130. Treatment Recommendations: Medications-Bupropion
|Patient selection||Appropriate as a first-line medication for treating tobacco use|
|Precautions, warnings, contraindications and side effects (see FDA package insert for complete list)||
Pregnancy-Pregnant smokers should be encouraged to quit without medication. Bupropion has not been shown to be effective for tobacco dependence treatment in pregnant smokers. (Bupropion is an FDA pregnancy Class C agent.) Bupropion has not been evaluated in breast-feeding patients.
Cardiovascular diseases-Generally well-tolerated; occasional reports of hypertension.
Side effects-The most common reported side effects were insomnia (35-40%) and dry mouth (10%).
Contraindications-Bupropion SR is contraindicated in individuals who have a history of seizures or eating disorder, who are taking another form of bupropion, or who have used an MAO inhibitor in the past 14 days.
Warning-In July, 2009, the FDA issued a boxed warning regarding the use of bupropion. Specifically, the use of bupropion has been associated with reports of changes in behavior such as hostility, agitation, depressed mood and suicidal thoughts or actions. The FDA is requiring the manufacturer of this product to add a new Boxed Warning to the product labeling to alert health care professionals to this important new safety information. People who are taking bupropion and experience any serious or unusual changes in mood or behavior or who feel like hurting themselves or someone else should stop taking the medicine and call their health care professional right away. See FDA.gov or package inserts for more information. In light of these FDA recommendations, clinicians should consider eliciting information on their patients' psychiatric history and monitoring for changes in mood and behavior.
|Dosage||Patients should begin bupropion SR treatment 1-2 weeks before they quit smoking. Patients should begin with a dose of 150 mg every morning for 3 days, then increase to 150 mg twice daily. Dosage should not exceed 300 mg per day. Dosing at 150 mg twice daily should continue for 7-12 weeks. For long-term therapy, consider use of bupropion SR 150 mg for up to 6 months post-quit.|
|Prescribing instructions||Stopping smoking prior to quit date-Recognize that some patients may lose their desire to smoke prior to their quit date, or will spontaneously reduce the amount they smoke.
Dosing information-If insomnia is marked, taking the PM dose earlier (in the afternoon, at least 8 hours after the first dose) may provide some relief.
Alcohol-Use alcohol only in moderation.
|Costa||1 box of 60 tablets, 150 mg= $97.00 per month (generic); $197.00 (Brand name)|
a Cost data were established by averaging the retail price of the medication at national chain pharmacies in Atlanta, GA, Los Angeles, CA, Milwaukee, WI, Sunnyside, NY and listed on-line during January, 2008 and may not reflect discounts available to health plans and others.