From the Guidelines
When prescribing Wellbutrin (bupropion) for smoking cessation, patients should typically set a target quit date within the first 1-2 weeks of starting the medication, as recommended by the NCCN clinical practice guidelines in oncology 1. The standard regimen begins with 150 mg once daily for the first 3 days, then increases to 150 mg twice daily, if tolerated. Key points to consider when prescribing Wellbutrin for smoking cessation include:
- The medication needs time to build up in the system to be effective, which is why patients shouldn't quit smoking immediately upon starting treatment.
- The full treatment course usually lasts 7-12 weeks, though some patients may benefit from longer treatment to prevent relapse.
- Patients should be advised that Wellbutrin reduces nicotine cravings and withdrawal symptoms by affecting dopamine and norepinephrine levels in the brain, which helps manage the neurochemical aspects of nicotine addiction.
- Side effects may include insomnia, dry mouth, and headache, so taking the second daily dose several hours before bedtime can help minimize sleep disturbances. It is essential to monitor patients for the development or worsening of serious neuropsychiatric issues, such as depression and suicidal ideation/behavior, and discontinue use if these signs occur, as stated in the Manufacturer Black Box Warning 1.
From the Research
Smoking Cessation with Wellbutrin
- Wellbutrin, also known as bupropion, is a prescription medication used for smoking cessation 2.
- The medication works by affecting pathways in the brain that influence nicotine craving and the withdrawal symptoms that many people experience when they stop smoking 2.
- Studies have shown that bupropion can aid long-term smoking cessation, with high-certainty evidence that it increases long-term smoking cessation rates (RR 1.64,95% CI 1.52 to 1.77) 2.
Quitting Smoking with Wellbutrin
- There is no specific guidance on when to quit smoking when prescribing Wellbutrin, but it is generally recommended to start taking the medication 1-2 weeks before the quit date 2, 3.
- A study found that bupropion increased long-term smoking cessation rates, with 71% of participants achieving 7-day point-prevalent smoking abstinence at 3 months and 58% at 6 months 4.
- Another study found that bupropion was more effective than nicotine replacement therapy (NRT) for smoking cessation, but less effective than varenicline 3.
Combination Therapy
- Combination therapy with varenicline and bupropion may be effective for increasing smoking abstinence rates above that observed with monotherapy 4.
- However, there is insufficient evidence to establish whether combination bupropion and nicotine replacement therapy (NRT) results in superior quit rates to NRT alone, or whether combination bupropion and varenicline results in superior quit rates to varenicline alone 2.