If you want to stop smoking, taking bupropion (trade name Zyban®) roughly doubles your chance of success.
Smoking and nicotine addiction
Most people who quit smoking have tried three or four times to do so before they succeed. This is because smoking, or more specifically nicotine in cigarette smoke, is highly addictive. You start to get withdrawal symptoms only a few hours after smoking a cigarette. Bupropion (Zyban®) can help by reducing these withdrawal symptoms.
What is bupropion and how does it work?
Bupropion (Zyban®) is a medicine that was first developed to treat depression. It was found that it helped smokers to stop smoking. It is not clear how it works. It alters the level of some chemicals in the brain (neurotransmitters). This seems to relieve the withdrawal symptoms that you experience when you stop smoking (such as craving, feeling anxious, restlessness, headaches, irritability, hunger, difficulty concentrating, or just feeling awful).
How effective is bupropion?
Taking bupropion does increase the chance of quitting smoking. Various studies have looked at this issue. The studies compared bupropion to a similar dummy (placebo) tablet in people who were keen to stop smoking. The results from the studies showed that, on average, about 19 in 100 people who took bupropion stopped smoking successfully. This compared to about 10 in 100 who took the dummy tablet. In other words, about twice the number of smokers who take bupropion stop smoking compared to those who don't take bupropion. About 1 in 5 smokers who want to stop will do it with the help of bupropion.
How do I take bupropion?
- You need a prescription to obtain bupropion - you cannot buy it at pharmacies.
- Start by taking one tablet (150 mg) each day for six days. Then increase to one tablet twice a day, at least eight hours apart. Do not take more than one tablet at any one time, and not more than two tablets in a day. (If you are elderly or if you have certain liver or kidney diseases, the dose may be different - your doctor will advise.)
- Set a target date to stop smoking one to two weeks after starting treatment. This allows bupropion to build up in your body before you stop completely.
- You should continue the tablets for a further seven weeks. (So, this is eight weeks in total, which is two packs of tablets.)
Bupropion does not 'make' you stop smoking. You still need determination to succeed and to break the smoking habit. A combination of bupropion with counselling from a nurse, doctor, pharmacist or other health professional increases your chance of successfully stopping smoking. Therefore, most doctors will only prescribe bupropion to people who really want to stop smoking as part of a 'stopping smoking' programme.
Are there any side-effects?
Most people take bupropion without any problem. Read the packet leaflet for a full list of possible side-effects and cautions. The most common are a dry mouth (which occurs in about 1 in 10 users) and some difficulty in sleeping (which occurs in about 1 in 3 users). Less common but more serious possible side-effects include the following:
If this occurs you should not drive and you should not operate machinery.
A seizure (fit or convulsion)
This occurs in about 1 in 1,000 people who take bupropion. Therefore, although this is uncommon, it can be serious, particularly if it occurs when you are operating machinery or driving. The risk of a seizure is increased if you have a history of certain medical conditions, or if you take certain medicines (listed below). Therefore, bupropion is not suitable for all people who wish to stop smoking (see below).
High blood pressure
Blood pressure sometimes goes up in people who take bupropion. You should have a baseline blood pressure reading done before you start treatment and it should be monitored from time to time.
Bupropion weight loss
Some people experience weight loss when taking bupropion. However, the effect on body weight is variable and your weight may stay the same or even increase when taking bupropion.
The main risk of overdose is a seizure. Death can occur but is rare.
How to report bupropion side-effects
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.
Who should not take bupropion?
You should not take bupropion if you:
- Are under the age of 18 years.
- Are pregnant or breastfeeding.
- Have ever had epilepsy, a seizure (fit or convulsion), or an unexplained blackout.
- Have ever had anorexia nervosa or bulimia nervosa.
- Have bipolar affective disorder (manic depression).
- Are withdrawing abruptly from benzodiazepines or alcohol dependence.
- Have a tumour of the brain or spinal cord.
- Have had a previous allergic reaction to bupropion tablets.
Also, the dose may need to be reduced if you have some medical conditions or if you take certain medicines. Tell your doctor or pharmacist if you:
- Have ever had a serious head injury.
- Have diabetes that is treated with insulin or medicines.
- Drink a lot of alcohol.
- Have a liver or kidney disease.
Bupropion combined with certain other medicines can increase the risk of having a seizure. Therefore, whilst you are taking bupropion, tell your doctor or pharmacist if you are prescribed or buy any new medicine. Also, tell a doctor or pharmacist if you are taking any of the following medicines:
- Antimalarial medicines (for example, chloroquine, proguanil).
- Medicines to treat depression or other mental illness.
- Theophylline, which is a medicine used to treat chest conditions.
- Steroids - taken as tablets or injections.
- Tramadol, which is a strong painkiller.
- Slimming medicines or other stimulant medicines.
If you are unable to take bupropion, there are other ways that you can get help to quit. See the separate leaflet called Quit Smoking (Smoking Cessation).
Further reading and references
Reid RD, Pritchard G, Walker K, et al; Managing smoking cessation. CMAJ. 2016 Dec 6188(17-18):E484-E492. doi: 10.1503/cmaj.151510. Epub 2016 Oct 3.
Smoking cessation; NICE CKS, October 2012 (UK access only)
British National Formulary (BNF); NICE Evidence Services (UK access only)
Smoking: harm reduction; NICE Public Health Guidance, June 2013
Wu J, Sin DD; Improved patient outcome with smoking cessation: when is it too late? Int J Chron Obstruct Pulmon Dis. 20116:259-67. doi: 10.2147/COPD.S10771. Epub 2011 May 2.
Cahill K, Stevens S, Perera R, et al; Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013 May 315:CD009329. doi: 10.1002/14651858.CD009329.pub2.
Hartmann-Boyce J, McRobbie H, Bullen C, et al; Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016 Sep 149:CD010216.
E-cigarettes: an evidence update; Public Health England, August 2015
Hughes JR, Stead LF, Hartmann-Boyce J, et al; Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2014 Jan 81:CD000031. doi: 10.1002/14651858.CD000031.pub4.
Cahill K, Lindson-Hawley N, Thomas KH, et al; Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2016 May 9(5):CD006103. doi: 10.1002/14651858.CD006103.pub7.
Anthenelli RM, Benowitz NL, West R, et al; Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016 Jun 18387(10037):2507-20. doi: 10.1016/S0140-6736(16)30272-0. Epub 2016 Apr 22.
Hackshaw A, Morris JK, Boniface S, et al; Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018 Jan 24360:j5855.
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