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Smoking in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Pharmacological Treatment

Table 4. Nicotine Patches continued...

In a pooled analysis of two randomized studies (N = 2,052) in which varenicline was directly tested against bupropion SR and a placebo,[3] results showed continuous abstinence rates of 44% with varenicline, 29.7% with bupropion SR, and 17.7% with placebo at weeks 9 through 12. Abstinence rates were followed through week 52 at study end, with varenicline at 22.4%, bupropion SR at 15.4%, and placebo at 9.3%. Factors found in previous studies to predict better quit rates-such as being older, being male, having a lower level of nicotine dependence, smoking fewer cigarettes at baseline, and having the first cigarette of the day at a later time-were not found to be predictive of higher quit rates in this pooled analysis.[3]

Bupropion hydrochloride (HCl)

Also used as an antidepressant, bupropion HCl (Zyban) is a non-nicotine aid to smoking cessation. It is a relatively weak inhibitor of the neuronal uptake of norepinephrine, serotonin, and dopamine and does not inhibit monoamine oxidase. The exact mechanism by which bupropion HCl enhances the ability of patients to abstain from smoking is unknown; however, it is presumed that this action is mediated by noradrenergic or dopaminergic mechanisms.[18] One study [19][Level of evidence: I] failed to find any additional value of bupropion HCl in reducing relapse in individuals using the nicotine patch compared with a placebo either as part of a relapse prevention program (after the end of successful patch therapy) or as a second-level treatment for individuals who were still smoking after nicotine-patch therapy.

Table 5. Varenicline and Bupropion HCl

BrandDoseSide EffectsWarning/Precautiona
bid = twice a day; HCl = hydrochloride; Rx = prescription; SR = sustained release.
a Clinicians need to closely monitor all patients taking varenicline and bupropion hydrochloride (HCl). The premarketing smoking cessation studies of these medications excluded patients with serious psychiatric illness (e.g., schizophrenia, bipolar disorder, and major depressive disorder), suggesting that the safety of these medications for these patients has not been investigated.[15,20]Therefore, during smoking cessation, patients with preexisting psychiatric illness who are receiving varenicline and bupropion HCl for smoking cessation need to be especially monitored.
RxChantix (varenicline)0.5 mg/d, days 1-3; 0.5 mg bid, days 4-7; then 1.0 mg bid through week 12Nausea, insomniaRisk of toxicity higher in patients with impaired renal function.
Not tested in children and pregnant women.
RxZyban (bupropion HCl)150 mg/d × 3 days, then increase to 300 mg/d × 7-12 weeksInsomnia, dry mouth, dizziness, rhinitisDo not take with Wellbutrin or Wellbutrin SR.
Higher incidence of seizures in patients treated for bulimia or anorexia.
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