Bupropion Dosing for Smoking Cessation
The standard dose of bupropion for smoking cessation is 300 mg per day, given as 150 mg twice daily in sustained release (SR) tablets. 1, 2
Dosing Schedule and Administration
- Treatment should begin 1-2 weeks before the target quit date and continue for 7-12 weeks 2, 3
- Initial dosing should start with 150 mg once daily for 3 days, then increase to 150 mg twice daily 2, 3
- The medication should be taken at consistent times each day, with at least 8 hours between doses to minimize the risk of seizures 4
- The maximum daily dose should not exceed 300 mg for smoking cessation to minimize seizure risk 1, 3
Efficacy and Outcomes
- Bupropion is an effective aid to smoking cessation, improving 12-month sustained abstinence rates and reducing the severity of withdrawal symptoms 1, 5
- Evidence shows bupropion increases long-term smoking cessation rates with a risk ratio of 1.64 compared to placebo 5
- One randomized controlled trial found higher one-year sustained abstinence rates with bupropion than with nicotine transdermal patch (30.3% vs 16.4%) 6
- Combining bupropion with nicotine replacement therapy may provide additional benefit, though the difference is not always statistically significant 6, 5
Special Population Considerations
- For patients with moderate to severe hepatic impairment, the total daily dose should not exceed 150 mg daily (one tablet) 2, 7
- For patients with moderate to severe renal impairment, the total daily dose should be reduced by half 2
- Bupropion should be avoided in patients with seizure disorders as it may lower the seizure threshold 2, 7, 4
- Bupropion is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 2, 7
Monitoring and Side Effects
- Common side effects include insomnia, headache, dry mouth, and anxiety 4
- The risk of seizures is approximately 1 in 1000, similar to other antidepressants 1
- The risk of allergic reaction is approximately 1 in 1000 to 1 in 10,000 1
- Patients should be monitored for neuropsychiatric adverse effects, especially in individuals younger than 24 years 2
- Blood pressure should be monitored as bupropion should be avoided in patients with uncontrolled hypertension 2
Behavioral Support
- Evidence on the effectiveness of bupropion is primarily from studies that included behavioral support 1
- Combining bupropion with behavioral counseling significantly improves outcomes 6, 5
- Health professionals who participate in smoking cessation programs themselves are more likely to provide effective smoking cessation advice to their patients 8
Clinical Pearls
- Bupropion may be particularly beneficial for patients with depression who also want to quit smoking 2
- The efficacy of bupropion in smoking cessation appears to be independent of its antidepressant effect 1
- Bupropion may help minimize weight gain associated with smoking cessation 6
- If a patient has not achieved significant progress toward abstinence by week 7-12, treatment should be reassessed 2, 3