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Communications to the Editor |

Nicotine Reduction and Bupropion FREE TO VIEW

Joseph K. Neumann, PhD; Benjamin Peeples, MA; Adam Seneker, PharmD
Author and Funding Information

Department of Veterans Affairs Johnson City, TN

Correspondence to: Joseph K. Neumann, PhD, Psychology Service (116B2), Department of Veterans Affairs, PO Box 4000, Mountain Home, TN 37684-4000



Chest. 2002;121(4):1378. doi:10.1378/chest.121.4.1378
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To the Editor:

In a recent article in CHEST, Dale and colleagues (May 2001)1reported on factors that are predictive of successful smoking cessation and noted that the first 2 weeks of treatment were the “most crucial.” We also noticed this time period and found no significant immediate, 3-month, or 6-month reduction or quit rate differences between 1 month and 2 months of use of bupropion SR, 300 mg/d.2 The results of the study of smoking cessation by Dale et al,1 as well as the work of others in antidepressant therapy,3 suggest very limited differences between bupropion SR dosing schedules of 150 and 300 mg/d.

We recently completed a treatment program evaluation to compare the relative effectiveness of 150 mg/d vs 300 mg/d bupropion SR as part of nicotine reduction therapy with older American veterans. Seventy-three patients completed all project requirements and were the focus of this study. Treatment condition assignment (150-mg group, 34 patients; 300-mg group, 39 patients) was random, with patients in the 150-mg group having the option to receive 1 month of bupropion therapy at 300 mg daily (our standard dosage) after the 2-month follow-up. All patients signed consent forms and received the same behavioral treatment during the first session. Patients returned after 2.5 weeks to discuss their progress and difficulties, to receive more behavioral change information, and to receive bupropion SR. Subjects were followed-up by mail 2 months after the end of the second session.

The typical veteran was a white male, aged 57 years. There were no significant (p < 0.05) differences between groups as a function of demographic factors, treatment motivation variables, or health habits. About 26% of patients reported quitting all nicotine use at follow-up, and 80% of those still using tobacco claimed nicotine reduction. Neither the group that quit (χ2 test, 0.27; p = 0.60) nor the group that reduced tobacco use (χ2 test, 1.35; p = 0.25) showed significant differences; however, side effect profiles tended to be different. In response to a yes-no question concerning the presence of side effects, a higher percentage of patients in the 300-mg group complained of side effects than did patient in the 150-mg group (χ2 test, 3.47; p = 0.06), with the total number of side effects averaging 2.6 per patient in the 300-mg group vs 1.2 per patient in the 150-mg group (t test, 1.92; p = 0.06). Weight change did not vary significantly between groups.

Larger studies with fewer methodological limitations are needed. However, this program evaluation indicates that 1 month of bupropion SR therapy at 150 mg/d may provide the maximum benefit for minimal expense and risk.

This study was supported by resources from the James H. Quillen Veterans Affairs Medical Center.

Dale, CD, Glover, ED, Sachs, DPL, et al (2001) Bupropion for smoking cessation: predictors of successful outcome.Chest119,1357-1364. [PubMed] [CrossRef]
 
Neumann, JK, Peeples, B, East, J, et al Nicotine reduction: effectiveness of bupropion.Br J Psychiatry2000;177,87-88
 
Reimherr, FW, Cunningham, LA, Batey, SR, et al A multicenter evaluation of the efficacy and safety of 150 and 300 mg/d sustained-release bupropion tablets versus placebo in depressed outpatients.Clin Ther1998;20,505-516. [PubMed]
 

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References

Dale, CD, Glover, ED, Sachs, DPL, et al (2001) Bupropion for smoking cessation: predictors of successful outcome.Chest119,1357-1364. [PubMed] [CrossRef]
 
Neumann, JK, Peeples, B, East, J, et al Nicotine reduction: effectiveness of bupropion.Br J Psychiatry2000;177,87-88
 
Reimherr, FW, Cunningham, LA, Batey, SR, et al A multicenter evaluation of the efficacy and safety of 150 and 300 mg/d sustained-release bupropion tablets versus placebo in depressed outpatients.Clin Ther1998;20,505-516. [PubMed]
 
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