Does Extended Pre Quit Bupropion Aid in Extinguishing Smoking Behavior?

Area of Science:

• Pharmacology
• Addiction Medicine
• Behavioral Science

Background:

• Understanding bupropion's smoking cessation mechanisms is crucial for treatment optimization.
• Reduced smoking reinforcement is a potential mechanism, suggesting longer pre-quit bupropion may enhance extinction of smoking behavior.

Purpose of the Study:

• To evaluate if 4 weeks of pre-quit bupropion (extended run-in) increases pre-quit reductions in smoking rate and cotinine compared to standard 1-week pre-quit bupropion (standard run-in).
• To assess if extended run-in bupropion therapy leads to greater short-term abstinence rates.

Main Methods:

• Ninety-five adult smokers were randomized into two groups: standard run-in (3 weeks placebo, 1 week bupropion) or extended run-in (4 weeks bupropion).
• Both groups received behavioral counseling and 7 weeks of post-quit bupropion.
• Daily smoking rate, craving, withdrawal, and subjective effects were recorded pre-quit; cotinine and carbon monoxide were measured biochemically.

Main Results:

• The extended run-in group showed a significantly greater decrease in smoking rate during the pre-quit period (interaction p = .03).
• Cigarette craving and salivary cotinine levels also decreased more in the extended run-in group, with cotinine reductions notable in women.
• Biochemically verified 4-week continuous abstinence rates were higher in the extended run-in group (53%) versus the standard run-in group (31%, p = .033).

Conclusions:

• Extended use of bupropion before a quit attempt effectively reduces smoking behavior and enhances short-term abstinence.
• Findings support an extinction-of-reinforcement model for bupropion's efficacy in smoking cessation.
• Further research into extended run-in bupropion therapy is warranted for smoking cessation treatment.