Supporting smoking cessation


A guide for health professionals
Bupropion
☰ Table of contents


Key points

 
  • Bupropion is a non-nicotine oral therapy, originally developed as an antidepressant.
  • It significantly increases cessation rates compared with placebo.>
  • It has been shown to be effective for smokers with depression, cardiac disease and respiratory diseases, including COPD.
  • It has been shown to improve short-term abstinence rates for people with schizophrenia.
  • Bupropion has been shown to be less effective than varenicline for smoking cessation.
  • There is limited evidence of the efficacy of combining bupropion with NRT and short-term evidence on its combination with varenicline.


Originally developed as an antidepressant, bupropion is a non-nicotine oral therapy that reduces the urge to smoke and reduces symptoms from nicotine withdrawal.


Efficacy


Bupropion significantly increases the long-term cessation rate compared with placebo RR 1.62; 95% CI: 1.49–1.67)97 over 12 months.132

It has been shown to be effective in a range of patient populations including smokers with depression, cardiac disease and respiratory diseases including COPD.133 It has also been shown to improve short-term abstinence rates for people with schizophrenia.134

Clinical trials have shown that bupropion is not as effective as varenicline. However, bupropion is a useful option in cases where varenicline is not appropriate (patient choice, or as a result of side effects). There is insufficient evidence that adding bupropion (12 trials, N = 3487, RR 1.9, 95% CI 0.94 to 1.51) to NRT provides an additional long-term benefit.97


Safety


Bupropion is contraindicated in patients with a history of seizures, eating disorders and those taking monoamine oxidase inhibitors. The current recommendation is that it should be used with caution in people taking medications that can lower seizure threshold, such as antidepressants, antimalarials and oral hypoglycaemic agents.97 Alternative medication should be considered in these situations.


Side effects


Seizures are the most clinically important adverse effect (0.1% risk) and fatalities have been reported. Common adverse effects are insomnia, headache, dry mouth, nausea, dizziness and anxiety.133 If bupropion is used in combination with NRT, blood pressure should be monitored.133


Availability of sustained release bupropion on the PBS


Since 2001, sustained release bupropion has been available in Australia as a PBS authority item once per year. It is a short-term adjunctive therapy for nicotine dependence in conjunction with counselling with the goal of maintaining abstinence. Making use of the Closing the Gap PBS co-payment can further reduce the cost for Aboriginal and Torres Strait Islander people.

Bupropion is available as a starter pack of 30 tablets and a continuation pack of 90 tablets. The dose of bupropion is 150 mg once per day for the first 3 days and then increased to 150 mg twice per day. The patient should stop smoking in the second week of treatment.

Health professionals should check for updated PBS listings.

 

Evidence

Bupropion sustained release is an efficacious smoking cessation treatment. Level I

Recommendation

Bupropion sustained release should be recommended to smokers who have been assessed as clinically suitable for this medication and provided in combination with counselling. Strength A

  1. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2007, Issue 1. Art. no. CD000031.
  2. Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2014 Jan 8;1:CD000031.
  3. Richmond R, Zwar N. Therapeutic review of bupropion slow release. Drug Alcohol Rev 2003;22:203–20.
  4. Evins AE, Cather C, Deckersbach T, et al. A doubleblind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. J Clin Psychopharmacol 2005;25:218–25.

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