Sustained-release Bupropion Hydrochloride Research Articles

Pharmacological intervention and abstinence in smokers undergoing cessation treatment: A psychophysiological study

As a composite concept, negative affect comprises various aversive emotional experiences, such as irritability and nervousness. It is a critical motivational factor that helps maintain smoking behavior, and contributes significantly to smoking cessation failure as a core withdrawal symptom. Prior research has indicated an important role of nicotinic mechanisms in negative affect processing. The most effective smoking cessation medication, varenicline, targets nicotinic acetylcholine receptors (nAChRs) as a partial agonist, while another first-line cessation medication, bupropion, has shown antagonistic effects on nAChRs. Therefore, it is possible that both medications work to reduce smoking behavior through modulating negative affect processing. To evaluate this hypothesis, we examined the impact of varenicline tartrate and bupropion hydrochloride sustained-release on electrophysiological responses to affective, cigarette-related, and neutral cues before and during smoking cessation treatment in a randomized placebo-controlled clinical trial. The participants were 206 smokers, a subset of 294 participants that were enrolled in a larger smoking cessation clinical trial who were randomly assigned to one medication group for 12weeks. Orbicularis oculi (startle eyeblink response) and corrugator supercilii facial electromyographic (EMG) reactivity toward emotional pictures (i.e., pleasant and unpleasant) in a picture-viewing task were measured before treatment and 2 and 6weeks after treatment was started. The startle and corrugator EMG activities increase with the exposure to unpleasant cues, and served as indices for negative emotional reactivity (NER). We found that after 6weeks, drug reduced startle-related NER in the varenicline group, but not in the bupropion or placebo group. Independent of medication treatment, lower baseline NER, as measured by the corrugator EMG activity, predicted a higher likelihood of smoking abstinence 1 and 3months after quitting smoking. These findings indicate the important roles of varenicline in negative affect processing and negative emotional reactivity in the course of smoking cessation.

Bupropion HCI Yavaş Salınımlı Formuna Bağlı Jeneralize Tonik Klonik Nöbet

ÖZETBupropion Hidroklorid (HCI), hızlı salınımlı (IR), sürekli salınımlı (SR) ve yavaş salınımlı (ER) olmak üzere üç farklı formu bulunmaktadır. Bupropion HCI'in özellikle sürekli ve hızlı salınımlı formlarının nöbeti tetiklediği bildirilmiştir. Yavaş salınımlı formunun nöbeti tetiklediği ise literatürde oldukça nadir olarak bildirilmiştir (1). Bu olgu sunumunda, bupropion'un yavaş salınımlı formunu kullanan ve acil servise jeneralize tonik klonik nöbetle gelen 37 yaşındaki bayan hasta tartışılmıştır. Daha önce epilepsi tanısı olmayan ve ilk nöbetle hastaneye başvuran hastaların değerlendirilmesi sırasında diğer nedenler araştırılırken, antidepressan ilaçların da sorgulanması gerekmektedir.

Bupropion and Cognitive Behavioral Therapy for Weight-Concerned Women Smokers

We previously documented that cognitive behavioral therapy for smoking-related weight concerns (CONCERNS) improves cessation rates. However, the efficacy of combining CONCERNS with cessation medication is unknown. We sought to determine if the combination of CONCERNS and bupropion therapy would enhance abstinence for weight-concerned women smokers. In a randomized, double-blind, placebo-controlled trial, weight-concerned women (n = 349; 86% white) received smoking cessation counseling and were randomized to 1 of 2 adjunctive counseling components: CONCERNS or STANDARD (standard cessation treatment with added discussion of smoking topics but no specific weight focus), and 1 of 2 medication conditions: bupropion hydrochloride sustained release (B) or placebo (P) for 6 months. Rates and duration of biochemically verified prolonged abstinence were the primary outcomes. Point-prevalent abstinence, postcessation weight gain, and changes in nicotine withdrawal, depressive symptoms, and weight concerns were evaluated. Women in the CONCERNS + B group had higher rates of abstinence (34.0%) and longer time to relapse than did those in the STANDARD + B (21%; P = .05) or CONCERNS + P (11.5%; P = .005) groups at 6 months, although rates of prolonged abstinence in the CONCERNS + B and STANDARD + B groups did not differ significantly at 12 months. Abstinence rates and duration did not differ in the STANDARD + B group (21% and 19%) compared with the STANDARD + P group (10% and 7%) at 6 and 12 months, respectively. There were no differences among abstinent women in postcessation weight gain or weight concerns, although STANDARD + B produced greater decreases in nicotine withdrawal and depressive symptoms than did STANDARD + P. Weight-concerned women smokers receiving the combination of CONCERNS + B were most likely to sustain abstinence. This effect was not related to differences in postcessation weight gain or changes in weight concerns. Trial Registration clinicaltrials.gov Identifier: NCT00006170.

Comparative Effectiveness of 5 Smoking Cessation Pharmacotherapies in Primary Care Clinics

Randomized efficacy clinical trials conducted in research settings may not accurately reflect the benefits of tobacco dependence treatments when used in real-world clinical settings. Effectiveness trials (eg, in primary care settings) are needed to estimate the benefits of cessation treatments in real-world use. A total of 1346 primary care patients attending routine appointments were recruited by medical assistants in 12 primary care clinics. Patients were randomly assigned to 5 active pharmacotherapies: 3 monotherapies (nicotine patch, nicotine lozenge, and bupropion hydrochloride sustained release [SR]) and 2 combination therapies (patch + lozenge and bupropion SR + lozenge). Patients were referred to a telephone quit line for cessation counseling. Primary outcomes included 7-day point prevalence abstinence at 1 week, 8 weeks, and 6 months after quitting and number of days to relapse. Among 7128 eligible smokers (> or =10 cigarettes per day) attending routine primary care appointments, 1346 (18.9%) were enrolled in the study. Six-month abstinence rates for the 5 active pharmacotherapies were the following: bupropion SR, 16.8%; lozenge, 19.9%; patch, 17.7%; patch + lozenge, 26.9%; and bupropion SR + lozenge, 29.9%. Bupropion SR + lozenge was superior to all of the monotherapies (odds ratio, 0.46-0.56); patch + lozenge was superior to patch and bupropion monotherapies (odds ratio, 0.56 and 0.54, respectively). One in 5 smokers attending a routine primary care appointment was willing to make a serious quit attempt that included evidence-based counseling and medication. In this comparative effectiveness study of 5 tobacco dependence treatments, combination pharmacotherapy significantly increased abstinence compared with monotherapies. Provision of free cessation medications plus quit line counseling arranged in the primary care setting holds promise for assisting large numbers of smokers to quit. Trial Registration clinicaltrials.gov Identifier: NCT00296647.

Selecting Among Second-Step Antidepressant Medication Monotherapies

Little is known about selecting among second-step medications for major depressive disorder after intolerance or lack of remission with an initial selective serotonin reuptake inhibitor. To determine whether sociodemographic, clinical, or first-step treatment features predict remission with or intolerance overall or differentially to any 1 of 3 second-step medications after an unsatisfactory outcome with citalopram hydrobromide. An equipoise stratified randomized study. Participants were recruited from July 17, 2001, through April 20, 2004. Public or private sector primary care (n = 18) and psychiatric care (n = 23) settings across the United States. Representative outpatients aged 18 to 75 years with nonpsychotic major depressive disorder (N = 727). Sustained-release bupropion hydrochloride was started at 150 mg/d and incrementally increased to 400 mg/d. Sertraline hydrochloride was started at 50 mg/d and incrementally increased to 200 mg/d. Extended-release venlafaxine hydrochloride was started at 37.5 mg/d and incrementally increased to 375 mg/d. The 16-item Quick Inventory of Depressive Symptomatology, Self-Rated and the Frequency, Intensity, and Burden of Side Effects Rating. Remission was more likely among participants who were white, employed, cohabiting or married, or privately insured or who had prior intolerance to citalopram or at least a response to citalopram, and no prior suicide attempts. Remission was less likely among participants with concurrent generalized anxiety, obsessive-compulsive, panic, or posttraumatic stress disorders; social phobia; anxious or melancholic features; or more severe depression. Intolerance was less likely for Hispanic participants, but more likely for participants with previous suicide attempts or intolerance to citalopram. Participants with concurrent substance use were less likely to remit (odds ratio, 0.37) and more likely not to tolerate extended-release venlafaxine. Intolerance to citalopram was associated with intolerance to sertraline (P = .04). Clinical, demographic, and treatment history were of little value in recommending 1 medication vs another as a second-step treatment for major depressive disorder. Participants most likely to remit in the second step had less Axis I psychiatric disorder comorbidity, less social disadvantage, and at least a response to citalopram in the first step. clinicaltrials.gov Identifier: NCT00021528.

Bupropion Efficacy for Smoking Cessation is Influenced by the DRD2 Taq1A Polymorphism: Analysis of Pooled Data from two Clinical Trials

We analyzed pooled data from two comparable randomized placebo-controlled clinical trials of bupropion pharmacotherapy for smoking cessation for which data on DRD2 Taq1A genotype were available. A total of 722 smokers across the two trials were randomized to 10 weeks of sustained-release bupropion hydrochloride or placebo. General estimating equation analysis demonstrated a significant gene x drug interaction (B = 0.87, SE = 0.34, p = .009). Smokers with the A2/A2 genotype using bupropion were more than three times as likely, relative to placebo, to be abstinent at end of treatment (35.2% vs. 15.1%; OR = 3.25, 95% CI 2.00-5.28) and at 6 months of follow-up (26.7% vs. 12.2%; OR = 2.81, 95% CI 1.66-4.77), which was attenuated by 12 months (16.3% vs. 10.7%; OR = 1.70, 95% CI 0.95-3.05). We found no significant benefit of bupropion relative to placebo on smoking cessation outcomes at any time point in participants with A1/A1 or A1/A2 genotypes. These data suggest that bupropion may be effective for smoking cessation only in a subgroup of smokers with the DRD2 Taq1 A2/A2 genotype.

Pharmacotherapy for Adolescent Smoking Cessation

Myra L. Muramoto, MD, MPH; Scott J. Leischow, PhD; Duane Sherrill, PhD; Eva Matthews, MPH; Louise J. Strayer, BSc, RN, MScObjective: To assess the safety and efficacy of sustained-release bupropion hydrochloride for adolescent smoking cessation.Design: Prospective, randomized, double-blind, placebo-controlled, dose-ranging trial.Setting: Metropolitan areas of Tucson and Phoenix, Arizona.Participants: Adolescents (N = 312) recruited through media and various community venues from March 1, 1999, through December 31, 2002, who were aged 14 to 17 years, smoked 6 or more cigarettes per day, had an exhaled carbon monoxide level of 10 ppm or greater, had at least 2 previous quit attempts, and had no other current major psychiatric diagnosis.Intervention: Sustained-release bupropion hydrochloride, 150 mg/d (n = 105) or 300 mg/d (n = 104), or placebo (n = 103) for 6 weeks, plus weekly brief individual counseling. Subjects were followed up at 12 weeks (by telephone call) and 26 weeks.Main Outcome Measure: Confirmed 7-day point prevalence abstinence at 6 weeks and 30-day prolonged abstinence (carbon monoxide level <10 ppm at each visit; urinary cotinine level ≤50 μg/L at weeks 2 and 6).Results: Cotinine-confirmed 7-day point prevalence abstinence rates at 6 weeks were as follows: placebo, 5.6%; 150 mg, 10.7%; and 300 mg, 14.5% (P = .03, 300 mg vs placebo). At 26 weeks, confirmed point prevalence abstinence rates were as follows: placebo, 10.3%; 150 mg, 3.1%; and 300 mg, 13.9% (P = .049). During treatment, confirmed point prevalence rates were significantly higher for 300 mg than placebo at every week except week 4.Conclusions: Sustained-release bupropion hydrochloride, 300 mg/d, plus brief counseling demonstrated short-term efficacy for adolescent smoking cessation. Abstinence rates were lower than those reported for adults, with rapid relapse after medication discontinuation.Trial Registration: clinicaltrials.gov Identifier: NCT00344695

A preliminary investigation of naltrexone augmentation of bupropion to stop smoking with less weight gain

Certain barriers prevent some cigarette smokers from attempting to quit, particularly the fear of post-cessation weight gain. This investigation was an open label study of naltrexone hydrochloride (25 mg/day) in combination with sustained-release (SR) bupropion hydrochloride (300 mg/day) for smoking cessation and minimization of post-quit weight gain in weight-concerned smokers. The study sample ( n = 20) was compared to matched controls ( n = 20) who received an identical psychosocial intervention and bupropion SR treatment regimen. The primary outcomes analyzed were: (a) biochemically verified continuous abstinence from smoking over the 6-week treatment, (b) point prevalence abstinence in the last 7 days of treatment, and (c) weight gain from baseline. Neither adherence to the combination pharmacotherapy nor the percentage of patients reporting adverse events differed significantly between the two groups nor were there differences in either continuous or point prevalence abstinence from smoking. Although not statistically significant in this small sample, continuously abstinent participants in the naltrexone + bupropion group gained less weight (mean = 1.67 lb) than those in the bupropion only group (mean = 3.17 lb; p = .35; Cohen's d = 0.56). The results of this preliminary study suggest that combining naltrexone and bupropion may help minimize post-cessation weight gain, but does not result in higher smoking cessation rates compared to bupropion alone. The effect size for the difference in weight gain among continuously abstinent participants was in the moderate range, suggesting that this treatment deserves further study in an appropriately powered clinical trial as an adjunct for weight-concerned smokers, who may value the weight-suppressant effect of naltrexone.

Smoking Cessation With Varenicline, a Selective α4β2 Nicotinic Receptor Partial Agonist

Currently available smoking cessation therapies have limited success rates. Varenicline tartrate is a novel, selective nicotinic receptor partial agonist developed specifically for smoking cessation. This study evaluated the efficacy, tolerability, and safety of 3 varenicline doses for smoking cessation. Bupropion hydrochloride was included as an active control. A phase 2, multicenter, randomized, double-blind, placebo-controlled study of healthy smokers (18-65 years old). Subjects were randomized to varenicline tartrate, 0.3 mg once daily (n = 128), 1.0 mg once daily (n = 128), or 1.0 mg twice daily (n = 127), for 6 weeks plus placebo for 1 week; to 150-mg sustained-release bupropion hydrochloride twice daily (n = 128) for 7 weeks; or to placebo (n = 127) for 7 weeks. During the treatment phase, the continuous quit rates for any 4 weeks were significantly higher for varenicline tartrate, 1.0 mg twice daily (48.0%; P<.001) and 1.0 mg once daily (37.3%; P<.001), than for placebo (17.1%). The bupropion rate was 33.3% (P = .002 vs placebo). The carbon monoxide-confirmed continuous quit rates from week 4 to week 52 were significantly higher in the varenicline tartrate, 1.0 mg twice daily, group compared with the placebo group (14.4% vs 4.9%; P = .002). The bupropion rate was 6.3% (P = .60 vs placebo). Discontinuation owing to treatment-emergent adverse events was 15.9% for bupropion, 11.2% to 14.3% for varenicline, and 9.8% for placebo. No dose-related increases occurred in adverse events for varenicline. Varenicline tartrate demonstrated both short-term (1 mg twice daily and 1 mg once daily) and long-term efficacy (1 mg twice daily) vs placebo. Varenicline was well tolerated and may provide a novel therapy to aid smoking cessation.

The influence of depressive symptoms on smoking cessation among African Americans in a randomized trial of bupropion

The influence of depressive symptoms on smoking cessation was examined among 600 African American smokers who participated in a randomized, placebo-controlled trial of sustained-release bupropion hydrochloride. Depressive symptoms were assessed at baseline, at week 6 (end of treatment), and at 6-month follow-up. The study examined three separate questions: (a) Whether depressive symptom levels were related to smoking cessation, (b) whether bupropion was more effective for smokers who had higher depressive symptoms at baseline (i.e., a moderator model), and (c) whether changes in depressive symptoms would account for the efficacy of bupropion for smoking cessation (i.e., a mediator model). Depressive symptoms at baseline were not predictive of cessation; however, increases in depressive symptoms from baseline predicted reduced cessation at the end of treatment, and higher depressive symptoms at week 6 and month 6 were associated with a reduced likelihood of smoking cessation at those time points. The moderator model was not supported, but the mediation analyses indicated that alleviation of depressive symptoms partly accounted for bupropion-assisted smoking cessation at end of treatment. Results extend prior findings to African American smokers and suggest that clinicians consider increases in depressive symptoms after quitting rather than baseline depressive symptoms in predicting risk of treatment failure. Results also suggest that even though bupropion may facilitate cessation in part by reducing depressive symptoms, it appears to be no more effective for more depressed smokers, and that mechanisms other than depressive symptom alleviation account for most of its efficacy.

Bupropion SR for the Treatment of Substance- Abusing Outpatient Adolescents with Attention- Deficit/Hyperactivity Disorder and Mood Disorders

Few studies exist on pharmacological interventions for adolescents with substance use disorders (SUD). To this end, we evaluated the response of bupropion hydrochloride sustained release (SR) in SUD adolescents with comorbid psychopathology (both attention-deficit/ hyperactivity disorder (ADHD) and a mood disorder). Fourteen adolescent outpatients were treated naturalistically and followed openly for 6 months. Adolescents were rated using the Drug Use Screening Inventory--Revised (DUSI-R), ADHD Symptom Checklist, and the Hamilton Rating Scale for Depression (HAM-D). Clinical Global Impression (CGI) Scale scores were obtained for Substance Abuse, ADHD, Anxiety, and Depression. The ratings were completed at baseline, at month 3, and at the 6-month endpoint. Bupropion SR was initiated at 100 mg once-daily and titrated naturalistically to a maximum dose of 400 mg/day. Of the 14 subjects followed, 13 subjects completed 6 months of treatment. At the 6- month endpoint compared to baseline, treatment with bupropion was associated with clinical and significant reductions in DUSI scores (-39%; p < 0.05), ADHD symptom checklist (-43%; p < 0.001), HAM-D (-76%; p < or = 0.001); and reductions in the CGIs for ADHD (p < or = 0.001), depression (p < or = 0.001), and substance abuse (p < 0.05). The mean daily dose of bupropion SR was 315 mg (in divided doses). No significant adverse events were noted during the follow-up period. These naturalistic data suggest that bupropion is well tolerated and may be an effective medication for the treatment of substance abusing adolescents with comorbid mood disorders and ADHD.

SMOKING CESSATION AND THE USE OF SUSTAINED-RELEASE BUPROPION AS AN AID TO SMOKING CESSATION AMONG FILIPINOS

PURPOSE: Smoking is very prevalent in the Philippines with 45% among Filipinos being ever-smokers and the number of current smokers increased from 32.7% in 1999 to 34.8% in 2003. This study aims to assess the rate of successful smoking cessation among Filipino smokers with the use sustained-release bupropion hydrochloride as the pharmacologic aid in achieving abstinence. Safety in the use of bupropion hydrochloride and factors that may promote smoking abstinence among Filipinos were also determined.

Oxygen as a therapy for reducing nicotine withdrawal symptoms

Nicotine addiction leads to withdrawal symptoms in many persons who quit smoking. In addition to craving, the most commonly experienced symptoms are: depression; difficulty sleeping; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain. The severity of withdrawal symptoms are variable, and often lead to relapse. By altering the course of withdrawal symptoms it is possible to improve the chances of the quit attempt and reduce the risk of relapse. There is strong evidence that dopamine is the primary neurotransmitter in the reward pathway in addiction. The use of nicotine replacement therapies and Zyban (sustained release bupropion hydrochloride), both of which are suspected of exploiting dopamine's role in addiction, enhance the likelihood of long-term smoking cessation. Anecdotal reports of oxygen's capacity to reduce both the desire for nicotine and withdrawal symptoms suggest that this may be a therapeutic possibility for those who do not experience success with more traditional cessation approaches. Oxygen may have a favorable effect on nicotine withdrawal, as it appears to alter the balance of central neurotransmitters such as dopamine.

Executive summary: Nicotine addiction

Nicotine addiction is one of the most prevalent addictive behaviors worldwide. According to the World Health Organization (WHO), 1.3 billion men, women and children worldwide are smokers. In spite of increased awareness and action on the part of both governments and individuals, tobacco continues to be the leading cause of preventable disease and death in the United States, as well as in many other countries. According to WHO, there are nearly 5 million tobacco-related deaths worldwide each year and nearly half of the smokers in the world today will die as a result of their addiction. For individuals who are motivated to quit smoking, a combination of pharmacotherapy and behavioral therapy has been shown to be most effective in controlling the symptoms of nicotine withdrawal. Drugs marketed as smoking cessation aids include nicotine replacement therapy (NRT) and sustained-release bupropion hydrochloride. New drugs in development are directed to targets including nicotinic acetylcholine receptors, cannabinoid receptors, dopamine receptors and opioid receptors. Several therapeutic vaccines are also in the pipeline.

Akute Psychose nach Gabe von Bupropionhydrochlorid (Zyban®)

A 29-year old had been admitted to our institution with acute onset of schizophreniform psychosis after 5-day administration of sustained-release bupropion hydrochloride, which had been prescribed for nicotine withdrawal in a daily dosage of 300 mg. Examination results were found to be completely normal, apart from a positive drug screen for cannabis. We hypothesize that bupropion had induced psychotic symptoms in this patient.

Pharmacokinetics of Bupropion and Its Metabolites in Haemodialysis Patients Who Smoke

To date, no study has investigated the effects of bupropion (BP) in renal-impaired humans. This study aims to identify the pharmacokinetics of BP and metabolites in haemodialysis patients who smoke, determine whether haemodialysis affects BP and metabolite clearance, and suggest the BP dose in haemodialysis. The pharmacokinetics of BP and two of its major metabolites, hydroxybupropion (HB) and threohydrobupropion (TB) were studied in 8 smokers with ESRD receiving haemodialysis. Following a single oral dose of 150 mg bupropion hydrochloride sustained-release, blood samples were taken over 7 days, which were assayed using HPLC-mass spectrometry. Pharmacokinetic analysis was undertaken by non-linear regression using MWPharm. The BP results were similar to those for individuals with normal renal function. The metabolites demonstrated increased areas under the curve, indicating accumulation. Dialysis clearance of HB is unlikely. The results suggest significant accumulation of the metabolites in renal failure. Clarification of the clinical importance of the metabolites and toxic plasma levels is required. The effects of haemodialysis on BP and metabolites require further study. A dose of 150 mg bupropion every 3 days in patients receiving haemodialysis is more appropriate than the current manufacturer’s recommendation (in renal impaired patients) of 150 mg daily. A multi-dose study is required.

Review of bupropion for smoking cessation.

The advent of bupropion hydrochloride sustained release (Zyban) has heralded a major change in the options available for smoking cessation pharmacotherapy. Bupropion is a selective re-uptake inhibitor of dopamine and noradrenalin which prevents or reduces cravings and other features of nicotine withdrawal. Bupropion is a useful oral and non-nicotine form of pharmacotherapy for smoking cessation. For this review a total of 221 papers were reviewed plus poster presentations. This review examines in detail original clinical trials on efficacy, categorised according to whether they were acute treatment trials in healthy smokers; studies in specific populations such as people with depression, chronic obstructive pulmonary disease (COPD) or cardiovascular disease; or relapse prevention studies. Overall, these studies in varying populations comprising over four thousand subjects, showed bupropion consistently produces a positive effect on smoking cessation outcomes. The evidence highlights the major public health role that bupropion has in smoking cessation. The methodological issues of published clinical trials reporting one year outcomes were examined in detail including: completeness of follow-up; loss to follow-up; intention to treat analysis; blindness of assessment; and validation of smoking status. The review discusses contraindications, adverse effects, dose and overdose, addictive potential, and the role of bupropion in reducing cessation-related weight gain. Bupropion combined with or compared to other pharmacotherapies (nicotine patch; nortriptyline) is considered. Impressive evidence exists for the use of bupropion in smoking cessation among difficult patients who are hard-core smokers such as those with cardiovascular disease, chronic obstructive pulmonary disease (COPD) and depression. Bupropion reduces withdrawal symptoms as well as weight gain and is effective for smoking cessation for people with and without a history of depression or alcoholism. Serious side effects of bupropion use are rare. The major safety issue with bupropion is risk of seizures (estimated at approximately 0.1%) and it should not be prescribed to patients with a current seizure disorder or any history of seizures. In clinical trials of bupropion for smoking cessation no seizures were reported. Allergic reactions occur at a rate of approximately 3% and minor adverse effects are common including dry mouth and insomnia.

Bupropion SR for smoking cessation

Cigarette dependence is recognised as a life-threatening disorder which can be treated by behavioural support and/or medication. Bupropion hydrochloride sustained-release (Zyban™, GlaxoSmithKline) is licensed in many countries including the US, Canada, UK, Australia and continental Europe to aid smoking cessation. The usual recommended dose is 150 mg b.i.d. taken for 7 – 14 days prior to the quit date, and then 6 – 8 weeks afterwards (figures vary across countries). Evidence from seven double-blind, placebo-controlled, randomised trials shows that it improves success at staying off cigarettes for at least 12 months by 9 – 10 percentage points. Taking into account estimates of subsequent cessation and relapse patterns in treated and untreated smokers, and the improvement in life-expectancy of smokers who manage to stop, the estimated cost/life/year saved from an episode of use of the medication is ∼ UK£1000 or US$1500. Bupropion has CNS stimulant properties; the common side effects are dry mouth and sleep disturbance. Rare but serious side effects are anaphylactic/hypersensitivity reaction and seizure (both estimated at 1 in a 1000). The drug is contraindicated in patients with hypersensitivity to the drug or its metabolites, any seizure disorder, eating disorder, severe hepatic cirrhosis, history of bipolar disorder or in patients taking monoamine oxidase inhibitors. Extreme caution is advised where there are any predisposing factors that may reduce the seizure threshold. Bupropion sustained-release and nicotine replacement therapies are both considered as first-line treatments to aid smoking cessation. Ideally patients should also enrol in a structured behavioural support programme to boost their chances of success.

Bupropion SR for smoking cessation

Cigarette dependence is recognised as a life-threatening disorder which can be treated by behavioural support and/or medication. Bupropion hydrochloride sustained-release (Zyban™, GlaxoSmithKline) is licensed in many countries including the US, Canada, UK, Australia and continental Europe to aid smoking cessation. The usual recommended dose is 150 mg b.i.d. taken for 7 – 14 days prior to the quit date, and then 6 – 8 weeks afterwards (figures vary across countries). Evidence from seven double-blind, placebo-controlled, randomised trials shows that it improves success at staying off cigarettes for at least 12 months by 9 – 10 percentage points. Taking into account estimates of subsequent cessation and relapse patterns in treated and untreated smokers, and the improvement in life-expectancy of smokers who manage to stop, the estimated cost/life/year saved from an episode of use of the medication is ∼ UK£1000 or US$1500. Bupropion has CNS stimulant properties; the common side effects are dry mouth and sleep disturbance. Rare but serious side effects are anaphylactic/hypersensitivity reaction and seizure (both estimated at 1 in a 1000). The drug is contraindicated in patients with hypersensitivity to the drug or its metabolites, any seizure disorder, eating disorder, severe hepatic cirrhosis, history of bipolar disorder or in patients taking monoamine oxidase inhibitors. Extreme caution is advised where there are any predisposing factors that may reduce the seizure threshold. Bupropion sustained-release and nicotine replacement therapies are both considered as first-line treatments to aid smoking cessation. Ideally patients should also enrol in a structured behavioural support programme to boost their chances of success.

Clinical Effectiveness of Sustained-Release Bupropion and Behavior Therapy for Tobacco Dependence in a Clinical Setting

Despite decades of public education, cigarette smoking remains a serious health problem. The treatment approach at Tripler Army Medical Center is a unique collaboration of family practice physicians and health psychologists providing combination therapy to patients attempting to quit smoking. This article discusses a program evaluation of the Tripler Army Medical Center smoking cessation program. Patients attempting to quit smoking were assisted with a combination of cognitive-behavioral group therapy and sustained-release bupropion hydrochloride. At 6 months postintervention, patients who attended the smoking cessation programs were contacted via telephone and asked to complete a survey regarding their smoking status. One hundred forty-four participants completed the survey. Thirty-five percent of all contacted attendees remained abstinent from smoking at 6 months after intervention. A significantly greater percentage of men quit than women. There were no significant differences of abstinence rates by any other demographic characteristic or smoking history variable. Family practice physicians and health psychologists providing a combination of pharmacological and group cognitive-behavior therapy for nicotine dependence are effective in promoting abstinence from smoking.