Bupropion Dosing and Duration for Smoking Cessation
The recommended dosing for Wellbutrin (bupropion SR) for smoking cessation is 150 mg once daily for the first 3 days, followed by 150 mg twice daily (300 mg total) for 7-12 weeks, starting 1-2 weeks before the target quit date, with possible extension up to 6 months to 1 year for continued cessation support. 1
Dosing Protocol
Initial Phase
- Start 1-2 weeks before the planned quit date 2, 1
- Days 1-3: 150 mg orally, once daily 2, 1
- Day 4 onward: 150 mg orally, twice daily (300 mg total daily dose) 2, 1
Duration
- Standard treatment duration: 7-12 weeks 2, 1
- Extended treatment: May be continued up to 6 months to 1 year to promote continued abstinence 2, 1
Efficacy
- Bupropion significantly improves long-term abstinence rates compared to placebo (23.1% vs 12.4% at one year) 3
- Works by reducing nicotine withdrawal symptoms and managing cravings 1
- Efficacy appears independent of its antidepressant effects 1
Contraindications
Bupropion is contraindicated in patients with:
- Seizure disorders or risk factors for seizures 2, 1
- Patients taking MAO inhibitors 2, 1
- Patients taking tamoxifen 2, 1
- Closed-angle glaucoma 2, 1
- History of eating disorders 1
- Brain metastases due to seizure risk 2
Side Effects and Monitoring
Common Side Effects
- Insomnia
- Dry mouth
- Headache
- Nausea 1
Serious Side Effects (Rare)
- Seizures (estimated at 1 in 1,000) 4
- Hypersensitivity reactions 4
- Neuropsychiatric symptoms (depression, hostility, suicidal behavior) 2, 1
Monitoring Recommendations
- Monitor for development or worsening of neuropsychiatric issues, particularly in patients with psychiatric history 2, 1
- Weight changes: Bupropion may help reduce weight gain associated with smoking cessation 5, 3
Special Considerations
- Evidence on effectiveness is primarily in medium to heavy smokers (15+ cigarettes per day) 1
- No dosage adjustments needed based on smoking status, as pharmacokinetics are similar between smokers and non-smokers 6
- Consider dose reduction for patients with moderate to severe hepatic or renal impairment 1
- Combining bupropion with nicotine replacement therapy may enhance efficacy for some patients 1, 5
Clinical Pearls
- The specific formulation used for smoking cessation is bupropion SR (sustained-release) marketed as Zyban 1
- Patients should set a specific quit date, typically around day 8 of treatment 5
- Lower smoking rate and longer previous periods of abstinence are predictive of better outcomes 7
- Behavioral support alongside medication significantly improves success rates 4
Bupropion has demonstrated effectiveness for smoking cessation with a favorable risk-benefit profile when used appropriately and with proper monitoring for potential adverse effects.