is associated with better treatment retention
rates.^103 Acamprosate generally is safe to use, as
it does not appear to have a potential for
addiction, has virtually no overdose risk, has
mostly mild side effects and does not interact
significantly with other medications.^104
Antidepressant medications also have proven to
be effective in smoking cessation. The
mechanism driving the efficacy of
antidepressants as cessation agents is not yet
fully understood. It may be that antidepressant
medications compensate for nicotine’s anti-
depressive effects during withdrawal, lessening
this withdrawal symptom. Alternatively,
antidepressant medications may work--
independent of their antidepressant qualities--on
the neural pathways or the nicotine receptors
that are active in addiction involving nicotine.*
(^105)
Bupropion sustained release (SR) (brand
names Zyban and Wellbutrin) is a
prescription antidepressant medication that
can be used alone or in combination with
nicotine replacement therapy (NRT) for
smoking cessation.^106 It is believed to work
by minimizing cravings and withdrawal
symptoms during the early stages of tobacco
cessation.^107 Bupropion may be effective in
relieving negative mood and feelings that
smokers may experience when going
through smoking cessation.^108 The
neurological effects of bupropion that aid in
its efficacy as a cessation medication may
include blocking the re-uptake of two
neurotransmitters that are active in addiction
involving nicotine--dopamine and
norepinephrine--and blocking nicotine
receptors.^109 The medication reduces the
severity of nicotine withdrawal and the
depression that may accompany smoking
cessation.^110 Another advantage of
bupropion for smoking cessation is that it
tends to lessen the weight gain that often
accompanies--and derails--smoking
cessation attempts.^111
- For example, by blocking nicotine receptors in the
brain.
Patients generally are advised to begin daily
bupropion treatment one to two weeks prior
to quitting so that adequate blood levels of
the medication can be reached.^112 The
standard course of treatment is seven to 12
weeks, although this period can be extended
for up to six months if necessary.^113
Possible side effects include insomnia, dry
mouth, nausea and a small risk of
seizures.^114 Bupropion SR carries a black
box warning† of increased suicidal
tendencies among children, adolescents and
young adults.^115
A meta-analysis of 24 bupropion studies
found that the drug can nearly double
smokers’ chances of achieving abstinence
lasting longer than five months compared to
a placebo.^116 Other analyses found similar
results.^117 The efficacy of the drug does not
seem to be sensitive to longer follow-up
periods (up to 12 months), treatment setting,
dosage or the level of supplementary
psychosocial therapy.^118
Bupropion also may be a promising
treatment for methamphetamine addiction; it
appears to reduce cravings and the
rewarding effects of methamphetamine.^119
However, evidence supporting its ability to
increase abstinence rates is mixed and
further research is needed to establish
bupropion as an effective treatment for
methamphetamine addiction.^120
Preliminary research indicates that another
antidepressant, nortriptyline (brand names
Pamelor and Aventyl), may be an effective
smoking cessation aid.^121 Nortriptyline has
been found to double patients’ chances of
cessation compared to placebos.^122
However, the medication has not yet been
approved by the FDA for use as a smoking
cessation aid; therefore, it only is
recommended for use by patients who have
not responded well to NRT or bupropion.^123
† A black box warning from the FDA denotes the
most serious warning of adverse effects for a
medication.