[Bupropion as an aid for smoking cessation]

Quitting smoking is a primary lifestyle option for reducing the risk of a number of diseases. Effective therapies include counselling, nicotine replacement and bupropion, a dopamine and noradrenaline reuptake inhibitor.

Double-blind, placebo-controlled studies with > or = 100 subjects identified through the Cochrane database or presented by the author at a congress are reviewed.

Bupropion initially increased quit rates in a dose-dependent manner among healthy smokers treated at specialist clinics. Recent trials have included smokers treated in a wider range of settings and in subgroups who often experience difficulties in quitting, including smokers with pulmonary or cardiovascular disease and smokers who relapsed after previous treatment with bupropion. In three studies reporting twelve-month results, quit rates were 27-30% for bupropion compared to 12-16% for placebo and continuous abstinence rates were 18-22% compared to 6-11% for placebo. In meta-analysis the odds ratio for smoking cessation of bupropion versus placebo was 2.16 (95% confidence interval 1.51-3.10) with combined data for six and twelve months of continuous abstinence. Bupropion was well tolerated in all the trials and is recommended in US and UK guidelines.

Physicians should recommend medication for smoking cessation for patients with no contraindications because of the enormous benefits of quitting.