buPROPion HCl ER (Smoking Det)

The typical dosage of BuPROPion HCl ER for smoking cessation is:

• Initial Dose: 150 mg once daily for the first 3 days.
• Maintenance Dose: After the initial period, the dose is typically increased to 150 mg twice daily, with at least 8 hours between doses. The total daily dose should not exceed 300 mg.

BuPROPion HCl ER is contraindicated in patients with:

• A history of seizure disorders, as BuPROPion can lower the seizure threshold.
• Current or prior diagnosis of bulimia or anorexia nervosa, as these conditions increase the risk of seizures.
• Abrupt discontinuation of alcohol or sedatives (including benzodiazepines), which can increase the risk of seizures.
• Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within 14 days of stopping an MAOI.

Patients using BuPROPion HCl ER for smoking cessation should be advised to:

• Take the medication exactly as prescribed and not to exceed the recommended dose, as this increases the risk of seizures.
• Be aware that it may take 1 to 2 weeks of treatment before the medication starts to reduce cravings and withdrawal symptoms, so it’s important to continue taking it even if they do not feel immediate effects.
• Avoid alcohol or significantly reduce alcohol consumption, as it can increase the risk of seizures.
• Report any unusual mood changes, such as agitation, depression, or suicidal thoughts, to their healthcare provider immediately.
• Follow a comprehensive smoking cessation plan that includes behavioral support and counseling, as this increases the likelihood of successfully quitting smoking.

• Insomnia or difficulty sleeping
• Dry mouth
• Dizziness or lightheadedness
• Weight loss
• Increased sweating

• Seizures: The most significant risk associated with BuPROPion, especially at higher doses or in patients with risk factors.
• Mood Changes: Including depression, anxiety, agitation, or suicidal thoughts, particularly in the first few weeks of treatment or when adjusting the dose.
• Hypertension: BuPROPion can increase blood pressure, so it should be monitored regularly, especially in patients with pre-existing hypertension.

• Seizure Risk: BuPROPion lowers the seizure threshold, and the risk is dose-dependent. It is crucial not to exceed the prescribed dose and to report any history of seizures to the healthcare provider.
• Neuropsychiatric Symptoms: Some patients may experience changes in mood or behavior, including depression, hostility, agitation, or suicidal thoughts. These symptoms require immediate medical attention.
• Hypertension: Blood pressure should be monitored, especially in patients with pre-existing hypertension or those using nicotine replacement therapy concurrently.

BuPROPion HCl ER may interact with other medications, including:

• Monoamine Oxidase Inhibitors (MAOIs): Concurrent use is contraindicated due to the risk of hypertensive crisis.
• Antidepressants and Antipsychotics: May increase the risk of seizures when used with BuPROPion.
• Drugs Metabolized by CYP2B6: BuPROPion is metabolized by the liver enzyme CYP2B6, and drugs that inhibit this enzyme (such as orphenadrine) can increase BuPROPion levels, raising the risk of side effects.
• Nicotine Replacement Therapy: Concurrent use with nicotine patches may increase the risk of hypertension.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for smoking cessation include:

• Nicotine Replacement Therapy (NRT): Such as nicotine patches, gum, lozenges, nasal sprays, or inhalers, which help reduce withdrawal symptoms by providing low levels of nicotine.
• Varenicline (Chantix): Another prescription medication that works by blocking nicotine receptors in the brain, reducing the pleasurable effects of smoking and easing withdrawal symptoms.
• Counseling and Behavioral Therapy: Often combined with pharmacotherapy, these approaches address the psychological aspects of nicotine addiction and provide strategies for coping with cravings and triggers.

The choice of treatment depends on the individual’s preferences, the severity of their nicotine dependence, and their response to previous cessation attempts.