Bupropion is an antidepressant with a second life as a cessation medication (branded Zyban in that indication). It is a solid second choice after varenicline and a good primary choice for quitters with concurrent low mood.
How it works
Bupropion inhibits reuptake of norepinephrine and dopamine. The cessation effect is thought to come from supporting dopamine after nicotine is removed — the dopamine dip that drives most withdrawal symptoms.
Unlike varenicline, it does not act at the nicotinic receptor. So it does not directly block the reward of a slip; it just makes not vaping tolerable.
Standard dosing
- Days 1-3: 150 mg once daily
- Day 4 onward: 150 mg twice daily
- Quit day: 1-2 weeks after starting
- Continue for 7-12 weeks
Side effects
- Insomnia (~one in three): take the second dose earlier in the day.
- Dry mouth (~one in five): stays a mild nuisance for most.
- Headache, agitation: usually mild.
- Rare: seizures at higher doses or in at-risk individuals.
Contraindications
- Current or past seizure disorder
- Current or past eating disorder (bulimia, anorexia)
- MAOI use within 14 days
- Heavy alcohol use with abrupt discontinuation
Who it suits
- Quitters with concurrent depression (bupropion treats both)
- Anyone for whom varenicline is unavailable or not tolerated
- Quitters who want to avoid nausea common with varenicline
Cost and access
Generic bupropion SR is inexpensive (~$20-40/month out of pocket in the US); typically covered at no copay. Requires a prescription in all markets. See getting a prescription.
