A patient with a history of seizures should avoid which smoking cessation medication?

• A. Bupropion
• B. Nicotine patch
• C. Varenicline
• D. Gum

Answer: (A)

When a patient has a history of seizures, the risk not to miss is medication that can provoke seizures. Bupropion raises the risk of seizures because it lowers the seizure threshold as its dopaminergic/noradrenergic activity increases neuronal excitability. This effect is more likely at higher doses or in someone with a preexisting seizure history, so it is contraindicated in these patients.

Other smoking cessation aids do not carry the same seizure risk. Nicotine replacement therapies like the patch or gum deliver nicotine in a controlled way and are generally considered safe for people with seizure histories. Varenicline reduces cravings by acting on nicotinic receptors with a different mechanism and is not typically associated with provoking seizures, though it can have other neuropsychiatric side effects. Therefore, the option to avoid in someone with seizures is the one that lowers the seizure threshold.