NEW YORK (Reuters Health) – Bupropion sustained release (SR) contributes to smoking cessation efforts in patients with schizophrenia, according to a report in the April 5th online Journal of Clinical Psychiatry.
“Many people with chronic psychotic symptoms who are stable on their medication and in ongoing care can tolerate smoking cessation and with the use of all available intervention, they can successfully quit smoking,” Dr. Elaine Weiner from University of Maryland School of Medicine, Baltimore, Maryland told Reuters Health in an email.
Dr. Weiner and colleagues investigated the efficacy and tolerability of bupropion SR in a 14-week randomized, open-label trial of 46 smokers with schizophrenia, 32 of which completed the study, and in a meta-analysis of 4 previously reported placebo-controlled, parallel-group studies.
In their trial, the rates of sustained abstinence were higher for bupropion participants (4/22, 18%) than for placebo participants (2/19, 11%), but this difference was not statistically significant (P=0.67).
Secondary measures in their randomized trial, including side effects, did not differ significantly between treatment groups.
“I believe that the low number of subjects made it hard to detect a statistically significant result,” Dr. Weiner said.
In contrast, the meta-analysis of studies including 119 participants randomized to bupropion and 121 randomized to placebo revealed a 2.7-fold greater likelihood of 4-week abstinence with bupropion than with placebo (P=0.009) and significantly lower end-expired carbon monoxide levels with bupropion by week 5 of double-blind treatment.
“Psychiatrists should make use of all available interventions- group/ individual counseling, nicotine replacement therapy, and either bupropion SR or varenicline-to treat nicotine addiction in their stable patients with schizophrenia,” Dr. Weiner concluded. “Whenever possible, all three modalities should be used.
“When cessation has occurred, pharmacologic support should continue for at least a year and maybe longer, as the pathophysiology of schizophrenia may make people more susceptible to relapse,” Dr. Weiner said.
“Care providers tend to have a nihilistic attitude toward smoking in this population and buy into arguments that these patients need to smoke to help them deal with psychotic symptoms or anxiety,” Dr. Weiner added. “Though there are many patients and care providers who will make this argument, when studied in larger groups, the data do not support these beliefs.”
Three of the 7 authors (not Dr. Weiner) have served as consultants to GlaxoSmithKline, manufacturer of bupropion. GlaxoSmithKline did not provide financial support for these studies.
J Clin Psychiatry
