Bupropion
A quit-smoking tablet that’s an antidepressant almost everywhere else. Energising rather than sedating, and kinder to libido and weight than most.
Quick answer: In Australia, bupropion (Zyban) is approved and on the PBS for quitting smoking. Overseas it’s a common antidepressant, and doctors here sometimes use it off label for depression, low energy, ADHD and to counter sexual side effects from SSRIs. It doesn’t usually cause weight gain or sexual problems. The main risk is seizures, so it’s avoided in epilepsy, eating disorders and heavy alcohol withdrawal.
At a glance
- For
- Quitting smoking (approved). Off label: depression, ADHD, SSRI sexual side effects
- Works
- Roughly doubles the chance of quitting smoking compared with placebo
- Cost
- $25 a script on the PBS for smoking cessation ($7.70 concession); other uses private
- Kicks in
- For smoking, start 1–2 weeks before your quit date; for mood, 2–6 weeks
- Dose
- 150 mg each morning for 3 days, then 150 mg twice a day, at least 8 hours apart; usually 7–12 weeks for smoking
- Watch for
- Trouble sleeping, dry mouth, headache, nausea, anxiety, raised blood pressure
The antidepressant that doesn’t flatten your libido or add kilos. The catch: seizure risk, so it’s not for everyone.
Brand names
- Zyban (sustained-release). Overseas brands include Wellbutrin
How it works
Bupropion blocks the reuptake of dopamine and noradrenaline, which lifts energy and motivation. It also blocks nicotine receptors, which takes the edge off cravings and withdrawal.
Used for
- Quitting smoking, with support (TGA-approved)
- Off label, depression: approved overseas; useful when tiredness, low motivation, weight gain or sexual side effects are a problem
- Off label, SSRI sexual side effects: sometimes added to help
- Off label, ADHD: modest benefit in trials, less than stimulants
- Off label, weight: with naltrexone as Contrave (not PBS listed)
Side effects
Trouble sleeping is the most common side effect; take the second dose by mid-afternoon. Dry mouth, headache, nausea and feeling anxious or shaky are also common. Seizures are uncommon to rare, more likely at higher doses or with risk factors.
Full side-effect list (from the product information)
How often, from the official product information. Bold = serious.
Very common more than 1 in 10
- Trouble sleeping
Common 1 in 10 to 1 in 100
- Dry mouth
- Headache
- Nausea, tummy pain or constipation
- Anxiety, agitation or shakiness
- Dizziness
- Rash or itch
- Sweating
- Taste changes
- Fever
- Less appetite
Uncommon 1 in 100 to 1 in 1,000
- Raised blood pressure
- Fast heartbeat
- Low mood or confusion
- Tinnitus
- Blurred vision
Rare 1 in 1,000 to 1 in 10,000
- Seizures (about 1 in 1,000 at the usual dose)
- Severe allergic reactions
- Hallucinations or psychosis
- Suicidal thoughts
Get help urgently if
- A seizure. Call 000
- Swelling of the face or throat, a widespread rash or trouble breathing
- Thoughts of self-harm. Call 000 or Lifeline 13 11 14
- Confusion, hallucinations or severe agitation
Good to know
- Not for people with epilepsy or seizures, eating disorders (anorexia or bulimia), or who are suddenly stopping alcohol or sedatives.
- Interactions: it strongly blocks the liver enzyme CYP2D6, raising levels of some antidepressants, antipsychotics, beta blockers (e.g. metoprolol) and atomoxetine. It can make tamoxifen and codeine less effective.
- Keep alcohol low; it raises seizure risk.
- Don’t take two doses close together, and don’t crush or chew the tablets.
Common questions
Is bupropion approved for depression in Australia?
No. In Australia it’s approved (as Zyban) for quitting smoking. It’s an approved antidepressant in many other countries, and doctors here sometimes prescribe it off label for depression.
Does bupropion cause weight gain or sexual side effects?
Usually not. It’s one of the few antidepressant-type medicines that tends not to cause weight gain or sexual problems, and it’s sometimes added to help SSRI sexual side effects.
Who shouldn’t take bupropion?
People with epilepsy or past seizures, eating disorders, or who are suddenly stopping alcohol or sedatives, because it raises seizure risk. It also interacts with several medicines through CYP2D6.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- Zyban product information (TGA)
- PBS: Bupropion
- Cochrane: Antidepressants for smoking cessation (2020)
- Healthdirect: Medicines information
maladywise.com/medicines/bupropion/