Discussions that mention bupropion

Smoking Cessation board


Puppy, nothing or nobody can "make" you quit smoking. Each quitter has his own list of reasons to quit. You've already begun to make that list in your post (the cough, the smell, the $). Then, strangely, you say health and money aren't good enough reasons!!! If dying isn't enough, I don't think any support group will help you very much. Wait for a health crisis to make the decision for you if you must. Only problem there, it may be too late for quitting to help you much. The damage will have been done. I truly hope that somewhere, somehow, you can find the motivation to stop smoking.

[quote]Originally posted by MudPuppy:

I do not want to use the patches, gum, or any other crutch to help me quit. I'm already spending money on smokes, why would I want to spend EVEN MORE money on things that cannot guarantee I will quit. .


Nothing can guarantee you will quit. And many people have successfully quit cold turkey. Personally I was a total failure at that method and I needed the help of NRT. Please note here that you will spend less $ in the long run, stopping the cigarettes and replacing them with NRT for a few weeks to help you quit. (It isn't recommended that you use NRT while you are still smoking). It is scientifically proven that NRT paired with a support group can double the chances that a quitter will stay quit. Many people also try wellbutrin (Rx) and it, along with NRT, is a first-line strategy for smoking cessation. I am re-submitting an earlier post of mine (below) regarding recommended pharmacotherapies for smoking cessation.
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This is what the "Clinical Practice Guidelines" for treating tobacco use and dependence (these are published on the internet by the National Library of Medicine) say about the first-line treatment of tobacco dependence:
"Recommendations Regarding Specific Pharmacotherapies: First-Line Medications
First-line pharmacotherapies have been found to be safe and effective for tobacco dependence treatment and have been approved by the U.S. Food and Drug Administration (FDA) for this use. First-line medications have established empirical record of efficacy, and should be considered first as part of tobacco dependence treatment except in cases of contraindications.

The listing of the first-line medications is provided alphabetically. Meta-analyses did not contrast the relative efficacy of these medications.

Bupropion SR (Sustained Release Bupropion)
Recommendation: Bupropion SR is an efficacious smoking cessation treatment that patients should be encouraged to use. (Strength of Evidence = A)


Two large multicenter studies met selection criteria and were included in the analysis comparing bupropion sustained release (SR) to placebo. Results of this analysis are shown in Table 25. As can be seen from this analysis, the use of bupropion SR approximately doubles long-term abstinence rates when compared to a placebo.

Bupropion SR is the first non-nicotine medication shown to be effective for smoking cessation and approved by the FDA for that use. Its mechanism of action is presumed to be mediated by its capacity to block neural re-uptake of dopamine and/or norepinephrine. It is contraindicated in patients with a seizure disorder, a current or prior diagnosis of bulimia or anorexia nervosa, use of a monoamine oxidase (MAO) inhibitor within the previous 14 days, or in patients on another medication that contains bupropion. Bupropion SR can be used in combination with nicotine replacement therapies. Bupropion SR is available exclusively as a prescription medication both with an indication for smoking cessation (Zyban) and an indication for depression (Wellbutrin). Suggestions regarding the clinical use of bupropion SR are provided in Table 33.

Nicotine Gum
Recommendation: Nicotine gum is an efficacious smoking cessation treatment that patients should be encouraged to use. (Strength of Evidence = A)

Recommendation: Clinicians should offer 4 mg rather than 2 mg nicotine gum to highly dependent smokers. (Strength of Evidence = B)
Thirteen studies met selection criteria and were included in the analysis comparing nicotine gum to placebo. Results of this analysis are shown in Table 26. As can be seen by the estimated odds ratio from this analysis, 2 mg nicotine gum improves long-term abstinence rates by approximately 30-80 percent as compared with placebo. Furthermore, a close review of the literature suggests that the 4 mg gum is more efficacious than the 2 mg gum as an aid to smoking cessation in highly dependent smokers (see Table 10. Variables associated with higher or lower abstinence rates).109,110

Nicotine gum is currently available exclusively as an over-the-counter medication and is packaged with important instructions on correct usage, including chewing instructions. Suggestions regarding the clinical use of nicotine gum are provided in Table 34.

Nicotine Inhaler
Recommendation: The nicotine inhaler is an efficacious smoking cessation treatment that patients should be encouraged to use. (Strength of Evidence = A)
Four studies met selection criteria and were included in the analysis comparing the nicotine inhaler to placebo. Results of this analysis are shown in Table 27. As can be seen from this analysis, the nicotine inhaler more than doubles long-term abstinence rates when compared to a placebo inhaler.

The nicotine inhaler is available exclusively as a prescription medication. Suggestions regarding the clinical use of the nicotine inhaler are provided in Table 35.

Nicotine Nasal Spray
Recommendation: Nicotine nasal spray is an efficacious smoking cessation treatment that patients should be encouraged to use. (Strength of Evidence = A)
Three studies met selection criteria and were included in the analysis comparing nicotine nasal spray to placebo. Results of this analysis are shown in Table 28. As can be seen from this analysis, nicotine nasal spray more than doubles long-term abstinence rates when compared to a placebo spray.

Nicotine nasal spray is available exclusively as a prescription medication. Suggestions regarding the clinical use of the nicotine nasal spray are provided in Table 36.

Nicotine Patch
Recommendation: The nicotine patch is an efficacious smoking cessation treatment that patients should be encouraged to use. (Strength of Evidence = A)
Twenty-seven studies met selection criteria and were included in the analysis comparing the nicotine patch to placebo. Results of this analysis are shown in Table 29. As can be seen from this analysis, the nicotine patch approximately doubles long-term abstinence rates over those produced by placebo interventions.

The nicotine patch is available both as an over-the-counter medication and as a prescription medication. Suggestions regarding clinical use of the nicotine patch are provided in Table 37.

Recommendations Regarding Specific Pharmacotherapies: Second-Line Medications
Second-line medications are pharmacotherapies for which there is evidence of efficacy for treating tobacco dependence, but they have a more limited role than first-line medications because: (1) the FDA has not approved them for a tobacco dependence treatment indication; and (2) there are more concerns about potential side effects than exist with first-line medications. Second-line treatments should be considered for use on a case-by-case basis after first-line treatments have been used or considered.

The listing of the second-line medications is provided alphabetically. Meta-analyses did not contrast the relative efficacy of these medications.

Clonidine
Recommendation: Clonidine is an efficacious smoking cessation treatment. It may be used under a physician's supervision as a second-line agent to treat tobacco dependence. (Strength of Evidence = A)
Five studies met selection criteria and were included in the analysis comparing clonidine to placebo. Results of this analysis are shown in Table 30. As can be seen from this analysis, the use of clonidine approximately doubles abstinence rates when compared to a placebo. These studies varied the clonidine dose from 0.1 to 0.75 mg/day. The drug was delivered either transdermally or orally. It should be noted that abrupt discontinuation of clonidine can result in symptoms such as nervousness, agitation, headache, and tremor, accompanied or followed by a rapid rise in blood pressure and elevated catecholamine levels.

Clonidine is used primarily as an antihypertensive medication and has not been approved by the FDA as a smoking cessation medication. Therefore, clinicians need to be aware of the specific warnings regarding this medication as well as its side-effect profile.

Additionally, a specific dosing regimen for the use of clonidine has not been established. Because of the warnings associated with clonidine discontinuation, the variability in dosages used to test this medication, and a lack of FDA approval, the guideline panel chose to recommend clonidine as a second-line agent. As such, clonidine should be considered for smoking cessation under a physician's direction with patients unable to use first-line medications because of contraindications or with patients who were unable to quit using first-line medications. Suggestions regarding clinical use of clonidine are provided in Table 38.

Nortriptyline
Recommendation: Nortriptyline is an efficacious smoking cessation treatment. It may be used under a physician's supervision as a second-line agent to treat tobacco dependence. (Strength of Evidence = B)
Two studies met selection criteria and were included in the analysis comparing nortriptyline to placebo. Results of this analysis are shown in Table 31. As can be seen from this analysis, the use of nortriptyline increases abstinence rates when compared to a placebo.

Nortriptyline is used primarily as an antidepressant and has not been evaluated or approved by the FDA as a smoking cessation medication. Clinicians need to be aware of the specific warnings regarding this medication as well as its side-effect profile. Because of the limited number of studies examining nortriptyline and the small sample sizes within those studies, the guideline panel determined that the recommendation warranted a strength of evidence equal to B. Because of this strength of evidence, the side-effect profile, and the lack of FDA approval for tobacco dependence treatment, nortriptyline is recommended as a second-line agent. As such, nortriptyline should be considered for smoking cessation under a physician's direction with patients unable to use first-line medications because of contraindications or with patients who were unable to quit using first-line medications. Suggestions regarding clinical use of nortriptyline are provided in Table 39.

Combination Nicotine Replacement Therapy
Recommendation: Combining the nicotine patch with a self-administered form of nicotine replacement therapy (either the nicotine gum or nicotine nasal spray) is more efficacious than a single form of nicotine replacement, and patients should be encouraged to use such combined treatments if they are unable to quit using a single type of first-line pharmacotherapy. (Strength of Evidence = B)

This is only part of the document. The complete document can be viewed at [url="http://hstat.nlm.nih.gov/hq/Hquest/db/local.ahcpr.clin.tob/screen/TocDisplay/s/41843/action/Toc"]http://hstat.nlm.nih.gov/hq/Hquest/db/local.ahcpr.clin.tob/screen/TocDisplay/s/ 41843/action/Toc[/url]



[This message has been edited by GeorgiaPeech (edited 10-24-2003).]