Nicotine addiction bupropion

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. 

Bruijnzeel AW, Markou A (2003) Characterization of the effects of bupropion on the reinforcing properties of nicotine and food in rats. Synapse 50 20-28 Buisson B, Bertrand D (2001) Chronic exposure to nicotine upregulates the human (alpha)4(beta)2 nicotinic acetylcholine receptor function. J Neurosci 21 1819-1829 Buisson B, Bertrand D (2002) Nicotine addiction the possible role of functional upregulation. Trends Pharmacol Sd 23 130-136... 

Despite the success of bupropion for depression, there has been little progress or apparent interest in antidepressants focused on dopaminergic activity or potentiation. The impact of more dopaminergic medications can be inferred from the unique clinical uses of bupropion for depression, nicotine addiction, ADFID... 

With the exceptions of methadone maintenance, LAAM maintenance, and nicotine substitution therapy (and probably naltrexone for alcohol addiction and bupropion for nicotine addiction), no clearly effective pharmacotherapy for drug addiction exists. Certainly, no broadly effective pharmacotherapy exists (effective for addictions to drugs of different chemical classes and pharmacological categories). Therapeutic strategies based on psychotherapy, group therapy, behavior modification, economic incentives, and aversion deconditioning have proven limited. 

In the late 1990s, a new approach to nicotine addiction was introduced. It involves the use of an antidepressant known by its generic name as bupropion. Bupropion is believed to act like nicotine in that it apparently can boost brain levels of dopamine as well as norepinephrine. Some patients have successfully terminated drug therapy after a few months with no ill effects. 

Nicotine replacement therapy in the form of transdermal nicotine preparations combined with sustained-release bupropion (51) has been successfully tried in some hard core nicotine addicts, after the above social and practical measurements have been taken. The combined therapy of transdermal nicotine and bupropion should last for at least 6 months, and in many cases much longer if the crave to smoke still exists. Sustained-release bupropion therapy alone resulted in a 23.1% tobacco use cessation at one year in a placebo-controlled trial (51). Combination therapy of bupropion and high dose transdermal nicotine has been successful for smoking cessation, but the physician should be certain that his or her patient is not prone to coronary spasm. In premenopausal women, nicotine has been identified as the most important risk factor for coronary spasm (52). 

Cryan JF, Gasparini F, van Heeke G, Markou A (2003b) Non-nicotinic neuropharmacological strategies for nicotine dependence beyond bupropion. Drug Discov Today 8 1025-1034 Dar R, Frenk H (2002) Nicotine self-administration in animals a reevaluation. Addict Res Theory 10 545-579... 

Bupropion and also varenicline are mentioned in Chapter 21, Section I.c.4. Bupropion is a norepinephrine and dopamine reuptake inhibitor de-veoped as an antidepressant. It is now used on a large scale as a smoking cessation aid. Varenicline is the first nicotinic receptor partial agonist approved to treat smoking addiction. 

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