Letters

Bupropion for smokers

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7283.431 (Published 17 February 2001) Cite this as: BMJ 2001;322:431

Bupropion may not be as good as editorial implies

  1. Christopher Harrison, general practitioner ([email protected])
  1. Barlow Medical Centre, Manchester M20 6TR
  2. Berkshire Diet Centre, Reading, Berkshire RG1 1SN
  3. Public Health Research Unit, Willerby, Hull HU10 6NS
  4. Meanwood Group Practice, Leeds LS6 4JN
  5. Division of Respiratory Medicine, University of Nottingham, City Hospital, Nottingham NG5 1PB
  6. Department of Epidemiology and Public Health, ICRF Health Behaviour Unit, University College London, London WC1E 6BT

    EDITOR—Britton and Jarvis give a surprisingly uncritical welcome to bupropion.1 Although Jorenby et al did find that 30% of patients who took bupropion were still non-smokers after 12 months (point prevalence data), these volunteers must have been highly motivated as 12-15% of those who took the placebo successfully stopped smoking.2 There are no studies showing that bupropion is effective in more averagely motivated patients.

    The patients in Jorenby et al's study received intensive counselling, which comprised more than three hours of face to face counselling and 80 minutes of telephone support over the 12 months. It is not realistic for the NHS to provide this level of support. The manufacturers are offering a telephone line for patients to ring for support, but this is not likely to be as effective in motivating and supporting patients. The high success rates reported by Jorenby et al are therefore unlikely to be repeated in day to day practice.

    Britton and Jarvis could have pointed out that half of patients who successfully stop smoking with the aid of bupropion will start again within 12 months of coming off the drug. They could also have referred in more detail to the side effect profile and the number of patients for whom the drug will be unsuitable. Bupropion may have a 1 in 1000 risk of inducing seizures (product information from GlaxoWellcome, the manufacturer of the drug). This may be an acceptable risk for drugs to treat disease but is less so for lifestyle drugs.

    Bupropion may well prove to be a useful adjunct to smoking cessation, but I would have preferred a more balanced appraisal in a BMJ editorial.

    Footnotes

    • Competing interests None declared.

    References

    1. 1.
    2. 2.

    Drug is almost identical in structure to diethylpropion, a controlled drug

    1. Herbert G Kinnell, medical adviser
    1. Barlow Medical Centre, Manchester M20 6TR
    2. Berkshire Diet Centre, Reading, Berkshire RG1 1SN
    3. Public Health Research Unit, Willerby, Hull HU10 6NS
    4. Meanwood Group Practice, Leeds LS6 4JN
    5. Division of Respiratory Medicine, University of Nottingham, City Hospital, Nottingham NG5 1PB
    6. Department of Epidemiology and Public Health, ICRF Health Behaviour Unit, University College London, London WC1E 6BT

      EDITOR—Britton and Jarvis's editorial on bupropion does not mention that the drug is an amphetamine derivative.1 It is almost …

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