Clinical bottom line (level 1a)
- Smokers who take bupropion compared with placebo are
more likely to stop smoking (NNT = 9 at 12 months) .
- Smokers who take bupropion compared with nicotine
patches are more likely to stop smoking (NNT = 12 at 12
- Adding nicotine patches to bupropion is not clearly more
effective than bupropion alone.
- Smokers who take nortryptiline compared with placebo are
more likely to stop smoking (NNT = 6 at 6 months) .
|Hughes et al: Cochrane Library 2000; 2 : -
||Expires June 2003 |
The studySystematic review of all randomised controlled trials of
Articles found in all languages using Cochrane
Tobacco Addiction Group trials register (indexed from Medline, Embase,
SciSearch and PsycLit, and meeting abstracts), 1966 to 1999 (search terms:
drug name and 'smoking' as free text terms ) and contacting investigators
in the area.
- Patients: smokers
- Intervention: antidepressant drugs compared with placebo or
alternative therapeutic control
- Outcome: abstinence from smoking at least 6 months from start of
Selection criteria: see above
by 2 independent reviewers: using method of randomisation and completeness
Articles excluded if:
10 studies found: 5 on bupropion, 1 on moclobemide, sertraline
and venlafaxine, 2 on nortryptiline and fluoxetine
- trials lasted less than 6 months
- nicotine, clonidine or lobeline used for smoking cessation
||Time to outcome
|smoking abstinence: bupropion v. placebo
(1.90 to 3.94)
(6 to 16)
|smoking abstinence: buproprion v. nicotine patch
(1.22 to 3.37)
(6 to 52)
|smoking cessation: bupropion + patch v. nicotine patch alone
(1.57 to 4.10)
(5 to 21)
|smoking cessation: bupropion + nicotine patch v. bupropion
(0.82 to 1.98)
(NNT = 8 to infinity;
NNH = 36 to infinity)
|long-term smoking cessation: nortryptiline v. placebo
(1.59 to 5.03)
(3 to 15)
- A small benefit was found using fluoxetine.
- No clear effect on smoking cessation was found for sertraline,
venlafaxine or moclobemide.
- Studies were generally small, and other smoking systematic reviews
have demonstrated evidence of publication bias.
Search Terms: bupropion in Cochrane Library
- Hughes LF, Stead LF, Lanacaster T, et al: anxiolytics and
antidepressants for smoking cessation. Cochrane Library 2000; 2 : -
Chris Ball, June 2000
|Intervention or Exposure
||antidepressants: bupropion, nortryptiline|
||long-term smoking cessation||