January 27, 2023

Your crow priam the name-brand is i’ve been learning objectives by completion of this activity participants will be able to describe the properties of appropriate lists its advantages and drawbacks describe availability cost and coverage explain standard and alternative dosing recommendations and lists common side effects and mitigating strategies an overview

Bupropion is an effective pharmacotherapy for smoking cessation and is also used to treat depression it’s thought to act by enhancing the central nervous system nor adrenergic and dopaminergic release which is essentially the brain’s reward system and the way that nicotine works the advantages of bupropion are that its state it’s it is safe for use in smokers with

Stable cardiovascular disease whereas we saw some significant possible problems with varenicline with cardiovascular disease and it’s also safe in patients with copd where whereas we saw that the nicotine inhaler can cause bronchospasms in those patients it’s safe for smokers hospitalized for acute martic myocardial infarction so this is presumably an unstable

Cardiovascular disease a population with where there’s been concerns with the use of her n acclaim however in the study that did prove that gu program was safe it did not prove that the program was effective for helping people quit another advantage is that your program temporarily blunts the post cessation weight gain and this can be a good choice for smokers who

Are especially concerned about weight gain after quit smoking the the the major drawback is that it lowers the seizure threshold so anybody with a history of seizures or a high risk for seizures is it’s contraindicated to use this drug this zyban or bupropion is available only with a prescription and the cost is approximately four dollars and thirty cents a pill if

You don’t have insurance which means eight dollars and sixty cents for the two pill dose per day coverage the affordable care act requires that all medicaid programs cover all tobacco cessation medications beginning january 1st 2014 and bupropion is covered in all 50 states it’s not covered in the district of columbia and its coverage varies by health plan in the

States listed the standard dose smokers are instructed to quit one week after starting group propria by which time there are stable blood levels achieved this is what we saw with varenicline where the a week was needed to achieve stable blood levels and the way that this is done is starting at 150 milligrams once a day for three days and then 150 milligrams twice

A day thereafter the recommended duration is a minimum of 12 weeks a lower dose of 150 milligrams per day instead of 150 milligrams twice per day is an option for smokers who do not tolerate the full dose due to side effects and to randomised trials have found that the hundred and fifty milligrams per day dose was as effective as a 300 milligram per day dose and

Associated with fewer side effects now it’s possible that longer than twelve weeks is effective for people who have successfully quit so one study compared continuing group obreon for a year after someone had successfully quit to stopping it and switching them to a placebo after they successfully quit and it was found that at one year the abstinence rate was higher

If they continued the program for that year 51 versus 42% and after they stopped the therapy or the placebo of one year and they looked 16 weeks later there is a higher abstinence rate 47 verses 37 if people relapsed the long the time to relapse was longer in the group who were receiving appropriate for 12 months 165 156 days until relapse versus 65 for those on

Placebo and the wait game was less than two years 4.1 kilograms versus 5.4 calories however probably the most important result was that the abstinence rate at two years was the same in both groups so perhaps the only clear advantage of two years is that people will not gain their weight back to the same degree but they’ll still be as likely to have quit smoking at

Two years if they continued the bupropion for a year versus 12 weeks so there are and just like we saw with varenicline post-marketing case reports where this drug was associated with increased risk of suicidal self injurious behavior depression and these risks were smaller than those observed for varenicline but greater than those seen in patients taking nicotine

Replacement and a randomized trial comparing bupropion varenicline and the nicotine patch of placebo i actually found no difference in adverse neuropsychiatric effects so though the fda had issued a blackbox warning for varenicline it only advises it doesn’t have the strong recommendation it only advises paper strong a warning for the appropriate in 2009 the fda

Recommendation advises patients to stop the drug and contact their clinicians office if they are their family notice any unusual behavior or mood symptoms another way of preventing this side effect is having the patient monitored for neuropsychiatric symptoms including changes in behavior hostility agitation depressed mood suicidal ideation and suicide attempts

And that can just be done by letting the patient note and form a significant other or loved one that these are the possible side effects and to be on the lookout a follow-up or visit or telephone call is also recommended within a week to monitor for adverse effects for the side effect of seizures your program does reduce the seizure threshold in clinical trials

Of appropriate for smoking cessation the risk of seizure was 0.1% however the risk was dose dependent so most often occurred in the setting of an overdose or impatience with predisposing risk factors for seizures the prevention strategy is simply not to prescribe the appropriate in patients with seizure disorder or predisposition to seizure the most common side

Effects are insomnia agitation dry mouth and headache and as we discussed earlier consider a lower dose just one pill a day instead of two for patients who are having these side-effects on the folders

Transcribed from video
bupropion By myfamilydoc