BMA Concise Guide to Medicine & Drugs

Bupropion

Brand name Zyban

Used in the following combined preparations None

QUICK REFERENCE

Drug group Smoking cessation aid

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Bupropion (also known as amfebutamone) is an antidepressant; chemically it is unrelated to other classes of antidepressant. It has been used to treat depression but is generally used as an aid to giving up tobacco smoking. The person being treated must commit in advance to a date for stopping smoking. Treatment is started while the patient is still smoking, and the “target stop date” decided on within the first two weeks of treatment. Bupropion will be stopped after 7 weeks if the smoker has not given up smoking completely by then.

Bupropion should not be prescribed for people with a history of seizures or eating disorders, or who are withdrawing from benzodiazepine or alcohol. Neither should the drug be used by people with bipolar disorder (manic depression) or psychosis because there is a risk of mania developing.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used SR tablets.

Frequency and timing of doses 1–2 x daily. Tablets should be swallowed whole.

Adult dosage range 150–300mg.

Onset of effect Up to 4 weeks for full effect.

Duration of action 12 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor. He or she may want to reduce the dose gradually.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if consciousness is lost.

POSSIBLE ADVERSE EFFECTS

Common adverse effects associated with bupropion include insomnia, poor concentration, headache, dizziness, sweating, tremor, nausea, vomiting, and constipation; discuss with your doctor if these are severe. Rash, fever, and depression are also common but should be discussed with your doctor in all cases. Some of these effects may be due to the withdrawal of nicotine rather than to the effects of bupropion itself. Rarely, jaundice, confusion, or anxiety may occur; if so, consult your doctor. If palpitations, fainting, chest pain, or seizures occur, stop taking the drug and consult your doctor at once.

INTERACTIONS

General note A wide range of drugs increases the likelihood of seizures when taken with bupropion. Check with your doctor if you are on other medications.

Ritonavir, amantadine, levodopa, and monoamine oxidase inhibitors increase the risk of adverse effects with bupropion.

Anti-epileptics Phenytoin and carbamazepine may reduce the blood levels and effects of bupropion. Valproate may increase its blood levels and effects.

Tamoxifen Bupropion may reduce blood levels and effects of tamoxifen.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have had a head injury or have a history of seizures or epilepsy.

· You have an eating disorder.

· You have cancer of the nervous system.

· You have diabetes.

· You have high blood pressure.

· You have bipolar disorder (manic depression) or a psychosis.

· You have kidney or liver problems.

· You are withdrawing from alcohol or benzodiazepine dependence.

· You are taking other medicines.

Pregnancy Safety not established. Try to give up smoking without using drugs.

Breast-feeding Safety not established. The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Increased sensitivity to the drug’s effects. Reduced dose may therefore be necessary.

Driving and hazardous work Avoid until you have learned how bupropion affects you. The drug may cause impaired concentration and dizziness.

Alcohol Avoid. Alcohol will increase any sedative effects.

PROLONGED USE

Bupropion is used for up to 9 weeks for cessation of smoking.

Monitoring Progress will be reviewed after about 3–4 weeks, and the drug continued only if it is having some effect. The drug may increase blood pressure, so this should be monitored.