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Reviewed by Dr Roy Kedem, MD
Information last reviewed 11/05/19
Bupropion is an antideperessant medication, which along with nicotine replacement therapy, and Varinecline (Chantix), is also FDA-approved for smoking cessation. For smokers who want to quit, a combination of behavioral modification, counseling, and medication, can significantly improve the chance of success. When used with nicotine replacement therapy, Bupropion has been shown to help with symptoms of nicotine withdrawal such as cravings and anxiety.
The exact mechanism by which Bupropion helps with smoking cessation is not known. It may work in part by extending the activity of dopamine in the brain, which in turn can reduce nicotine withdrawal symptoms. Bupropion was developed to treat depression. Individuals who were being treated for depression with Bupropion reported decreased cigarette cravings, which led the manufacturer to study the drug for the purpose of smoking cessation.
Bupropion has been studied in randomized trials for smoking cessation. People treated with Bupropion had higher rates of smoking cessation than people taking a placebo. In one study, patients treated with Bupropion 150 mg twice a day, had greater rates of abstinence after 7 weeks (44% compared to 19%) and one year (23% vs. 12%), than patients who received a placebo. In a large trial of over 8000 people, Bupropion was found to be more effective than placebo and comparable in effect to the nicotine patch. In the same study Varenicline (Chantix) proved more effective than Bupropion.
Each tablet contains 150 mg of bupropion hydrochloride.
The inactive ingredients in Bupropion are: carnauba wax, cysteine hydrochloride, hypromellose, magnesium stearate, 625 microcrystalline cellulose, polyethylene glycol, polysorbate 80, titanium dioxide and edible black ink. In addition, the 150-mg tablet contains FD&C Blue No. 2 Lake 627 and FD&C Red No. 40 Lake.
This medication has been linked to a severe allergic reaction called anaphylaxis. It contains 2 dyes Red 40. And Blue 2. which has been linked to allergic reactions. Signs of a severe allergic reaction are: hives/rash, trouble breathing, dizziness, facial/tongue swelling and flushing. This is a medical emergency and you should seek emergency medical help as soon as possible.
Bupropion is dosed at 150 mg daily. After three days, the dose can be increased to 150 mg twice a day (maximum 300 mg/day). If the higher dose is not well tolerated (due to side effects as discussed below), the lower dose of 150 mg a day can be resumed as it has been shown to be effective.
Treatment should begin at least two weeks before a target quit date, while you are still smoking, as it takes 1-2 weeks for the drug to start taking effect. If you successfully quit smoking after 7-12 weeks, you may consider continuing Bupropion as maintenance therapy for up to an additional year. Alternatively, if there is no progress after the seventh week of treatment, then Bupropion is not likely to work, and your provider can consider stopping the medication.
You should take Bupropion as prescribed by your doctor. The dose for smoking cessation is 150 mg daily or 150 mg twice a day. It must be started 1-2 weeks before the planned “quit date” as the medication takes that long to start working. It does not need to be taken with food. The tablets should be taken whole, not chewed or crushed.
If you miss a scheduled dose of Bupropion, take it as soon as you remember. Try to space the remaining doses evenly throughout the day, at least 4 hours apart. If you are closer than 4 hours to your next dose, you should skip the missed dose altogether and take the next dose as scheduled. It is important not to ingest an extra dose to make up for a missed one, as this could produce dangerous side-effects.
If you take more Bupropion than recommended, you may have dangerous levels of the drug in your body, which could prove to be fatal. Symptoms of an overdose include:
If you think you may have overdosed on Bupropion, seek emergency medical assistance by either calling your doctor or local poison control center. If your symptoms are severe, call 911 immediately.
When used for smoking cessation, serious neurologic and psychiatric events have occurred in patients taking Bupropion. These include mood changes (depression, mania), psychosis, hallucinations, paranoia, delusions, homicidal thoughts, agitation, suicidal thoughts and suicide attempts. These symptoms may be related to nicotine withdrawal and have occurred in patients with and without underlying psychiatric conditions (such as depression). It is important to stop taking Bupropion and contact a health care provider if any side effects occur.
Bupropion is also used to treat psychiatric disorders such as depression. The medication carries important warnings when used to treat psychiatric disorders, including risk of suicidal ideation and related behavior, especially in young adults.
Bupropion should not be used if you have a history of seizures, epilepsy, or are stopping alcohol use suddenly as it can increase the risk of seizures.
Bupropion may cause mild pupil dilation, which can cause an episode of narrow-angle glaucoma in susceptible patients.
The most common side effects (>10%) include:
Bupropion has the potential to interact with the following medications:
Bupropion should not be taken by patients with the following conditions:
Studies of pregnant women who took Bupropion during the first trimester did not show any increased risk of birth defects. However, it has not been studied extensively and there is no long-term data. Bupropion should only be used in pregnancy if the benefit justifies the potential risk to the fetus. The potential for long-term effects on child development and behavior from Bupropion use has not been studied. Always talk to your obstetrician before starting any new medication if you are pregnant, planning to become pregnant or if you are breastfeeding.
Bupropion is present in breast-milk. Seizures and sleep disturbances were reported in breastfeeding infants whose mothers were using Bupropion, and infants should be closely monitored. However, the use of Bupropion is not considered a contraindication to breastfeeding. The risks and benefits of breastfeeding should be discussed with your doctor.
Bupropion was first approved on the US market in 1985. It was approved for smoking cessation in 1997.
Bupropion is available as a generic medication, from multiple manufacturers such as Mylan, Sandoz, Novo. However, the brand name Zyban is made by GlaxoSmithKline.
Several clinical studies have confirmed the efficacy of Bupropion in helping individuals to quit smoking with relative ease. Approximately 1 in 5 smokers are able to successfully remain abstinent from smoking after a year of medicating with Bupropion.
Bupropion affects the part of the brain that is responsible for addictive behavior. By specifically disrupting the nicotine receptors, the medication can decrease nicotine cravings, as well as associated withdrawal symptoms. Therefore, it is possible that Bupropion can eradicate nicotine addiction caused by processes other than smoking.
Up to now, there have been no known risks associated with the long-term use of Bupropion; it is well-tolerated, and a safe and effective medication in smoking cessation, when used as instructed.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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