Bupropion Benefits Smoking Cessation

Hays JT, Ebbert JO: Bupropion sustained release for treatment of tobacco dependence. Mayo Clin Proc 2003;78(8):1020-1024.

Based on five published randomized controlled clinical trials and a meta-analysis, bupropion sustained release (SR) more than doubles the likelihood of successful smoking cessation after 6 or 12 months (OR 2.54; 95% CI 1.90-3.41). Bupropion SR provides additional benefit by reducing the weight gain that often follows when tobacco is stopped. Unlike tricyclic antidepressants, bupropion SR is virtually free of cardiovascular side effects. The most common adverse effects have been insomnia (30%-45%) and dry mouth (5%-15%).

In the United States, there have been no reports of death or increased serious adverse effects with bupropion. Contraindications to bupropion therapy include an increased risk of seizures including a history of previous closed head trauma. Cigarette smokers who are motivated to stop smoking should be offered appropriate drug therapy with bupropion SR alone or in combination with nicotine replacement therapy. For pregnant and lactating smokers, children, and adolescent smokers, the United States Public Health Service Clinical Practice Guideline advises initial use of behavioral interventions. As a second line therapy, those motivated to quit may be offered bupropion SR if the benefits are thought to outweigh the risks. In clinical trials, therapy has lasted 7 to 12 weeks, but it can be continued for 12 months to delay relapse to smoking.