The impact of chronic bupropion on plasma cotinine and on the subjective effects of ad lib smoking: A randomized controlled trial in unmotivated smokers
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Abstract
Bupropion is an efficacious non-nicotine medication for smoking cessation; however,
its cessation-mediating mechanism is unclear. This randomized, placebo-controlled
trial examined the effect of bupropion SR (300 mg/day for 6 weeks) on plasma cotinine
and on the subjective effects of smoking in 24 current daily smokers who were not
trying to quit or reduce smoking. Subjective effects of smoking, as well as cue-elicited
responses were assessed at bi-weekly experimental sessions using validated scales.
Several indices of cigarette consumption were measured. Plasma cotinine decreased
from 280 (+/-133) microg/l at baseline to 205 (+/-108) microg/l at end of treatment
in the bupropion group (p=0.036), but no significant change was found in the placebo
group. Daily cigarette count and puff topography did not significantly change in either
group. In contrast to placebo, bupropion increased post-smoking satiety (p=0.045).
Both groups reported higher craving (p=0.025) and withdrawal (p=0.014) after exposure
to smoking-related pictures, compared to neutral pictures. This biased reactivity
was not significantly affected by treatment condition (p>0.1). Therefore, bupropion
does not appear to impact the smokers' response to conditioned smoking-related cues
but influences the unconditioned subjective effects of smoking in unmotivated smokers.
This study is among the first to systematically investigate the effect of chronic
bupropion administration, free from the confounding effect of the smoker's motivation
to quit smoking.