📋 Indications & Clinical Dosage
*To aid smoking cessation in combination with motivational support in nicotine-dependent patients:*
Adult: Initially 150 mg daily for 6 days, then 150 mg twice daily (max. per dose 150 mg), minimum 8 hours between doses; period of treatment 7-9 weeks, start treatment 1-2 weeks before target stop date, discontinue if abstinence not achieved at 7 weeks; max. 300 mg per day, consider max. 150mg daily in patients with risk factors for seizures
Elderly: 150 mg daily for 7-9 weeks, start treatment 1-2 weeks before target stop date, discontinue if abstinence not achieved at 7 weeks; max. 150 mg per day.
⛔ Contraindications
CNS tumour, acute alcohol withdrawal, acute benzodiazepine withdrawal, bipolar disorder, eating disorders, history of seizures, severe hepatic
Cirrhosis, bulimia, anorexia nervosa,
⚠️ Precautions & Warnings
Alcohol abuse, diabetes, elderly, history of psychiatric illness, history of head trauma, predisposition to seizures (avoid), mild to moderate hepatic or renal impairment. Monitor BP before and during treatment, especially in patients with pre-existing hypertension. Monitor BP weekly if using concomitant transdermal nicotine.
🔄 Drug Interactions
MAOIs, antipsychotics, antidepressants, anti-malarials, tramadol, theophylline, systemic steroids, sedating antihistamines, quinolones, beta-blockers, classic antiarrhythmics, alcohol or benzodiazepine withdrawal. Central stimulants, anorectic agents, drugs metabolised by CYP2D6, 1A2 or 2136, Carbamazepine, phenytoin, valproate, levodopa.
⚠️ Adverse Reactions / Side Effects
Anxiety, agitation, dizziness, depression, dry mouth, fever, GI disturbances, headache, impaired concentration, insomnia (avoid dose at bedtime), pruritus, rash, sweating, taste disturbance, tremor, anorexia, asthenia, chest pain, confusion, flushing, hypertension, tachycardia, tinnitus, visual disturbances. Rare: Ataxia, depersonalization, dystonia, exacerbation of psoriasis, hallucinations, hepatitis, hostility, impaired memory, irritability, jaundice, palpitation, paraesthesia, postural hypotension, seizures, Stevens-Johnson syndrome, twitching, urinary frequency, urinary retention, vasodilatation
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated
Lactation / Breastfeeding:
Contraindicated
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.