What is a green pill used for smoking cessation?

Green Pill for Smoking Cessation

Bupropion SR (Zyban), which comes in a green pill form, is an effective medication for smoking cessation and should be considered as a first-line pharmacotherapy option for patients who want to quit smoking. 1

First-Line Pharmacotherapy Options

• Bupropion SR (sustained-release) is one of the preferred primary therapies for smoking cessation, alongside combination nicotine replacement therapy (NRT) and varenicline 1
• The standard dose for smoking cessation is 150 mg twice daily (300 mg total daily) 1, 2
• Treatment should begin 1-2 weeks before the target quit date and typically continues for 7-12 weeks 1, 2
• Bupropion works by inhibiting dopamine reuptake and acting as a nicotinic acetylcholinergic receptor inhibitor 1

Efficacy

• Bupropion improves 12-month abstinence rates with an odds ratio of 2.07 (95% CI, 1.75-2.45) compared to placebo 1
• Efficacy is similar to nicotine patch but less than varenicline 1
• Bupropion may be particularly beneficial for patients with depression who also want to quit smoking 1
• Longer duration of bupropion treatment may help prevent relapse in those who have successfully quit 1

Administration and Dosing

• Initiate dosing 1-2 weeks prior to quitting 1
• Days 1-3: 150 mg orally once daily 1, 2
• Day 4 through 12 weeks: 150 mg orally twice daily, if tolerated 1, 2
• Maximum dose: 300 mg per day 1, 2

Side Effects and Safety

• Common side effects include dry mouth, disturbed sleep, headaches, and nausea 1, 3
• Bupropion reduces the seizure threshold with a 0.1% seizure risk 1, 3
• Contraindicated in patients with:
  • Seizure disorders or factors that lower seizure threshold 1, 2
  • Taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 1, 2
  • History of eating disorders 4
  • Severe hepatic cirrhosis 2, 4
  • History of bipolar disorder 4
  • Patients taking tamoxifen 1, 2
  • Closed-angle glaucoma 1

Special Considerations

• Dose adjustments are required for:
  • Moderate to severe hepatic impairment: do not exceed 150 mg daily 2
  • Moderate to severe renal impairment: reduce total daily dose by half 2
  • Older adults: consider starting at lower doses 2
• Neuropsychiatric effects have been a concern, but recent studies including the EAGLES trial found that serious neuropsychiatric adverse events were rarely associated with bupropion prescribed for smoking cessation 1
• No significant increase in cardiovascular risk has been observed with bupropion use for smoking cessation 1

Behavioral Support

• Bupropion should be combined with behavioral support for optimal outcomes 1, 4
• Four or more sessions during each 12-week course of pharmacotherapy is recommended 1
• Follow-up is recommended within 2-3 weeks after starting pharmacotherapy 1

Alternative Options

• If bupropion is not suitable, consider:
  • Combination NRT (nicotine patch + short-acting NRT) 1
  • Varenicline (also FDA-approved for smoking cessation) 5
• Bupropion can also be used in combination with NRT for potentially improved outcomes 1