Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new bupropion research articles will be listed here shortly after becoming available to us.
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Medical research on bupropion
Pharmacol Biochem Behav. 2008 Jun 3;
Stairs DJ, Dworkin SI
Bupropion has been found to be a useful pharmaceutical agent in furthering smoking abstinence. Preclinical research investigating the effects of bupropion on nicotine self-administration has indicated bupropion has selective effects on nicotine self-administration. However since response rates maintained by nicotine were significantly lower than rates of response maintained by the non-drug reinforcers, bupropion may have resulted in rate-dependent effects. The current experiments attempted to decrease the high response rate maintained through non-drug reinforcers in order to have more comparable control rates when investigating the selectivity of bupropion for nicotine self-administration. The effects of bupropion on nicotine self-administration (0.03 mg/kg/inf) were compared to food-maintained responding at two levels of food deprivation (deprived and satiated). Rats were satiated prior to the experimental session in order to decrease the overall response rates maintained through food reinforcement. Bupropion increased nicotine intake, but dose-dependently decreased food intake, when rats were food-deprived. However, when more comparable rates of behavior in the food-satiated group were investigated, bupropion had similar effects on nicotine and food-maintained responding. The data indicate that the effects of bupropion can be influenced by the control rate of responding. The results from these experiments also indicate that bupropion may not exert a selective effect on nicotine self-administration, since low rates of food and drug maintained responding were increased by the drug. These results indicate the importance of controlling for differences in response rates when attempting to assess the effects of drugs on responding maintained by different reinforcers. Furthermore, the results from the present study suggest that motivational variables (i.e. food deprivation) may be used to control for response rate differences maintained by drug and non-drug reinforcers.
Comparing the tolerability and effectiveness of two treatment regimens in a smoking clinic.
Mil Med. 2008 Jun; 173(6): 550-4
Sherman SE, Aldana I, Estrada M, York L
This study compares the effectiveness and tolerability of bupropion versus bupropion plus nicotine patch for smoking cessation in a routine clinical setting. Patients at the Sepulveda Veterans Health Administration Smoking Cessation Clinic completed a baseline survey and received counseling over 2 months, along with bupropion or bupropion plus nicotine patch. Of the 227 patients randomized to treatment, 112 (49%) received bupropion only and 115 (51%) received the combination therapy. At least one side effect was noted in 55% of bupropion patients and 70% of combination therapy patients; treatment regimens were changed in 7% and 14%, respectively. Abstinence rates at 2 months were 26% for the bupropion group and 37% for the combination therapy group (p = 0.1), and at 6 months were 42% versus 35%, respectively (p = 0.4). Although 6-month abstinence rates were derived from patient self-report and should be interpreted with caution, these results suggest that most patients referred to the clinic are able to take these medications. There was no difference in the rate of switching treatments, or in long-term abstinence rates.
Hum Mol Genet. 2008 Jul 1;
Conti DV, Lee W, Li D, Liu J, Van Den Berg D, Thomas PD, Bergen AW, Swan GE, Tyndale RF, Benowitz NL, Lerman C,
While the efficacy of pharmacotherapy for tobacco dependence has been previously demonstrated, there is substantial variability among individuals in treatment response. We performed a systems-based candidate gene study of 1,295 single nucleotide polymorphisms (SNPs) in 58 genes within the neuronal nicotinic receptor and dopamine systems to investigate their role in smoking cessation in a bupropion placebo-controlled randomized clinical trial. Putative functional variants were supplemented with tagSNPs within each gene. We used global tests of main effects and treatment interactions, adjusting the p-values for multiple correlated tests. A SNP (rs2072661) in the 3' UTR region of the beta2 nicotinic acetylcholine receptor subunit (CHRNB2) has an impact on abstinence rates at end of treatment (adjusted p = 0.01) and after a 6-month follow-up period (adjusted p = 0.0002). This latter p-value is also significant with adjustment for the number of genes tested. Independent of treatment at 6-month follow-up, individuals carrying the minor allele have substantially decreased odds of quitting (OR = 0.31; 95% CI 0.18-0.55). Effect estimates indicate that treatment is more effective for individuals with the wild-type (OR = 2.14, 95% CI 1.20-3.81) compared to individuals carrying the minor allele (OR = 0.83, 95% CI 0.32-2.19), although this difference is only suggestive (p = 0.10). Furthermore, this SNP demonstrated a role in the time to relapse (p = 0.0002) and an impact on withdrawal symptoms at target quit date (p = 0.0009). Overall, while our results indicate strong evidence for CHRNB2 in ability to quit smoking, these results require replication in an independent sample.
J Gen Intern Med. 2008 Jun 29;
Thomas JL, Guo H, Lynam IM, Powell JN, Okuyemi KS, Bronars CA, Ahluwalia JS
BACKGROUND: The double-blind placebo-controlled design is commonly considered the gold standard in research methodology; however, subject expectation bias could subvert blinding. OBJECTIVE: The primary aim of this study was to examine the impact of expectation bias. Specifically, we examined perceived treatment assignment on smoking cessation outcome rates among participants enrolled in a clinical trial of bupropion (150 mg SR, BID). DESIGN: Analyses were conducted on data collected during "Kick It at Swope," a double-blind, placebo-controlled, randomized trial of 600 African-American smokers. Chi-square and multiple logistic regression analyses were used to examine the impact of perception of assignment on treatment effect and cotinine-verified smoking abstinence rates. PARTICIPANTS: Participants were predominantly middle-aged (mean 44.7, SD 11.2), African-American women (68.6%), who smoked 19 CPD (SD = 8.1). Most had completed at least a high school education or GED (51.6%), and 55% had a monthly family income
Nicotine Tob Res. 2008 Jun; 10(6): 995-1008
Paterson NE, Balfour DJ, Markou A
Bupropion is an effective anti-smoking agent in humans, but the behavioral mechanisms mediating this effect are unclear. The present studies assessed the effects of chronic bupropion on the reinforcing and reward-enhancing effects of self-administered nicotine, and on the motivational properties of a nicotine-associated conditioned reinforcer. The present studies also assessed the reward-enhancing effects of nicotine self-administration under different levels of access to nicotine, and the effects of enforced abstinence from self-administered nicotine on brain reward function and somatic signs. Rats were prepared with bipolar electrodes in the lateral hypothalamus and trained on a discrete trial intracranial self-stimulation (ICSS) task. After establishing stable ICSS thresholds, rats were prepared with intravenous catheters and allowed to self-administer nicotine at different levels of access. Self-administered nicotine lowered ICSS thresholds, thereby providing a measure of the reward-enhancing effects of nicotine. Abstinence from 6h/d 7d/wk nicotine self-administration was associated with increased somatic signs of nicotine withdrawal and unchanged brain reward thresholds. Chronic bupropion administration via subcutaneous osmotic minipump had no effect on nicotine self-administration, but attenuated nicotine-induced enhancement of brain reward function and enhanced the motivational properties of a previously nicotine-associated conditioned stimulus. Thus, it is unlikely that chronic bupropion exerts anti-smoking effects by attenuating the primary or conditioned reinforcing effects of nicotine. Rather, preclinical investigations suggest that bupropion attenuates nicotine-induced enhancement of brain reward function and reverses the anhedonic, somatic, and neurochemical correlates of nicotine withdrawal.
Survey of treatment practices for sexual dysfunction(s) associated with anti-depressants.
J Sex Marital Ther. 2008; 34(4): 353-65
Balon R, Segraves RT
There are many management strategies and antidotes available for sexual dysfunction associated with antidepressants available. However, only a few of these strategies and antidotes were tested in rigorous trials and most of them probably will not be rigorously tested. Surveying the prescribing practices of experts in this area provides another opportunity to evaluate these strategies and antidotes. The authors surveyed 29 (of 50) "expert" psychiatrists in the area of sexual dysfunction associated with antidepressants. Switching to another antidepressant, decreasing the dose of an antidepressant, and adding oral agents such as bupropion, phosphodiesterase-5 inhibitors, and some dopaminergic agents (dextroamphetamine, methylphenidate) and a testosterone patch in some dysfunctions (libido, orgasm) are management strategies most frequently used by the experts. The experts also consider these strategies as the most effective ones. These findings are compared with other studies and discussed with regard to the evidence from clinical trials.
New Zealand smoking cessation guidelines.
N Z Med J. 2008; 121(1276): 57-70
McRobbie H, Bullen C, Glover M, Whittaker R, Wallace-Bell M, Fraser T
AIMS: To summarise the key recommendations made in the 2007 New Zealand Smoking Cessation Guidelines. METHODS: A comprehensive literature review of smoking cessation interventions was undertaken in November 2006. Recommendations were formulated from the findings of the literature review in line with the methods recommended by the New Zealand Guidelines Group. RESULTS: The Guidelines have been structured around a new memory aid (ABC) which incorporates and replaces the 5A's (ask, advise, assess, assist, arrange). ABC prompts healthcare professionals to ask about smoking status; give brief advice to stop smoking to all smokers; and provide evidence-based Cessation support for those who wish to stop smoking. Healthcare professionals should briefly advise all people who smoke to stop smoking, regardless of whether they say they are ready to stop smoking or not. They should then offer smoking cessation support which includes both behavioural (e.g. telephone and face-to-face support) and pharmacological (e.g. nicotine replacement therapy, nortriptyline, bupropion, or varenicline) interventions. Recommendations were also formulated for priority populations of smokers: Māori, Pacific, pregnant women, and people with mental illness and other addictions. CONCLUSIONS: These guidelines will assist healthcare professionals in providing evidence-based smoking cessation support to people who smoke. To be effective, the ABC model needs to be integrated into routine practice.
Physical activity as a strategy for maintaining tobacco abstinence: A randomized trial.
Prev Med. 2008 May 16;
Prochaska JJ, Hall SM, Humfleet G, Muňoz RF, Reus V, Gorecki J, Hu D
OBJECTIVES: For smoking cessation, physical activity (PA) may help manage withdrawal symptoms, mood, stress, and weight; yet studies of PA as an aid for smoking cessation have been mixed. This study examined: (1) the impact of an extended relapse prevention program on increasing moderate to vigorous PA (MVPA) in adults enrolled in a tobacco cessation treatment trial; (2) whether changes in MVPA were associated with sustained abstinence from smoking; and (3) mechanisms by which MVPA may support sustained abstinence from smoking. METHODS: In a randomized controlled trial conducted from 2003-2006 in San Francisco, California, 407 adult smokers received a 12 week group-based smoking cessation treatment with bupropion and nicotine patch with the quit date set at week 3. At week 12, participants were randomized to no further treatment or to 40 weeks of bupropion or placebo with or without an 11-session relapse prevention intervention of which 2 sessions (held at weeks 16 and 20) focused on PA. Participants receiving the PA intervention (n=163) received a pedometer, counseling to increase steps 10% biweekly towards a 10,000 steps/day goal, and personalized reports graphing progress with individualized goals. The International Physical Activity Questionnaire assessed weekly minutes of MVPA at baseline and weeks 12 and 24. Sustained abstinence from tobacco at week 24 was validated with expired carbon monoxide. RESULTS: In a repeated mixed model analysis, intervention participants significantly increased their MVPA relative to control participants, F(1,475)=3.95, p=.047. Pedometer step counts also increased significantly, t(23)=2.36, p=.027, though only 15% of intervention participants provided 6 weeks of pedometer monitoring. Controlling for treatment condition, increased MVPA predicted sustained smoking abstinence at week 24, odds ratio=1.84 (95% CI: 1.07, 3.05). Among participants with sustained abstinence, increased MVPA was associated with increased vigor (r=0.23, p=.025) and decreased perceived difficulty with staying smoke-free (r=-0.21, p=.038). CONCLUSION: PA promotion as an adjunct to tobacco treatment increases MVPA levels; changes in MVPA predict sustained abstinence, perhaps by improving mood and self-efficacy.
[The importance of treating tobacco dependence]
Rev Esp Cardiol. 2008 Jun; 61(6): 620-8
McRobbie H, Thornley S
Smoking is a well-established risk factor for cardiovascular disease (CVD). Stopping smoking confers significant health benefits and is especially important for those with pre-exisiting CVD. Healthcare facilities should have systems in place to enable the identification of people who smoke, and ensure that smokers receive evidence based treatments to provide the best possible chances of stopping for good. Physicians have a crucial role to play to prompt quit attempts by giving brief advice to stop, and offering cessation support. Behavioural support strategies such as telephone, individual and group-based counselling improve the chances of long-term abstinence. Nicotine replacement therapy, bupropion and varenicline are medicines that have proven efficacy in aiding smoking cessation and increase the odds of quitting about 2-3 fold compared to placebo. Even patients with established cardiovascular disease can safely use nicotine replacement therapy to help them quit. For the greatest chance of success, physicians should recommend a combination of behavioural support and pharmacotherapy.
Neuropsychiatr Dis Treat. 2005 Mar; 1(1): 3-7
Pinder RM
Noradrenaline has long played a key role in the way the etiology of depression is conceptualized and in the mechanism of action of many current antidepressants. Tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), selective noradrenaline reuptake inhibitors (NRIs), the noradrenergic and specific serotonergic antidepressant (NaSSA) mirtazapine, and many atypicals, like mianserin and bupropion, influence, at least in part, central noradrenergic function. Enhancement of noradrenergic function may be particularly helpful in patients with melancholia. However, while noradrenaline will continue to be a target for research into the etiology and treatment of depression, it is unlikely that antidepressants acting solely on noradrenaline will be pursued.