What is the recommended treatment plan for smoking cessation using Wellbutrin (bupropion)?

Wellbutrin (Bupropion) for Smoking Cessation

Bupropion SR (Wellbutrin) is an effective first-line pharmacotherapy for smoking cessation that should be combined with behavioral interventions to maximize quit rates. 1

Recommended Treatment Plan

First-Line Pharmacotherapy Options

• Bupropion SR increases smoking abstinence rates from approximately 11% to 19% compared to placebo 1
• The standard dosing regimen for bupropion SR is:
  • Start 1-2 weeks before quit date 1
  • Initial dose: 150 mg once daily for 3 days 1
  • Target dose: 150 mg twice daily 1
  • Continue for 7-12 weeks after quit date 2

Behavioral Support Components

• Combine bupropion SR with behavioral counseling for optimal results 1, 3
• Provide at least 4 in-person counseling sessions 1
• Include practical problem-solving skills training and social support 1
• Total counseling contact time of 91-300 minutes is most effective 1
• Telephone counseling with at least 3 calls can supplement in-person support 1
• Provide tailored self-help materials 1

Follow-Up Schedule

• Assess smoking status and medication side effects within 2-3 weeks after starting therapy 1
• Conduct follow-up assessment at 12 weeks 1
• For patients who successfully quit, additional follow-up at 6 and 12 months 1
• Use motivational strategies to promote continued abstinence 1

Alternative and Combination Approaches

• If bupropion SR alone is not effective, consider:
  • Switching to varenicline (increases abstinence rates to approximately 28%) 1
  • Switching to combination nicotine replacement therapy (NRT) 1
  • Adding NRT to bupropion SR for potentially greater efficacy 1
• Combination pharmacotherapy plus behavioral interventions may increase cessation rates from 8% to 14% compared to usual care 1

Efficacy Considerations

• Success rates at 1 year are approximately:
  • 3-5% with unassisted quitting 4
  • 7-16% with behavioral intervention alone 4
  • Up to 24% with combined pharmacological treatment and behavioral support 4, 3

Safety Considerations

• Common side effects of bupropion SR include dry mouth and sleep disturbance 2
• Rare but serious side effects (approximately 1 in 1,000) include:
  • Seizures 2
  • Anaphylactic/hypersensitivity reactions 2
• Contraindications include:
  • Seizure disorders 2
  • Eating disorders 2
  • Severe hepatic cirrhosis 2
  • History of bipolar disorder 2
  • Concurrent use of monoamine oxidase inhibitors 2
  • Brain metastases (due to increased seizure risk) 1

Special Considerations

• Bupropion should be avoided in pregnant women due to insufficient evidence on safety and efficacy 1
• For patients who continue to smoke or relapse:
  • Continue initial pharmacotherapy or switch to alternative option 1
  • Consider more intensive behavioral therapy 1
  • Try combination approaches (bupropion + NRT) 1
• The cost-effectiveness of bupropion SR is approximately £1,000 or $1,500 per life-year saved 2

Common Pitfalls to Avoid

• Insufficient behavioral support - ensure multiple counseling sessions 1
• Inadequate follow-up - maintain contact throughout treatment period 1
• Premature discontinuation - encourage continued adherence despite brief slips 1
• Failure to address withdrawal symptoms - these typically peak within 1-2 weeks 1
• Not considering combination therapy for highly dependent smokers 1