Facts about Wellbutrin and its effect on your smoking habits

Smoking remains a very common habit in the United States, with recent estimates showing that 23% of adults are still smoking.  In the past few years, there has been a great increase in the amount of research on smoking, and several new therapeutic methods have been developed. This article looks at a general approach to quitting smoking, with the importance on developments in drug therapy that are based on Agency for Health Care Policy and Research (AHCPR) guidelines. These guidelines hightlight systematic identification of smokers, conditions depending on physicians advice on quiting, and use of drug therapy to assist smokers to quit smoking.

Quitting smoking and Antidepressants

Bupropion is the first non-nicotine containing agent to be approved by the FDA for smoking cessation. Bupropion is a non-tricyclic antidepressant that has most of its neurochemical effect on the dopamine and norepinephrine transmitter systems. It has been used as a second-line antidepressant, and is also effective for patients with mania, adult attention deficit disorder, and other psychiatric conditions. Bupropion is available in two sustained-release forms (Wellbutrin and Zyban; Glaxo-Wellcome; Research Triangle Park, NC).

The Zyban form was developed specifically to help in quitting to smoke, and comes with a smoker support program that includes tailored messages on quitting and relapse prevention. Zyban is used in a somewhat lower maximal dose than Wellbutrin for depression. The initial study on bupropion has just been published and included less than 600 patients. The investigators excluded patients with current depression which was very important. Patients were randomized to placebo or bupropion, 50 mg bid, 150 mg qd, and 150 mg bid, and treated for 6 weeks.

The quit rates at the end of therapy were 10.5%, 13.7%, 18.3%, and 24.4%, respectively. Follow-up to 1 year suggested a continued benefit to bupropion therapy. Data from a study of bupropion combined with transdermal nicotine show high long-term quit rates with the combination therapy. The retail cost of bupropion is relatively high, at about $90 for 60 tablets of 150-mg strength. A typical duration of therapy is 7 to 12 weeks.  This means a 3-month supply would be about $270. Unfortunately, many insurers are not paying for bupropion therapy for smoking cessation, and restrict the use of the drug to psychiatrists only.

Wellbutrin is the generic name for bupropion, Bupropion (amfebutamone) is an antidepressant of the amino ketone class, chemically unrelated to tricyclics or selective serotonin reuptake inhibitors (SSRIs). It is similar in structure to the stimulant cathinone, and to phenethylamines in general. It is a chemical derivative of diethylpropion, an amphetamine-like substance used as an anorectic. It is in the class of the dopamine reuptake inhibitors. It does seem a bit confusing, but all it was is a comparison of wellbutrin to other forms of chemicals.

Bupropion was first synthesized by Burroughs Research in 1966, and patented by Burroughs-Wellcome (later Glaxo-Wellcome, and, as of 2000, GlaxoSmithKline) in 1974. It was approved by the FDA in 1985 and marketed under the name Wellbutrin as an antidepressant, but clinical trials indicated that incidence of seizure was two to four times greater than other antidepressants and the drug was quickly taken off the market.

Glaxo, realizing that seizure risk was a function of dosage, then developed and marketed a sustained-release (SR) version of Wellbutrin which, when ingested, releases bupropion hydrochloride at a constant, gradual rate into the body. Because of this altered mechanism of delivery, incidence of seizure with Wellbutrin-SR is comparable to, and in some cases, lower than that of other antidepressants.

Although the cessation rates with therapy for nicotine dependence are relatively low, systematic application of these principles in doctors’ offices is feasible, and over time will result in clinically important quit rates. Integration of smoking cessation into physician practice is a cornerstone of lung cancer prevention.

Health-care providers can help their patients quit smoking by using the following multiple steps approach: (1) identify all smokers and diagnose nicotine dependence; (2) provide self-help smoking cessation brochures; (3) provide brief, tailored advice to all smokers; (4) refer recalcitrant smokers to specialized clinics; and (5) use nicotine replacement and/or bupropion in combination with brief counseling and active follow-up.

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