare but serious side effects including anaphylactic/hypersensitivity reaction and seizure (both estimated at 1 in a 1000) 2
• A low potential for inducing seizures (seizure rate approximately 0.1% in patients with depression) 5