Bupropion vs. Placebo in Smoking Cessation

Antidepressant medications have received mixed reviews as adjuncts for smoking cessation in persons free of depression. The current study investigated 615 adult smokers who used at least 15 cigarettes daily. Patients were administered bupropion at 100, 150, or 300 mg daily in sustained-release form vs. placebo. Subjects were seen weekly in the first eight weeks, then periodically over the remainder of 52 weeks.

Six weeks after the target quit date, each dose of active drug was superior to placebo in achieving smoking cessation. More than 44% of participants were nonsmokers at six weeks vs. 19% of placebo recipients. Similarly, at one year, 23.1% of bupropion recipients were successful vs. 12.4% of the placebo group. When broken down by dose, 150 mg and 300 mg of bupropion were efficacious, but 100 mg was not.

Weight gain was substantially greater in the placebo group (2.9 kg) than in the treatment group (2.3 kg at 150 mg/d and 1.5 kg at 300 mg/d) during treatment, though the relationship of weight gain and treatment was no longer linear at six months. As pointed out by previous investigators, initial weight gain associated with smoking cessation is a hindrance to success, hence most pertinent to eventual outcome.

Overall, therapy was well tolerated, with only 5% of placebo recipients withdrawing due to adverse events and 5-8% of bupropion recipients discontinuing, most commonly due to tremor, headache, rash, and urticaria. Sustained-release bupropion is a well-tolerated, effective method for smoking cessation, which additionally assists in obviating weight gain that may deter intended non-smokers from achieving their goal.

Hurt RA, et al. N Engl J Med 1997; 337:1195-1202.