Overview of bupropion for tobacco smoking and nicotine dependence
Bupropion is a noradrenaline and dopamine reuptake inhibitor and a nicotinic receptor antagonist, reducing the severity of both nicotine withdrawal and cravings that persist beyond the withdrawal period. Although it is a first-line option for smoking management, bupropion is less commonly used than combination nicotine replacement therapy (NRT) or varenicline because it is less effective.
Consider bupropion for tobacco smoking and nicotine dependence for people who:
- cannot tolerate varenicline or combination NRT or found them ineffective
- require concomitant treatment for depression1
- prefer the simplicity of taking a single drug.
Bupropion is contraindicated in patients with a history of seizures, eating disorders, those taking irreversible monoamine oxidase inhibitors, and during abrupt withdrawal from alcohol or benzodiazepines (because seizure risk may be increased). Like varenicline, bupropion is only considered for management of smoking during pregnancy when NRT is not suitable. Bupropion is not recommended in people younger than 18 years.
Use bupropion with caution in patients who:
- use other drugs that lower seizure threshold (eg antipsychotics, antidepressants). Doses of bupropion more than 300 mg daily are not recommended because of the risk of dose-dependent seizures
- have bipolar affective disorder, because of the risk of mania.
Bupropion is metabolised by cytochrome P450 enzymes; consider potential drug interactions before prescribing.
The most common adverse effect of bupropion is insomnia, followed by dizziness, anxiety, nausea and dry mouth. Seizures are a rare but serious adverse effect.