Bupropion Hydrochloride
Fluoxetine
Nicotine Products
Lobeline (Bantron)
Summary

The following information is based on the successful use of pharmacological agents in the cessation of smoking in the general population. None of the following agents have been studied in large placebo-controlled studies in cancer patients for aid in smoking cessation. Dosage adjustments or titrations may be required when administering these agents to oncology patients.

Also used as an antidepressant, bupropion hydrochloride (HCl) (Zyban) is a nonnicotine aid to smoking cessation. It is a relatively weak inhibitor of the neuronal uptake of norepinephrine, serotonin, and dopamine and does not inhibit monoamine oxidase. The exact mechanism by which bupropion HCl enhances the ability of patients to abstain from smoking is unknown; however, it is presumed that this action is mediated by noradrenergic or dopaminergic mechanisms.[1] One study [2] failed to find any additional value of bupropion HCl in reducing relapse in individuals using the nicotine patch compared with a placebo either as part of a relapse prevention program (after the end of successful patch therapy) or as a second-level treatment for individuals who were still smoking after nicotine-patch therapy.

Although bupropion HCl (Zyban) is the only U.S. Food and Drug Administration (FDA)-approved antidepressant for smoking cessation, fluoxetine HCl (Prozac) has recently been studied and shown to be effective.[1]

These products are designed to aid in the withdrawal symptoms associated with nicotine. Several precautions must be considered before initiating therapy, but these precautions do not constitute absolute contraindications.

• Patients who are pregnant or nursing should obtain advice from a health care professional before using these products.



• Patients should be advised to not use these products if they continue to smoke, chew tobacco, use snuff, or use other nicotine-containing products.



• Patients should be instructed to consult a physician before using these products if they are younger than 18 years, have heart disease or an irregular heartbeat, have high blood pressure not controlled by medication, have a history of or currently have esophagitis or peptic-ulcer disease, use insulin for diabetes, or take prescription medications for depression or asthma.[3]

Lobeline (Bantron) is classified as a category III agent by the FDA (safe but no proven effectiveness). This product is not recommended for use in any smoking cessation program because of its lack of efficacy.[4]

• Continued smoking substantially increases the likelihood of recurrence or occurrence of a second cancer in survivors, particularly in those who received radiation therapy.



• Most patients with smoking-related cancer appear motivated to quit smoking at the time of diagnosis.



• A stepped-care approach is recommended, with strong physician advice and brief counseling to quit and provision of basic information to all patients at each contact during the first month of diagnosis, followed by more intensive treatment (pharmacologic and counseling by a smoking specialist) for those having difficulty quitting or remaining abstinent.

References

1. Hitsman B, Pingitore R, Spring B, et al.: Antidepressant pharmacotherapy helps some cigarette smokers more than others. J Consult Clin Psychol 67 (4): 547-54, 1999.  [PUBMED Abstract]
   
   
2. Hurt RD, Krook JE, Croghan IT, et al.: Nicotine patch therapy based on smoking rate followed by bupropion for prevention of relapse to smoking. J Clin Oncol 21 (5): 914-20, 2003.  [PUBMED Abstract]
   
   
3. Fincham JE: Smoking cessation products. In: Covington TR, Berardi RR, Young LL, et al., eds.: Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996, pp 715-723. 
   
   
4. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons, 1998. 
   
   

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