Starting and reviewing bupropion for tobacco smoking and nicotine dependence

If bupropion is preferred for smoking management, use:

bupropion 150 mg orally, in the morning for 3 days, then 150 mg orally, twice a day. Review symptom control and adverse effects after 14 days. If effective and tolerated, continue at this dose for the remainder of a 9-week course. bupropion bupropion bupropion

Patients usually stop smoking around the second week of therapy, but the full 9-week course should be completed. Review patients at the end of the second week of treatment to assess efficacy, tolerability and adjust smoking management advice.

Anecdotal evidence supports the addition of medium- or fast-acting NRT to bupropion after the first 2 weeks if required to manage cue-driven cravings. Evidence is lacking for the impact of combining bupropion and vareniclineThe Royal Australian College of General Practitioners (RACGP), 2021.

Review all patients 2 weeks after starting bupropion and again at 9 weeks (or earlier) to assess the effectiveness and tolerability of bupropion and provide encouragement.

Bupropion is subsidised by the Pharmaceutical Benefits Scheme (PBS) for one 9-week course per year. Some patients benefit from longer or repeated courses. Offer a further course to any patient who wishes to continue, regardless of whether their smoking has reduced with the current course.