The pharmacology underlying pharmacotherapy for tobacco dependence: a focus on bupropion

Tobacco dependence remains the major preventable cause of early mortality and morbidity in the developed world. The primary reinforcer of the dependence is the nicotine present in tobacco smoke and, for many smokers, successful treatment depends upon breaking this dependence. Until recently, the only specific pharmacotherapy available for tobacco dependence was nicotine replacement therapy (NRT). Although this approach does significantly increase long-term cessation rates, it is by no means a panacea for the many smokers who require help to quit. Recently, a new drug, bupropion (Zyban), has been licensed as an additional pharmacological aid for smoking cessation. This commentary discusses the mechanisms that may account for its efficacy in this indication and considers the impact its introduction may have on the approach of healthcare systems to the treatment of tobacco dependence.