If you want to stop smoking, taking bupropion (trade name Zyban®) roughly doubles your chance of success.
This leaflet is part of our series on smoking
A brief overview of smoking and nicotine addiction
Nicotine is a drug that is inhaled from the tobacco in cigarettes. It gets into the bloodstream, and stimulates the brain. Most regular smokers are addicted to nicotine.
If you are a smoker, when the blood level of nicotine falls, you usually develop withdrawal symptoms such as restlessness, increased appetite, inability to concentrate, irritability, dizziness, constipation, nicotine craving, or just feeling awful. These symptoms begin within a few hours after having the last cigarette. If they are not relieved by the next cigarette, withdrawal symptoms get worse. If you do not smoke any more cigarettes, the withdrawal symptoms peak after about 24 hours, and then gradually ease over about 2-4 weeks. So, most smokers smoke regularly to feel 'normal', and to prevent withdrawal symptoms.
About 2 in 3 smokers want to stop smoking but, without help, many fail to succeed. The main reason why so few smokers succeed, even though they want to stop smoking, is because nicotine addiction is strong and difficult to break. This is where bupropion can help.
What is bupropion and how does it work?
Bupropion (trade name 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 get when you stop smoking (such as craving, anxiety, restlessness, headaches, irritability, hunger, difficulty with concentration, 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 (placebo) tablet. In other words, about twice the number of smokers who take bupropion stop smoking compared to those who don't, and 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 or operate machinery.
read it whenever you feel the temptation to light up.
research shows that if you cut down the number of cigarettes you smoke, you are likely to smoke more of the cigarette. Therefore it’s best to just stop once and for all on a given date.
Friends and family can give vital support while you’re quitting. Try and get other people in your household to quit at the same time to make it easier.
lighters, ashtrays and cigarettes lying around will be a constant source of temptation for you so throw them out!
Many people say they feel worse just after quitting. This is the airways “coming back to life” and is a good thing. Just resist the temptation to light up and wait for the cough to ease.
Drinking alcohol is often accompanied by smoking and is a common factor in people failing to quit. Try changing your social habits for the first few weeks and avoid places you might smoke or drink alcohol.
Mark off each successful day on a calendar. Look at it when you feel tempted to smoke, and tell yourself that you don't want to start all over again.
You can tell people that you don't smoke. You will smell better. After a few weeks you should feel better, taste your food more, and cough less. You will have more money. Perhaps put away the money, which you would have spent on cigarettes, for treats.
Some people worry about gaining weight when they give up smoking, as the appetite may improve. Anticipate an increase in appetite, and try not to increase fatty or sugary foods as snacks. Try sugar-free gum and fruit instead.
It takes on average 3-4 attempts to quit completely so don’t get too upset, it will only make you stronger next time.
are available on the NHS. They have good success in helping people to stop smoking. Your doctor may refer you to one if you are keen to stop smoking but are finding it difficult to do so.
to increase your chance of quitting. These include nicotine replacement therapy (NRT) which comes as gums, sprays, patches, tablets, lozenges, and inhalers. You can buy NRT without a prescription.
Now you have read 12 smoking cessation secrets, why not look at some of our other slideshows.
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.
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 the following web address: 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 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.
- Information about 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.
- Are pregnant or breast-feeding.
- 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.
Further reading & references
- Various factsheets and guidelines on smoking and smoking cessation, Action on Smoking and Health (various dates)
- Smoking Cessation Services; NICE Public Health Guidance (Feb 2008)
- Hughes JR, Stead LF, Lancaster T; Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD000031.
- King D et al; Smoking Cessation Pharmacogenetics: Analysis of Varenicline and Bupropion in Placebo-Controlled Clinical Trials, Neuropsychopharmacology, Nov 2011
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Laurence Knott
Dr John Cox