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Treatment with bupropion SR should be initiated while the patient is still smoking, because approximately 1 week of treatment is required to achieve steady-state blood levels. Patients should set a target quit date that falls within the first 2 weeks of treatment, generally in the second week (GlaxoSmithKline, 2006).

The starting dose of bupropion SR is one 150-mg tablet each morning for the first 3 days. If the initial dose is tolerated adequately, the dosage should be increased on day 4 to the recommended, maximum dosage of 300 mg/day, given as two 150-mg doses taken at least 8 hours apart. Doses above 300 mg/day should not be used.

Duration of therapy is recommended to be 712 weeks; however, some patients may benefit from extended treatment. Systematic evaluation of bupropion SR 300mg per day for maintenance therapy demonstrated that treatment for up to 6 months was efficacious (GlaxoSmithKline, 2006). Whether to continue treatment with bupropion for periods longer than 12 weeks (3 months) for smoking cessation must be determined for individual patients. In selected patients, maintenance treatment up to 12 months may be appropriate (Hays et al., 2003).

Note to instructor(s): For patients experiencing side effects with the 300 mg/day regimen, Swan et al. (2003) suggest that 150 mg/day is better tolerated and exhibits comparable long-term efficacy. Similarly, Hurt and colleagues (1997) found no significant difference in long-term (>6 months) abstinence rates between subjects randomized to 150 mg/day or 300 mg/day.

GlaxoSmithKline Inc. (2006, May). Zyban Package Insert. Research Triangle Park, NC.
Hays JT, Hurt RD, Rigotti NA, et al. (2001). Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation. a randomized, controlled trial. Ann Intern Med 135:423433.
Hurt RD, Sachs DP, Glover ED, et al. (1997). A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 337:11951202.
Swan GE, McAfee T, Curry SJ, et al. (2003). Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial. Arch Intern Med 163:23372344.

Slide is used with permission, Rx for Change: Clinician-Assisted Tobacco Cessation. Copyright 1999-2007 The Regents of the University of California, University of Southern California, and Western University of Health Sciences. All rights reserved.