Bupropion
🚭 Bupropion is used for smoking cessation (anti-craving/anti-withdrawal).
⚠️ Key safety issue is seizure risk (dose-related) — keep to max 150 mg per dose and max 300 mg/day.
📚 Always check the BNF for the most up-to-date prescribing advice.
ℹ️ About
- 💊 Bupropion hydrochloride (Zyban®) is licensed in the UK for nicotine dependence.
- 🧠 Pharmacology: a norepinephrine/dopamine reuptake inhibitor (NDRI) with nicotinic receptor effects that reduce withdrawal symptoms and craving.
- 🎯 Works best with behavioural support (stop-smoking services, counselling, quit plan).
Mode of action
- 🧠 NDRI: increases synaptic dopamine/noradrenaline → reduces craving and withdrawal dysphoria.
- 🚬 Has additional effects on nicotinic acetylcholine receptors, contributing to anti-withdrawal benefit.
- ⚠️ Not “side-effect free” — compared with SSRIs it is often less sedating/less sexual dysfunction, but insomnia/anxiety can be prominent.
Indication / Dose (smoking cessation)
- 📅 Start 1–2 weeks before the target quit date.
- 1️⃣ Days 1–6: 150 mg once daily (PO).
- 2️⃣ From day 7: 150 mg twice daily (PO), doses at least 8 hours apart.
- ⛔ Max single dose: 150 mg
| Max total daily dose: 300 mg.
- ⏱️ Typical course is several weeks (follow local stop-smoking service/BNF advice).
Dose summary
| Name |
Dose |
Frequency |
Route |
Key limits |
| Bupropion (Zyban®) |
150 mg |
OD → then BD |
PO |
⚠️ Max 150 mg per dose, max 300 mg/day |
💡 Practical prescribing tips
- 🌙 Avoid late-evening dosing to reduce insomnia (common).
- 🧠 Screen for seizure risk factors before starting (see contraindications/cautions).
- 🚬 Agree a quit date, provide NRT/behavioural support, and review early (1–2 weeks) for tolerability and progress.
Interactions
- 📚 See BNF for full list.
- 🧪 Bupropion inhibits CYP2D6 → can increase levels of some antidepressants/antipsychotics/beta-blockers; check carefully.
- ⚠️ Drugs that lower seizure threshold (e.g. some antipsychotics, tramadol) increase risk.
- 🍺 Alcohol: excess intake and withdrawal can raise seizure risk — counsel moderation and avoid binge/withdrawal cycles.
Cautions
- 🫘 Renal impairment and 🧫 hepatic impairment (dose adjustment / closer monitoring may be needed).
- 🤰 Pregnancy and breastfeeding: specialist discussion; use only if benefit outweighs risk (consider alternatives and support).
- 🧠 Anxiety/insomnia history: may worsen early on; consider dosing timing and close follow-up.
- ⚖️ Low body weight/eating disorders increase seizure risk (do not use if active anorexia/bulimia).
Contraindications (high-yield)
- 🚫 Seizure disorder or history of seizures.
- 🚫 CNS tumour or conditions predisposing to seizures.
- 🚫 Eating disorders (anorexia nervosa or bulimia).
- 🚫 Alcohol or benzodiazepine withdrawal (seizure risk).
- 🚫 Severe hepatic cirrhosis.
- 🚫 Concomitant use of MAO inhibitors (needs washout — see BNF).
Side effects
- 😴/🌙 Insomnia, agitation/anxiety, headache (common early).
- 🤢 Dry mouth, constipation, nausea, abdominal pain.
- 📈 Can increase BP in some patients — check baseline BP if hypertensive.
- 🚨 Rare but serious: seizures, severe allergic reactions, mood/behaviour changes (seek urgent review if concerning).
References
