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We administered bupropion sustained-release (SR) in a pharmacist-managed outpatient smoking-cessation program. Patients were referred to the program by their primary care physician. All patients completed initial visit questionnaires, received behavioral counseling by a clinical pharmacist, and were provided educational materials on smoking cessation. Seventy-one patients received bupropion SR for treatment of nicotine dependence and were followed for 6 months. Point prevalence abstinence rates were 28.2% and 25.4% at 8 weeks and 6 months, respectively. The trend was toward lower cessation rates in patients with a documented psychiatric diagnosis at 6 months (p=0.064). Bupropion SR was fairly well tolerated, with the most common adverse effects being dry mouth and bad taste. The agent appears to have better success for smoking cessation in patients free of psychiatric comorbidities, but further research is required to support this finding.
Cigarette smoking is the single most preventable cause of disease and death in the United States. Over 400,000 Americans die every year from tobacco-related diseases, more than from acquired immunodeficiency syndrome, illegal drugs, alcohol, fires, motor vehicle crashes, murders, and suicides combined. Direct medical costs attributable to smoking total at least $50 billion/year. In 1997, 36% of adolescents and 24% of adults were smokers. Seventy percent of smokers want to quit completely, 46% try to quit each year, and more than 70% visit a health care setting each year. Given these findings, the variety of effective treatments, and significant morbidity, mortality, and economic effects attributed to smoking, the U.S. Public Health Service recently published a clinical practice guideline that provides recommendations for brief and intensive clinical interventions and strategies to promote treatment of tobacco dependence. Available Food and Drug Administration-approved pharmacologic agents for smoking cessation are nicotine gum, transdermal nicotine patch, nicotine inhaler, nicotine nasal spray, and bupropion sustained-release (SR).
Bupropion SR, first developed and marketed as an antidepressant (Wellbutrin; Glaxo Wellcome Inc, Research Triangle Park, NC), was approved under the brand name Zyban (Glaxo Wellcome Inc.) in May 1997 as a nonnicotine aid to smoking cessation. The mechanism by which it enhances a person's ability to abstain from smoking is unknown. It is presumed to work on the neurochemistry of nicotine addiction by enhancing dopamine levels in the mesolimbic system and affecting noradrenergic neurons in the locus ceruleus. Clinically, these pharmacologic properties are thought to be beneficial in reducing withdrawal symptoms, cravings, and the urge to smoke.
We used bupropion SR in a pharmacist-managed, smoking-cessation program in patients with a variety of medical and psychiatric conditions. Because earlier research was restricted to healthy volunteers, little information is available regarding the effectiveness and tolerability of the agent when taken for smoking cessation in an outpatient setting.
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