What is buproprion (Wellbutrin) used for and how is it taken?

Bupropion (Wellbutrin): Uses and Administration

Bupropion is primarily used for treating major depressive disorder and as an effective smoking cessation aid, with a unique mechanism of action that affects dopamine and norepinephrine rather than serotonin. 1, 2

Primary Uses

• Bupropion is FDA-approved for the treatment of major depressive disorder (MDD) 2, 3
• It is also approved and effective as a smoking cessation aid under the brand name Zyban 4
• Bupropion may be particularly beneficial as a smoking cessation agent for people with depression 4, 1
• It works by inhibiting norepinephrine and dopamine reuptake and acting as an inhibitor of nicotinic acetylcholinergic receptors 4, 1

Dosing and Administration

• For depression:

  • Starting dose is typically 150 mg once daily for 3 days 2
  • Then increased to 150 mg twice daily if tolerated 2
  • Maximum dose is 300 mg per day (for standard formulation) 4, 2
  • Available in immediate-release (three times daily), sustained-release (twice daily), and extended-release (once daily) formulations 5

• For smoking cessation:

  • Start 1-2 weeks prior to your quit date 4
  • Days 1-3: 150 mg once daily 4
  • Day 4 through 7-12 weeks: 150 mg twice daily if tolerated 4
  • Maximum 300 mg per day 4

Effectiveness

• For depression: Bupropion has comparable efficacy to other standard antidepressants 6, 5
• For smoking cessation: Significantly increases abstinence rates compared to placebo (OR, 2.07; 95% CI, 1.75–2.45) 4
• Efficacy for smoking cessation is similar to nicotine patch but less than varenicline 4
• Longer duration of bupropion treatment may help prevent relapse in those who have successfully quit smoking 4

Side Effects and Safety Concerns

• Common side effects include:

  • Disturbed sleep/insomnia 4, 6
  • Dry mouth 4, 3
  • Headaches 4, 3
  • Nausea 4, 3
  • Nervousness 6

• Important safety concerns:

  • Seizure risk (0.1% or 1/1000 patients) - dose-dependent 4, 7
  • Neuropsychiatric effects, though recent studies show these are rare 4, 1
  • May increase blood pressure in some patients 2

Contraindications

• Bupropion should NOT be used in patients with:
  • Seizure disorders or epilepsy 7, 2
  • History of bulimia or anorexia nervosa 7, 2
  • Brain metastases due to increased seizure risk 4, 7
  • Patients taking monoamine oxidase inhibitors (MAOIs) 7, 2
  • Patients abruptly discontinuing alcohol or sedatives 2
  • Closed-angle glaucoma 4, 7

Advantages Over Other Medications

• Less sexual dysfunction compared to many antidepressants, particularly SSRIs 6, 5
• Less weight gain than some other antidepressants 6, 5
• Dual benefit for patients with both depression and tobacco use disorder 1, 8
• Starts working for depression within 2 weeks, with full effect at 4 weeks 3
• For smoking cessation, can help reduce negative affect and urges to smoke on quit day 9

Important Monitoring and Precautions

• Monitor for development or worsening of neuropsychiatric symptoms 4, 2
• Start medication 1-2 weeks before planned quit date for smoking cessation 4
• Avoid combining with other medications containing bupropion to prevent overdose 2
• Use caution in patients with cardiovascular disease or hypertension 7, 2
• Take with food if stomach upset occurs 2