Richmond Robyn, Zwar Nicholas
School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.
Drug Alcohol Rev. 2003 Jun;22(2):203-20. doi: 10.1080/09595230100100642.
The advent of bupropion hydrochloride sustained release (Zyban) has heralded a major change in the options available for smoking cessation pharmacotherapy. Bupropion is a selective re-uptake inhibitor of dopamine and noradrenalin which prevents or reduces cravings and other features of nicotine withdrawal. Bupropion is a useful oral and non-nicotine form of pharmacotherapy for smoking cessation. For this review a total of 221 papers were reviewed plus poster presentations. This review examines in detail original clinical trials on efficacy, categorised according to whether they were acute treatment trials in healthy smokers; studies in specific populations such as people with depression, chronic obstructive pulmonary disease (COPD) or cardiovascular disease; or relapse prevention studies. Overall, these studies in varying populations comprising over four thousand subjects, showed bupropion consistently produces a positive effect on smoking cessation outcomes. The evidence highlights the major public health role that bupropion has in smoking cessation. The methodological issues of published clinical trials reporting one year outcomes were examined in detail including: completeness of follow-up; loss to follow-up; intention to treat analysis; blindness of assessment; and validation of smoking status. The review discusses contraindications, adverse effects, dose and overdose, addictive potential, and the role of bupropion in reducing cessation-related weight gain. Bupropion combined with or compared to other pharmacotherapies (nicotine patch; nortriptyline) is considered. Impressive evidence exists for the use of bupropion in smoking cessation among difficult patients who are hard-core smokers such as those with cardiovascular disease, chronic obstructive pulmonary disease (COPD) and depression. Bupropion reduces withdrawal symptoms as well as weight gain and is effective for smoking cessation for people with and without a history of depression or alcoholism. Serious side effects of bupropion use are rare. The major safety issue with bupropion is risk of seizures (estimated at approximately 0.1%) and it should not be prescribed to patients with a current seizure disorder or any history of seizures. In clinical trials of bupropion for smoking cessation no seizures were reported. Allergic reactions occur at a rate of approximately 3% and minor adverse effects are common including dry mouth and insomnia.
盐酸安非他酮缓释片（畅沛）的出现预示着戒烟药物治疗的可用选择发生了重大变化。安非他酮是一种多巴胺和去甲肾上腺素的选择性再摄取抑制剂，可预防或减轻对尼古丁的渴望及其他戒断症状。安非他酮是一种用于戒烟的有用的口服非尼古丁药物治疗形式。本次综述共查阅了221篇论文及壁报展示。本综述详细审视了关于疗效的原始临床试验，根据试验对象是否为健康吸烟者的急性治疗试验、特定人群（如抑郁症患者、慢性阻塞性肺疾病（COPD）患者或心血管疾病患者）的研究或预防复吸研究进行分类。总体而言，这些涉及四千多名受试者的不同人群的研究表明，安非他酮对戒烟结果始终产生积极影响。证据凸显了安非他酮在戒烟方面的重大公共卫生作用。详细审查了报告一年结果的已发表临床试验的方法学问题，包括：随访完整性；失访情况；意向性分析；评估的盲法；以及吸烟状态的验证。本综述讨论了禁忌证、不良反应、剂量与过量、成瘾可能性以及安非他酮在减轻戒烟相关体重增加方面的作用。还考虑了安非他酮与其他药物治疗（尼古丁贴片、去甲替林）联合使用或进行比较的情况。有令人信服的证据表明，对于心血管疾病、慢性阻塞性肺疾病（COPD）和抑郁症等重度吸烟者这类难治性患者，安非他酮在戒烟方面有应用价值。安非他酮可减轻戒断症状以及体重增加，对有或无抑郁症或酗酒史的人戒烟均有效。使用安非他酮的严重副作用罕见。安非他酮的主要安全问题是癫痫发作风险（估计约为0.1%），不应给目前患有癫痫症或有任何癫痫病史的患者开此药。在安非他酮戒烟的临床试验中未报告癫痫发作情况。过敏反应发生率约为3%，常见的轻微不良反应包括口干和失眠。
