Bupropion
Bupropion, commonly known by its brand names Wellbutrin and Zyban, is primarily an antidepressant that also aids in smoking cessation. It works by influencing two key brain chemicals, dopamine and norepinephrine, which are linked to nicotine addiction. This medication helps reduce cravings and alleviates withdrawal symptoms such as irritability and frustration when individuals attempt to quit smoking. Originally approved as an antidepressant in 1985, it faced a temporary withdrawal from the market due to seizure risks, but was reintroduced in 1989 with adjusted dosage guidelines. Beyond its use for depression and smoking cessation, bupropion is also prescribed for conditions like ADHD, major depressive disorder, and seasonal affective disorder.
While most users tolerate bupropion well, potential side effects can include mood changes, anxiety, and insomnia, with young adults being particularly susceptible to severe mood alterations. Patients are advised to start bupropion one week prior to their planned quit date for smoking, and it’s important to adhere to prescribed dosages to avoid serious risks, such as seizures. Overall, bupropion offers a multifaceted approach to treating both depression and nicotine dependency, but it requires careful monitoring for side effects and interactions with other medications.
Subject Terms
Bupropion
ALSO KNOWN AS: Wellbutrin; Zyban
DEFINITION: Bupropion is an antidepressant, but it is also prescribed to help people quit smoking. It can be used in combination with a nicotine replacement product. Bupropion appears to affect two brain chemicals that may be related to nicotine addiction: dopamine and norepinephrine. Bupropion reduces the cravings for cigarettes that smokers experience when they try to quit. The drug also seems to reduce many of the nicotine withdrawal symptoms, including irritability, frustration, and anger.
History of Use
Bupropion is a widely prescribed antidepressant. It was the fifth-most prescribed antidepressant in the United States (US) in 2022. It was invented in 1969 by GlaxoSmithKline (then Burroughs Wellcome) and was designed and synthesized by Nariman Mehta. It was approved as an antidepressant in 1985 by the US Food and Drug Administration, withdrawn in 1986 because of concerns over seizures, and reintroduced to the market in 1989 after the maximum dosage was adjusted. Bupropion was approved in 1997 as an aid for smoking cessation (under the name Zyban). Under the name Wellbutrin XL, it has also been approved to treat seasonal affective disorder, a mood disorder prevalent in either the winter or the summer months.
Treatment
Patients are instructed to start taking bupropion one week before they plan to stop smoking. It takes about one week for this medication to reach adequate levels in a person’s system, and patients are instructed to target a specific quit date during the second week that they are taking bupropion. If a dose is missed, patients are instructed to skip it and to stay with their regular dosing schedule. Taking too much bupropion at one time can cause seizures.
Bupropion is also used to treat attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), antidepressant-induced sexual dysfunction, obesity, and other conditions.
Effects and Potential Risks
Most people do not have side effects from taking bupropion for smoking cessation. If side effects do occur, they can usually be minimized. In addition, side effects are most often temporary, lasting only as long as one takes the medication.
There are rare but serious side effects of which patients should be aware. In some people, medications like bupropion may cause severe mood and behavior changes, including suicidal and intrusive thoughts. Young adults may be more at risk for these side effects.
Other side effects include anxiety; buzzing or ringing in the ears; headache (severe); severe insomnia; and skin rash, hives, or itching. Side effects that may occur frequently or become bothersome include abdominal pain, constipation, decreased appetite, dizziness, dry mouth, increased sweating, nausea or vomiting, trembling or shaking, insomnia, vivid dreams, and weight loss.
Symptoms of an overdose may be more severe than side effects seen at regular doses, or two or more side effects may occur together. They include fast heartbeat, hallucinations, loss of consciousness, nausea or vomiting (or both), and seizures.
Bupropion should not be combined with other medications that lower the threshold for seizures. These medications include theophylline, antipsychotic medications, antidepressants, Tramadol (Ultram), Tamoxifen, steroids, diabetes drugs, and Ritonavir.
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