Bupropion (Zyban, Wellbutrin): a non-nicotine stop-smoking tablet explained

Bupropion is a centrally acting noradrenaline and dopamine reuptake inhibitor, according to the Zyban product information. The same document notes that bupropion is indicated for the treatment of depression in some countries, which is why you may see the brand name Wellbutrin in American sources. In the UK, the licensed Zyban tablets are for smoking cessation.

It is one of the nicotine-free options. The NHS describes nicotine-free medicines as working by blocking the effects of nicotine in your brain, making smoking less enjoyable, available from a local stop smoking service or a GP. It also notes that varenicline is available again in the UK, along with cytisine. The NHS page does not name bupropion, so the product information is the source for bupropion itself.

The product information says there is a potential for drug abuse in animals but that human studies and extensive clinical experience show low abuse potential.

The product information recommends that treatment is started while the person is still smoking and a target stop date is set within the first two weeks, preferably in the second week. The initial dose is 150 mg daily for six days, increasing on day seven to 150 mg twice daily, with at least 8 hours between doses, and the maximum total daily dose must not exceed 300 mg. Insomnia is very common and can be reduced by avoiding bedtime doses.

It is used with motivational support. The product information says smoking cessation therapies are more likely to succeed in people who are motivated to quit and have support, and that prescribers should assess motivation. The NHS says that talking to a local stop smoking service or GP helps you choose the right product and increases your chances, and that the local service is free.

The NHS adds that studies show combining nicotine-free medicines with nicotine replacement therapy gives the best chance to quit, making you over 5 times more likely to quit for good. The product information says limited trial data suggest higher quit rates with bupropion plus a nicotine patch, but a higher rate of raised blood pressure, so weekly blood pressure monitoring is recommended in that case.

Stop-smoking products are generally used for at least 12 weeks, the NHS says, although the labelled course of Zyban is 7 to 9 weeks; your clinician will explain how this fits with your plan.

The product information lists several contraindications. These include a current seizure disorder or any history of seizures, a known central nervous system tumour, abrupt withdrawal from alcohol or from medicines associated with seizure risk on withdrawal such as benzodiazepines, a current or previous diagnosis of bulimia or anorexia nervosa, severe hepatic cirrhosis, a history of bipolar disorder, and use of MAOIs (at least 14 days must elapse after stopping an irreversible MAOI). It also must not be combined with any other bupropion product.

Conditions that lower the seizure threshold need particular care, including use of antipsychotics, antidepressants, antimalarials, tramadol, theophylline, systemic steroids, quinolone antibiotics and sedating antihistamines, alcohol misuse, head trauma, diabetes treated with insulin or hypoglycaemic medicines, and use of stimulants or appetite suppressants. In such cases a maximum of 150 mg daily may be considered.

It is not recommended under 18 years. Older people, and people with liver or kidney impairment, are advised a lower dose of 150 mg once a day.

At doses up to the maximum recommended daily dose the incidence of seizures is approximately 0.1%. Zyban should be discontinued and not restarted if a seizure occurs. Because seizure risk is dose related, never exceed the recommended dose and never crush or chew the tablets.

On mood, the product information says depressed mood may be a symptom of nicotine withdrawal, and that depression, rarely including suicidal thoughts and behaviour, has been reported in people trying to stop smoking, including during Zyban treatment, generally early in the course. Psychotic and manic symptoms have been reported mainly in people with a history of psychiatric illness. Tell your prescriber about any change in mood, and seek urgent help if you have thoughts of harming yourself.

Hypersensitivity reactions can occur: symptoms typically include skin rash, itching, hives or chest pain, with more severe reactions including angioedema, breathing problems and anaphylactic shock. Severe skin reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, AGEP and DRESS have been reported; if they appear bupropion should be withdrawn immediately and must not be restarted. A baseline blood pressure is advised, with monitoring, as hypertension has been reported. Bupropion may also unmask Brugada syndrome.

It inhibits the enzyme CYP2D6, and the product information says use should whenever possible be avoided during tamoxifen treatment because reduced concentrations of its active metabolite endoxifen may result.

The NHS says quitting is hard, and that using the right products can make it easier by managing cravings and withdrawal symptoms, with irritability, headaches and restlessness among those eased. It says nicotine replacement can be bought from pharmacies and shops as patches, gum, sprays or lozenges and is safe in pregnancy, and that vapes are not completely harmless but are safer than cigarettes for adult smokers.

The NHS says many people do not use stop-smoking products for long enough, which can cause cravings to return, and recommends at least 12 weeks or longer if needed. It encourages people not to stop their support products if unsure about staying quit, and notes that your local Stop Smoking Service is free and offers expert support in person, online or by phone.

Smoking also changes the way the body handles some medicines. A separate page on this site explains how stopping smoking can change medicine levels, which can matter if you take certain drugs.

Bupropion for smoking cessation is a prescription medicine, available through GPs and, depending on the area, stop smoking services. A prescriber should check your history for seizures, eating disorders and interacting medicines. Private clinics prescribe it under the same product information and should carry out the same checks.