Nicotine Bupropion

Numerous pharmacotherapies have been proven to be effective for smoking cessation and should be offered in the absence of contraindications. These include sustained-release bupropion, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch. 

Fora report of acute myocardial ischaemia attributed to combined use of bupropion, nicotine (from smoking) and pseudoephedrine, see Bupropion + Pseudoephedrine , below. 

An isolated report describes acute myocardial ischaemia associated with bupropion, nicotine and pseudoephedrine. 

Jorenby DE, Leischow SJ, Nides MA, et al A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Eng J Med 340 685— 691, 1999... 

Efficacy. A pivotal study by Hurt et al. (1997) established the efficacy and safety of bupropion SRfor treatment of nicotine dependence, which led to its approval for this indication by the FDA in 1998. This study was a 7-week, double-blind, placebo-controUed, multicenter trial of three doses of bupropion SR (100 mg/day, 150 mg/day, or 300 mg/day in twice daily dosing). Patients were 6l5 cigarette smokers who smoked at least 15 cigarettes/day. The medication was administered in combination with weekly individual cessation counseling. End-of-trial 7-day point prevalence cessation rates were 19.0% for placebo and 28.8%, 38.6%, and 44.2% for the 100 mg/day, 150 mg/day, and 300 mg/day bupropion doses, respectively. At 1-year follow-up, cessation rates were 12.4% for placebo and 19.6%, 22.9%, and 23.1% for the 100 mg/day,... 

Nortriptyline. Nortriptyhne, a tricychc antidepressant, has been shown in double-blind, placebo-controlled randomized trials to be superior to placebo for smoking cessation (Prochazka et al. 1998). Nortriptyline appears to have efficacy comparable to that of bupropion for smoking cessation (Hall et al. 2002). The efficacy of this agent may be improved with more intensive behavioral therapies (Hall et al. 1998). Nortriptyline s mechanism of action is thought to relate to its noradrenergic and serotonergic reuptake blockade, because these two neurotransmitters have been implicated in the neurobiology of nicotine dependence. Side effects of nortiptyline are typical of tricyclic antidepressants and include dry mouth, blurred vision, constipation, and orthostatic hypotension. Nortriptyline appears to have some utility for smokers with a past history of major depression, and it can be recommended as a second-... 

In general, for smokers with cardiac disease, the benefits of nicotine replacement therapy outweigh the potential risks. In a safety and efficacy study that included veterans with cardiac disease, smoking concurrently with the nicotine patch was not associated with an increase in adverse events (Joseph et al. 1996). Although bupropion SR is generally well tolerated by smokers, it has not been adequately studied in persons with cardiac disease, and definitive conclusions regarding its safety in this patient population cannot currently be made (Society for Research on Nicotine and Tobacco 2003). 

Evins AE, Mays VK, Rigotti NA, et al A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia. Nicotine Tob Res 3 397-M03, 2001... 

Hays JT, Hurt RD, Rigotti NA, et al Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation. Ann Intern Med 135 423 33, 2001 Henningfleld JE Nicotine medications for smoking cessation. N Engl J Med 333 1196-1203, 1995... 

Slemmer JE, Martin BR, Damaj MI Bupropion is a nicotinic antagonist. J Pharmacol Exp Therap 295 321-327, 2000... 

Nicotine vapor inhaler Buccal Bupropion Oral tablets Clonidine Oral tablets 6-16 mg/day continuous puffing up to 10 puffs per cartridge maximum of 12 cartridges daily (approx. 120 puffs) Begin at 150 mg/day x 3-7 days then 300 mg/day in twice-per-day dosing 0.6-1.2 mg/day, 2-3 times/day... 

A combination of the nicotine antagonist mecamylamine and bupropion (Quitpack )... 

Withdrawal from nicotine is treated in the outpatient setting. Symptomatic detoxification from nicotine is achieved with any single or combination of NRTs. Additional nonnicotine medications such as bupropion, nortriptyline, and clonidine may be helpful to reduce craving and various other withdrawal symptoms. Including a behavioral therapy component increases abstinence rates when combined with pharmacologic treatment. 

Buproprion SR4 First-line Titrate up to 150 mg orally twice daily 3-6 months Patients receiving both bupropion and a nicotine patch should be monitored tor hypertension. At... 

Nicotine replacement therapies can be combined with each other and/or bupropion to increase long-term abstinence rates. bOo not abruptly discontinue. Taper up initially, and taper off once therapy is complete. cClonidine and nortriptyline are not FDA approved for smoking cessation. 

Bupropion is another alternative pharmacological approach to tobacco abstinence. It is an antidepressant drug that blocks reuptake of norepinephrine and dopamine, and also blocks nicotinic receptors in the low to intermediate micromolar range (Fryer and Lukas 1999). Thus, the effects of bupropion on nicotine addiction may be through dual effects on dopaminergic and nicotinic systems. Further, it has been an effective treatment in controlled studies, both alone and in combination with the nicotine patch. Bupropion alone or in combination with a nicotine patch was more effective than placebo or the nicotine patch alone. 

Fryer JD, Lukas RJ. (1999). Noncompetitive functional inhibition at diverse, human nicotinic acetylcholine receptor subtypes by bupropion, phencyclidine, and ibogaine. J Pharmacol Exp Ther. 288(1) 88-92. 

Patterson F, Schnoll R, Wileyto E, Pinto A, Epstein L, Shields P, Hawk L, Tyndale R, Benowitz N, Lerman C (2008) Toward Personalized Therapy for Smoking Cessation A Randomized Placebo-controlled Trial of Bupropion. Chn Pharmacol Ther 84(3) 320-325 Perez-Stable EJ, Herrera B, Jacob P 3rd, Benowitz NL (1998) Nicotine metabohsm and intake in black and white smokers. JAMA 280(2) 152-156 Perry RJ, Griffiths W, Dextraze P, Solomon RJ, Trebbin WM (1984) Elevated nicotine levels in patients undergoing hemodialysis. A role in cardiovascular mortality and morbidity Am J Med 76(2) 241-246... 

Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE, et al (2006) Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation a randomized controUed trial. JAMA 296(l) 56-63... 

---