Bupropion and Gabapentin Dosing for Smoking Cessation in Renal Impairment

Introduction to Dose Adjustment

• The American College of Cardiology and other guideline societies recommend adjusting the dose of gabapentin in patients with impaired renal function, with a maximum dose of 1400mg/day for CrCl 30-60 mL/min, 700mg/day for CrCl 15-30 mL/min, and 300mg/day for CrCl <15 mL/min 1, 2

Gabapentin Dose Adjustment

• The Mayo Clinic recommends reducing the gabapentin dose in patients with renal insufficiency, with adjustments based on creatinine clearance 1, 2
• The current dose of 3600mg/day is excessive for impaired renal function and must be reduced before adding bupropion 1

Bupropion Dose Adjustment

• For patients with any renal impairment (GFR <90 mL/min), the recommended dose of bupropion is 150mg once daily, which is half of the standard dose 3
• The National Comprehensive Cancer Network recommends starting bupropion at a reduced dose of 75mg once daily and increasing to 150mg once daily after 3 days 3, 4

Monitoring and Efficacy

• The Journal of the National Comprehensive Cancer Network recommends monitoring patients closely for adverse effects within 2 weeks of starting bupropion and throughout the 7-12 week treatment course 3, 4
• The American College of Cardiology recommends combining bupropion with behavioral therapy to compensate for lower medication doses 4, 5

Drug Interaction Considerations

• The Mayo Clinic recommends monitoring for independent accumulation of gabapentin and bupropion due to renal impairment, as both drugs can cause dose-dependent dizziness and sedation 1, 2