Combination bupropion SR and varenicline for smoking cessation: a systematic review

Abstract

This therapy is a combination of medicines consisting of nicotine replacement therapy (NRT) using a prolonged modality such as the patch, along with a short-acting medicine such as chewing gum, lozenge, gum, or nasal inhaler).This means two or more drugs approved and demonstrated useful for cessation of smoking with or without the support of NRT. It is very important to consider medical and psychiatric comorbidity because the population that persists addicted is increasingly complex in terms of comorbidities and high addictive level. Most of the combination therapies use NRT associated with bupropion or varenicline. There is evidence on the effectiveness and safety of TRN used in both moda-litres (long and short acting) in combination with varenicline or bupropion. However, safety evidence is not robust for the combination modality as it is for, each drug as monotherapy, since adverse effects are added so it is suggested to reserve the combinations for people with high level of addiction and / or history of failure in previous attempts with monotherapy. In summary, therapy with demonstrated effectiveness as NRT, bupropion and varenicline can be used in double or triple combination, prefering the use of short acting NRT added to one of the oral drugs to alleviate smoking anxiety. Resumen La terapia combinada es la de mezcla de farmacos para al cesación del tabaquismo, tal como tera-pias de reemplazo nicotínico (TRN) en modalidad prolongada como es el parche junto a una modalidad de acción corta como puede ser chicle, goma, lozenge, pastillas o inhalador nasal), es decir dos o más fármacos aprobados y demostrados útlies para el cese del tabaco con o sin el apoyo de TRN. Es muy importante considerar la comorbilidad médica y psiquiatrica porque la población que persiste adicta es cada vez más compleja en términos de comorbilidades y elevado nivel adictivo. La mayor parte de las terapias combinadas usan TRN asociadas a bupropión o vareniclina. Existe evidencia sobre efectividad y seguridad de las TRN utilizadas entre ellas o en asociación a vareniclina o bupropión, sin embargo, la evidencia sobre seguridad en la modalidad combinada no es tan robusta como la que existe para cada fármaco en monoterapia, ya que los efectos adversos se suman de manera que se sugiere reservar las combinaciones para personas con alto nivel de adicción y/o con historia de fracaso en intentos previos con monoterapia. En suma, los fármacos de demostrada efectividad y seguridad como TRN, bupropión y vareniclina pueden usarse en combinación doble o triple, preferenciando el uso de TRN de corta acción cuando se adiciona a alguno de los fármacos orales para aliviar la ansiedad por fumar. Palabras clave: Dejar de fumar; productos para dejar de fumar; nicotina; bupropión; vareniclina. La terapia combinada se refiere fundamental-mente a la estrategia de combinación de terapias de reemplazo nicotínico (TRn) en que se combi-na una modalidad prolongada como es el parche a una de acción corta como puede ser chicle, losenge o pastillas, inhalador o spray...

A 4-year Follow-up Evaluation Of A Pharmacist-managed Smoking Cessation Programme With Emphasis On Effectiveness Of Different Treatment Modalities

“…Evidence has emerged recently demonstrating the tolerability and efficacy of combination treatment with varenicline and bupropion in smoking cessation 11,[23][24][25] . However, there is also a study which proposed contradicting result 26 .…”

Effects of menthol and its interaction with nicotine-conditioned cue on nicotine-seeking behavior in rats

“…Although the majority of smokers want to quit smoking and have made attempts to do so, the vast majority (up to 97%) of smokers who try to quit eventually relapse and continue to smoke (Benowitz, 2010; CDC, 2014; Hughes et al, 2008; Shiffman et al, 1998). Even when treated with medications that are currently approved by the U.S. Food and Drug Administration (i.e., nicotine replacement, bupropion, and varenicline), long-term abstinence rates have remained unsatisfactorily low (Aubin et al, 2008; Gonzales et al, 2006; Jorenby et al, 2006; Rose and Behm, 2014; Vogeler et al, 2016). Thus, high rates of relapse present a formidable challenge for successful smoking cessation.…”

Serum Sickness-Like reaction developed due to Bupropion Hcl during smoking cessation therapy: Case Report

“…0-2 puan hafif, 3-4 puan düşük, 5 puan orta, 6-7 puan yüksek ve 8-10 puan çok yüksek bağımlılığı gösterir. [6][7][8] Sigara bağımlılığı tedavisinde en sık kullanılan farmakolojik tedaviler nikotin replasman tedavisi ve nikotin dışı ilaçlardır. Sigara bırakma tedavisinde etkin olan bupropion, yoksunluk semptomlarını ve tedavi süresince sigarayı bırakma sonrası ortaya çıkan kilo alımını azaltır ve iyi tolere edilir.…”