Comparison of Nortriptyline and Bupropion as Smoking Cessation Aids: Implications for Patients with Severe Chronic Obstructive Pulmonary Disease

ABSTRACT Background: Smoking cessation is the single most effective way of preventing progression of chronic obstructive pulmonary disease (COPD), and it is imperative that patients with this disease quit smoking. However, there is only limited information on the role of non-nicotine replacement therapy for achieving smoking cessation in these patients. Objective: To review the efficacy and toxicity of the 2 most commonly employed forms of non-nicotine replacement therapy and to determine the implications of this information as it pertains to patients with advanced COPD. Methods: A MEDLINE search was performed for the period 1996–2002 to identify randomized placebo-controlled trials examining the use of bupropion or nortriptyline for smoking cessation. The search terms were “smoking cessation”, “abstinence”, “bupropion”, and “nortriptyline”. Trials with less than 6 months’ follow-up, those examining smoking cessation in patients with primary mental illness, and those dealing with relapse or having a primary objective of identifying predictors of response were excluded from review. Results: Bupropion and nortriptyline were comparable to each other and both were superior to placebo in terms of smoking cessation. Nuisance side effects occurred more often with nortriptyline. Conclusions: Buproprion and nortriptyline are both effective therapies for smoking cessation. In patients with advanced COPD, nortriptyline may offer some advantages over bupropion. RESUME Historique : La desaccoutumance au tabac est le moyen le plus efficace de prevenir l’evolution de la maladie pulmonaire obstructive chronique (MPOC), et il est imperatif que les patients atteints de MPOC cessent de fumer. Cependant, on ne dispose que de peu de donnees sur le role de la therapie de remplacement non nicotinique (TRNN) dans la desaccoutumance au tabac chez ces patients. Objectif : Examiner l’efficacite et la toxicite des deux formes de TRNN les plus utilisees et determiner la portee des resultats pour les patients atteints de MPOC avancee. Methodes : Une recherche sur MEDLINE a ete effectuee pour la periode allant de 1996 a 2002, afin de reperer les essais cliniques aleatoires comparatifs contre placebo evaluant l’emploi du buproprion ou de la nortriptyline dans la desaccoutumance au tabac. Les termes utilises pour la recherche etaient «smoking cessation», «abstinence», «buproprion» et «nortriptyline». Les essais comportant une periode de suivi inferieure a six mois, ceux evaluant la desaccoutumance au tabac chez les patients atteints d’un trouble mental primaire ainsi que ceux traitent les rechutes ou visent premierement a determiner les indicateurs previsionnels de la reponse ont ete exclus. Resultats : Le buproprion et la nortriptyline etaient comparables et tous deux superieurs au placebo pour la desaccoutumance au tabac. Les effets indesirables incommodants etaient plus frequents avec l’emploi de la nortriptyline. Conclusions : Le buproprion et la nortriptyline sont tous deux des traitements antitabagiques efficaces. Chez les patients atteints d’une MPOC avancee, la nortriptyline pourrait offrir certains avantages sur le buproprion.