• Pregnancy and breastfeeding: bupropion should not be used during pregnancy or breastfeeding.
• Children and adolescents: bupropion should not be used in smokers younger than 18 years of age.
• Epilepsy (or increased risk of seizures): bupropion is associated with a dose-related risk of seizure:
• Bupropion is contraindicated in people with:
• A current seizure disorder or any history of seizures.
• A current or previous diagnosis of bulimia or anorexia nervosa.
• A central nervous system tumour.
• Abrupt withdrawal from alcohol or benzodiazepines.
• Severe hepatic cirrhosis.
• Bipolar disorder.
• Only prescribe bupropion to people with other risk factors for seizures if there is compelling clinical justification. If bupropion is prescribed for these people, use a lower dose of 150 mg daily throughout the entire treatment period. Risk factors for seizures include:
• Concomitant use of any drug known to lower the seizure threshold (including antipsychotics; antidepressants; some antimalarials, such as mefloquine; theophylline; systemic corticosteroids; tramadol; quinolones; and sedating antihistamines).
• Alcohol abuse.
• A history of head trauma.
• Diabetes treated with hypoglycaemic drugs or insulin.
• Use of stimulants or anorectic products.
• Stop bupropion if an individual has a seizure while taking it.

In depth

• Do not give bupropion with other drugs that lower the seizure threshold (e.g. antipsychotics; antidepressants; some antimalarials, such as mefloquine; theophylline; systemic corticosteroids; tramadol; quinolones; and sedating antihistamines).
• Do not give bupropion within 2 weeks of stopping a monoamine oxidase inhibitor (MAOI). For moclobemide (a reversible MAOI), this can be reduced to 2–3 days.

In depth

• The recommended treatment dose is 150 mg once a day for 6 days, increasing to 150 mg twice a day (doses at least 8 hours apart).
• Continue the lower dose of 150 mg once a day if the person:
• Is older than 65 years of age.
• Has hepatic impairment (mild to moderate).
• Has renal impairment (glomerular filtration rate < 50 mL/min).
• Advise the person to stop smoking 7–14 days after starting bupropion.
• The recommended course of treatment is 7–9 weeks.
• After a usual course of 7–9 weeks, bupropion can be stopped without tapering the dose. If the course of bupropion has been longer than 6 months, consider a tapering period.

In depth

• The most common adverse effects of bupropion include dry mouth, gastrointestinal disturbances, insomnia (which can be reduced by not giving the last dose at bedtime), headache, impaired concentration, and dizziness.
• Seizures occur rarely in people taking bupropion (incidence of seizures is approximately 0.1%):
• Do not prescribe for people at increased risk of seizures (see Contraindications to bupropion).
• To minimize the risk, do not exceed the recommended daily dose.
• Stop bupropion if an individual has a seizure while taking it.
• Reports of seizures as an adverse effect of prescribed medication do not automatically imply that such events will be considered by the DVLA as provoked. The person may, therefore, be disallowed from driving a car or motorcycle for 1 year, or an LGV or PCV for 5 years.

In depth