Bupropion smoking cessation dose: How much Zyban to take

In this article:

• How does Zyban (bupropion SR) help you quit smoking?
• What is the recommended bupropion smoking cessation dose?
• How to use bupropion to quit smoking
• Bupropion side effects and warnings

In this article

• How does Zyban (bupropion SR) help you quit smoking?
• What is the recommended bupropion smoking cessation dose?
• How to use bupropion to quit smoking
• Bupropion side effects and warnings

Bupropion is a prescription medication that affects chemicals in the brain linked to mood and cravings. It’s used to treat a range of conditions, including depression, seasonal mood changes, and even to support smoking cessation. Not all forms of bupropion are the same, and the dosage and purpose can vary depending on the specific product. For example, Wellbutrin XL (bupropion) is a common bupropion product that’s approved by the Food and Drug Administration (FDA) to treat major depressive disorder (MDD) and seasonal affective disorder. Zyban (bupropion SR) is a sustained-release version of bupropion that’s specifically approved to help people quit smoking. In this article, we’ll focus on Zyban and how it works to help people stop smoking, how it’s typically prescribed, and what side effects to keep in mind. 

How does Zyban (bupropion SR) help you quit smoking?

The exact way Zyban helps people quit smoking isn’t fully understood, but most research suggests it works by reducing cravings and easing withdrawal symptoms. Nicotine from tobacco activates reward centers in the brain, which can lead to addiction. Cooper Stone, DO, a psychiatrist in Philadelphia, explains: “Bupropion is thought to work by acting on the receptors and chemicals in the brain that produce the urge to smoke. Specifically, it does so by modulating the neurotransmitters and receptors related to dopamine, norepinephrine, and nicotine.”

Cravings are the strong urges to smoke, and withdrawal symptoms are the mental and physical effects that happen when you stop using something you’re addicted to. Common withdrawal symptoms from quitting smoking include irritability, restlessness, anxiety, and a larger appetite. 

Products like nicotine patches and gum help people quit smoking by delivering nicotine without smoking, giving the body time to adjust. Unlike other smoking cessation methods, Zyban doesn’t contain nicotine to help people quit smoking. Instead, it affects some of the same brain pathways as nicotine, particularly those involving dopamine and norepinephrine. This helps reduce cravings and withdrawal symptoms, making it easier to quit smoking by removing the need for nicotine.

What is the recommended bupropion smoking cessation dose?

The usual dose of bupropion is 150 mg daily for the first three days, then 150 mg twice daily (300 mg daily in total) after the third day.

How to use bupropion to quit smoking

Bupropion is prescribed slightly differently for smoking cessation than it is for depression. According to the prescribing information, treatment should begin one to two weeks before your planned quit date.

Patients are recommended a lower dose (150 mg daily) for the first three days. Then, the dose will be increased to 150 mg twice a day, taken at least eight hours apart. Most people stay on this dose for about seven to 12 weeks, depending on their treatment plan. 

If you’re considering quitting smoking, it’s important to work with your healthcare provider to build a personalized plan that supports your goals. Starting bupropion about a week before your quit date can improve your chances of success. You may still experience withdrawal symptoms, and your care team can help manage them. For example, therapists who specialize in substance use disorder can help with the mental and emotional challenges of quitting, and a nutritionist can help manage appetite changes or weight gain.

Your healthcare provider may also recommend additional support, such as nicotine replacement therapy or sleep aids, to manage bupropion-related side effects.

For more tips and tools to quit smoking, see SmokeFree.gov. The website is created by the National Cancer Institute (NCI) and offers a Build My Quit Plan tool.

Bupropion side effects and warnings

The most common side effects of bupropion are dry mouth and sleep disturbances. Using a lower dose may reduce the likelihood of these effects. People who have trouble sleeping on bupropion may find relief by taking their second dose of the day a little earlier, away from bedtime (but still at least eight hours after the first dose of the day).

Other common side effects of bupropion include headache, dizziness, nausea, constipation, sore throat, appetite and weight loss,  and skin rashes. 

“The side effects often get better over time. They are most common during the first couple of weeks. However, if they don’t go away, talk to your healthcare provider,” says Jeffery Chester, DO, medical director of the Ohana Luxury Addiction Treatment Center in Kailua Kona, Hawaii. 

Although less common, bupropion can also cause serious side effects such as: 

• Suicidal thoughts or behaviors
• Changes in mood, including depression, anxiety, psychosis, and panic
• Seizures, especially at doses more than 300 mg daily
• High blood pressure, particularly when combined with nicotine replacement therapy
• Mania or hypomania in people with bipolar disorder
• Closed-angle glaucoma
• Allergic reactions

“It’s vital to share a complete list of all medications and supplements that you take with your prescriber,” Dr. Chester says. Bupropion can interact with many common medications, including:

• Monoamine oxidase inhibitors (MAOIs) such as Nardil (phenelzine) and Marplan (isocarboxazid)
• Drugs that affect an enzyme called cytochrome P450 (CYP) 2B6, such as Dilantin (phenytoin), Norvir (ritonavir), and Tegretol (carbamazepine); common antidepressants such as Effexor (venlafaxine) and Prozac (fluoxetine); antipsychotics such as Risperdal (risperidol); beta blockers such as Lopressor (metoprolol tartrate); and Type 1C antiarrhythmic drugs such as propafenone
• Drugs that increase the risk of seizures, such as Benadryl (diphenhydramine) and Flexeril (cyclobenzaprine)
• Drugs that increase dopamine levels, such as Sinemet (carbidopa/levodopa)

Alcohol and caffeine can also raise the risk of side effects when taken with bupropion.

“Generally speaking, bupropion should not be used in those who have a history of seizures. The use of this medication in somebody who has a history of a seizure disorder is generally not advised, even if they are on a medication to prevent seizures,” Dr. Stone says. In addition, people who have a history of eating disorders (e.g., anorexia or bulimia), head injury, stroke, or other central nervous system conditions should not take bupropion. 

Bottom line

Be sure to talk with your healthcare provider about any side effects or interactions you may be at risk for. Following your treatment plan and reporting any new or worsening symptoms can help your provider adjust your medication as needed so you can quit smoking safely and effectively.