From the Guidelines
Bupropion (Wellbutrin) is an effective medication for smoking cessation, with a recommended dosage of 150 mg once daily for 3 days, then increasing to 150 mg twice daily for 7-12 weeks, as supported by the most recent and highest quality study 1.
Key Points
- Bupropion SR has been shown to be associated with a significantly higher rate of smoking abstinence at 6 months or more than placebo or no bupropion SR, with a relative risk (RR) of 1.62 [CI, 1.49 to 1.76] 1.
- The medication works by affecting dopamine and norepinephrine levels in the brain, which helps reduce nicotine cravings and withdrawal symptoms.
- Common side effects include dry mouth, insomnia, headache, and nausea.
- Bupropion may be particularly helpful for smokers concerned about weight gain during quitting, as it can suppress appetite.
- It's contraindicated for people with seizure disorders, eating disorders, or those taking MAO inhibitors.
Combination Therapy
- Combining bupropion with behavioral support, such as counseling, can increase cessation rates from approximately 8% to 14% compared with usual care or minimal behavioral interventions 1.
- Using bupropion in combination with nicotine replacement therapies (NRT) may be more effective than using bupropion alone, but not necessarily more effective than NRT alone 1.
Recommendations
- For best results, combine bupropion with behavioral support, such as counseling, and consider using it alongside NRT for enhanced effectiveness in heavy smokers.
- Treatment should begin 1-2 weeks before the target quit date to allow the medication to reach effective levels in the body.
- Patients should be informed about the potential side effects and benefits of bupropion, as well as the importance of combining it with behavioral support for optimal results.
From the Research
Effectiveness of Bupropion for Smoking Cessation
- Bupropion is effective for smoking cessation, with studies showing it can help approximately one in five smokers to stop smoking 2.
- The effectiveness of bupropion is improved by a moderate level of counselling 3.
- Bupropion has been shown to be more effective than nicotine replacement therapy (NRT) in some studies, with a long-term direct comparison of bupropion with transdermal nicotine showing that bupropion was more effective than nicotine 3.
- However, other studies have found that the addition of bupropion to treatment with NRT and counseling did not significantly increase smoking cessation rates 4.
Comparison with Other Treatments
- A direct comparison of varenicline with bupropion has shown that varenicline is at least as good as and probably more effective than bupropion for smoking cessation 3.
- Bupropion has been compared to nicotine patch, with one study finding that bupropion was associated with significantly higher quitting rates than nicotine patch 5.
- Combination therapy with bupropion and nicotine patch has been found to provide slightly higher abstinence rates than bupropion alone, although differences were not statistically significant 5.
Safety and Tolerability
- Bupropion is generally well tolerated, with the most common adverse events being insomnia and dry mouth 2, 5.
- Bupropion has a low potential for inducing seizures, with a seizure rate of approximately 0.1% in patients with depression 5.
- Bupropion can be used in combination with NRT, and has been found to reduce the potential for weight gain associated with smoking cessation 5.