Smoking tobacco is responsible for 480,000 deaths per year in the US, according to the U.S. Centers for Disease Control and Prevention (CDC). It causes a multitude of health problems, such as emphysema, asthma, upper airway infection, heart disease, chronic obstructive pulmonary disease (COPD), and cancer of the lungs, throat, or mouth—among others. Though tobacco use has been steadily decreasing since the early 2000’s, more than 34.3 million American adults still smoke.
The reason people continue to smoke cigarettes (despite the dismal health outcomes) is simple: addiction. It is very difficult to quit smoking—whether you use nicotine replacement therapy or stop cold turkey. You may have heard of Nicorette or Chantix to help with withdrawal symptoms but I finally kicked the habit with Wellbutrin, also known as bupropion, a lesser-known generic medication used for smoking cessation.
What is Wellbutrin (bupropion)?
Bupropion—available in brand names Wellbutrin SR, Wellbutrin XL, and Zyban—is an antidepressant primarily used to treat major depressive disorder and seasonal affective disorder. Physicians also prescribe it for smoking cessation, and off-label as a treatment for medical conditions like ADHD.
Bupropion works by blocking dopamine absorption in your brain—resulting in higher levels, which can boost mood or have other beneficial effects, according to Nakia Eldridge, Pharm.D., Directory of Pharmacy Operations with Mercy Medical Center in Baltimore.
“Dopamine is a neurotransmitter that regulates the reward system associated with smoking addiction,” says Dr. Eldridge. “It is believed that dopamine is a motivator toward future rewards. By blocking the reuptake of dopamine, it is believed that bupropion is reducing the reward signal that comes from smoking a cigarette.”
Dr. Eldridge notes that Wellbutrin and Zyban have the same active ingredient, and both are manufactured by GlaxoSmithKline (GSK). Their formulations are a little different, though. Zyban is sustained release form of bupropion that is marketed specifically for smoking cessation. It has U.S. Food and Drug Administration (FDA) indications for major depression and seasonal affective disorder as well. Wellbutrin is available in immediate release and extended release formulations. There are many FDA indications for Wellbutrin.
RELATED: Wellbutrin for ADHD
Can Wellbutrin help you quit smoking?
The short answer is yes, but it depends on a number of other factors. Clinical studies show that bupropion is an effective smoking cessation medication and helps people stay off of cigarettes, according to Katie Taylor, Pharm.D., principal pharmacist with Gore & Company.
“In clinical trials, patients on Zyban 300mg/day had a four-week quit rate of 36 percent, 25 percent at week 12, and 19 percent at week 26,” says Dr. Taylor. These numbers increased significantly if patients used bupropion alongside nicotine patches. More than half of those participants remained cigarette-free at 10 weeks.
There is a clinical trial currently planned at the University of California Los Angeles (UCLA) to determine whether Wellbutrin XL is more effective in high doses for people with mental health disorders who want to quit smoking. Dr. Taylor believes that Wellbutrin might work better for smoking cessation in people who also have depression, as that is the drug’s primary indication.
Since Wellbutrin and Zyban have the same active ingredient, Dr. Eldridge explains, there have been no head to head studies between the two brand names to see which works better.
How do you use Wellbutrin to stop smoking?
Wellbutrin works best for people who smoke 10 or more cigarettes per day—a half a pack or more. If you choose to use bupropion to quit smoking, your doctor will determine the dosage that is best. It is available in the following forms and dosage options:
- Bupropion hydrochloride tablet, immediate release: 75 mg, 100 mg
- Bupropion hydrochloride tablet, sustained release 12 hour: 100 mg, 150 mg, 200 mg
- Bupropion hydrochloride tablet, extended release 24 hour: 150 mg, 300 mg, 450mg
- Bupropion hydrobromide tablet, extended release 24 hour: 174 mg, 348 mg, 522 mg
You take it daily, starting one to two weeks before your “quit date.” This gives the medication time to build up in your body, and reach full effectiveness. During these initial weeks, you continue to smoke.
When your quit date arrives, you stop smoking all together. You can continue to take Wellbutrin for 6 months to a year to help you stop smoking and quit for good.
What are the side effects of Wellbutrin?
Most patients don’t experience any of these side effects. Common side effects of bupropion include:
- Trouble sleeping
- Muscle or joint pain
- Strange dreams
- Dry mouth
- Changes in behavior
- Weight gain or weight loss
In rare cases, these drugs might have more severe adverse effects such as hostility, suicidal thoughts, risk of seizures, or irregular heartbeat. There is a low risk of heart problems, especially for people with high blood pressure or heart disease. You should not take bupropion if you are taking a monoamine oxidase inhibitor (MAOI), it could have a dangerous drug interaction. It is not approved for patients with bipolar disorder due to increased risk for mania.
This is not a complete list of side effects. It’s important that you talk to your provider to find out if you are at risk for any of these serious side effects before starting any prescription drugs.
What other drugs are available for smoking cessation?
Before the 1980’s, the only real medicines available for smoking cessation were various nicotine replacement therapies, including:
These drugs help to reduce cravings and the symptoms of nicotine withdrawal that usually occur after a person quits smoking. Now there are more options.
In addition to Wellbutrin and Zyban, doctors might choose to prescribe Chantix (varenicline) to patients who want to quit smoking. According to Dr. Taylor, Chantix works on the nicotine receptors in your brain and helps to curb cravings.
Which drug should you choose to quit smoking??
“The choice of drug is very patient specific,” says Dr. Taylor. “Most patients do well with nicotine replacement products and there are a variety to choose from, so patient preference can steer that decision.” The way a medication affects each person can vary.
Indeed, as with all antidepressants, the drug might work differently from one patient to the next. Bupropion SR might help one patient quit smoking on the first try, while it has no effect on another.
Additionally, patients will experience side effects differently. The common side effects for Wellbutrin, Zyban, and Chantix are very similar.
Cost and insurance coverage
There are different price points to consider for smoking cessation medications. Your insurance may cover one drug at a different rate than another. Nicotine replacement products are available over the counter, and therefore will be priced differently than a prescription.
Smoking habits and other health conditions
The patient’s attitude toward quitting might be the most important factor, though. “Medications work best on smokers who plan to quit or are willing to quit,” says Dr. Eldridge. “Treatment should be individualized to accommodate heaviness of smoking and any outstanding disease states like acute coronary syndromes and cardiovascular disease.” She also notes that studies have found that combination therapies, such as using bupropion hydrochloride or varenicline together with nicotine replacement, are more effective than any single therapy used on its own.
All of these considerations are valid, and each person must weigh them for themselves and discuss the decision with their healthcare provider.
Should you use Wellbutrin to quit smoking?
You have a lot of choices available to help you quit smoking. So how can you decide Wellbutrin is the right choice for you?
Perhaps you want to try natural remedies to quit smoking. “Non-pharmacological behavioral interventions use cognitive behavioral therapy techniques and various incentives to motivate and reinforce behavior changes,” says Dr. Eldridge. “The goal of this intervention is to bolster self-control over smoking by structuring efforts to change smoking behavior. Motivational interviewing or counseling helps smokers explore and resolve ambivalent attitudes toward smoking cessation. Other approaches include meditation, hypnotherapy, yoga, acupuncture, and tai chi.”
For some people who prefer to avoid taking prescription medications, these non-pharmacological approaches might be worth exploring. In fact, even if you do take Wellbutrin, it could benefit you to try some of these recommendations.
Only you and your doctor can determine which approach to quitting is best for you. The most important advice is this: Never stop trying to quit. I tried seven times before I was successful. So if one method of quitting doesn’t work for you, try another. Try a few in combination. Your heart and your lungs will thank you!