Bupropion is NOT Commonly Used to Treat Alcohol Use Disorder
Bupropion is not an FDA-approved or guideline-recommended medication for treating alcohol use disorder, unlike disulfiram, naltrexone, and acamprosate, which are all established first-line pharmacotherapies for AUD. 1, 2
FDA-Approved Medications for AUD
The three medications approved in the United States specifically for treating AUD are:
- Disulfiram - An ALDH inhibitor that causes aversive reactions when alcohol is consumed, though it is currently not commonly used due to its mechanism 1, 2
- Naltrexone (oral and long-acting injectable) - Decreases dopamine concentration and dampens the reward pathway, reducing excessive drinking and increasing abstinence duration 1, 2
- Acamprosate - Reduces withdrawal effects and craving for alcohol, effective at maintaining abstinence 1, 2
Why Bupropion is Different
Bupropion is a norepinephrine-dopamine reuptake inhibitor approved for depression and smoking cessation, NOT for alcohol use disorder. 1, 3 While it affects dopamine systems theoretically relevant to addiction, it lacks FDA approval or strong guideline support for AUD treatment.
- Recent research has explored bupropion's potential role in AUD, but this remains investigational 3
- One study examining comorbid depression and AUD found that bupropion was associated with lower odds of response (OR = 0.22, p = 0.024) in patients with comorbid conditions 4
- Bupropion is primarily used for tobacco cessation, where it has established efficacy alongside varenicline 1
Clinical Practice Implications
When prescribing for AUD, clinicians should prioritize the three FDA-approved medications 2:
- Naltrexone and acamprosate are considered first-line treatments with established efficacy 1
- Disulfiram can be offered as part of treatment, though patient preferences and motivation should guide selection 1
- These medications are significantly underprescribed despite being first-line treatments in clinical practice guidelines 2
Common Pitfall
Do not confuse bupropion's role in treating tobacco use disorder (where it IS approved) with alcohol use disorder (where it is NOT approved). 1 The evidence base for bupropion in AUD remains insufficient for guideline recommendations, whereas the three approved medications have demonstrated efficacy in reducing alcohol consumption and maintaining abstinence 1, 2.