Nicotine reduction: Effectiveness of bupropion

Hayford et al (1999) and others have found sustained-release bupropion useful as part of nicotine reduction treatment programmes. However, our clinical experience suggested the primary benefit of sustained-release bupropion (300 mg/day) occurred within the first month of treatment and the recommended second month of medication was probably not helpful.

We evaluated the treatment progress of 74 (30 one-month, 44 two-month) research volunteers (further details available from the first author upon request). Treatment condition assignment was random but one-month patients had the option of an additional two months of medication if they were not successful at quitting at immediate follow-up, thus decreasing the number of one-month participants for this study. Volunteers had a mean age of 56 and were primarily male (91%), cigarette smoker (96%) and White (92%). One-and two-month groups did not differ significantly on a number of treatment motivation measures, demographic variables and self-reported health variables.

All patients signed consent forms and received the same behavioural treatment information in the first session. All were also instructed to return to a second meeting at which time their progress was evaluated and they received more behavioural strategy information and their assigned sustained-release bupropion. Participants were followed (a) as soon as convenient after nicotine quit date, (b) three-months after immediate follow-up, and (c) six-months after initial group meeting. About 80% of potential subjects volunteered for this project and follow-up return rate averaged 81%.

Use of one or two months of bupropion did not significantly affect self-reported quit rates at immediate, three-month or six-month follow-up periods. Self-reports of decreased nicotine intake among patients who did not quit entirely also did not differ between one- and two-month groups at immediate, three-month, or six-month follow-up periods. Only weight gain was associated with six-month treatment success. Participants who were successful reported more weight gain than those who were not. However, one- or two-month dosing schedule was not significantly associated with reported weight changes. Quitting success at six months was not related to age, gender, tobacco type, income category, race, combat exposure, years' service, side-effect ratings, health problem ratings concerning breathing, heart, general medical, psychiatric, or substance dependence areas, religious behaviour, immediate weight gain, or initial self-ratings of treatment programme helpfulness/motivation/self-control/completion.

Our programme evaluation results suggest that one-month use of sustained-release bupropion (300 mg/day) is as effective as two-month use in American veterans. One-month use reduced cost but had no clear effect on general (yes/no) side-effect ratings. Future programme evaluation efforts may increase both the population size and sophistication of follow-up procedures. In addition, it may be useful to evaluate whether 15 mg of bupropion daily may be just as effective as 300 mg daily. Over two-month periods, previous research suggests that neither the antidepressant (Reimherr et al, 1998) nor nicotine reduction (Hurt et al, 1997) effects of bupropion were significantly different between these two dosing schedules, even with patients with a history of major depression (Hayford et al, 1999).