Chronic Obstructive


Bupropion is one of the most common therapies employed to aid in smoking cessation. In 1999 in Canada, there were approximately 1.1 million visits to a physician for smoking cessation advice. Eighty-five percent of these visits resulted in a drug recommendation, 90% of which were for bupropion. This agent, however, may not be the ideal drug for all patients, as it has been associated with serious allergic, cardiovascular, and central nervous system side effects.

The adverse effect profile of bupropion may be an even greater problem for patients with advanced chronic obstructive pulmonary disease (COPD). In this population, smoking cessation is desirable, as it may favourably alter the progression of the disease. These patients often have disabling dyspnea, disruptions in the normal sleep cycle, and anxiety secondary to advanced lung disease and malnutrition. Bupropion, which is chemically related to the anorectant diethylpropion, may inhibit the ability of patients with COPD to maintain or gain body weight, which is a desired endpoint to help deal with the chronic respiratory insufficiency. In addition, central nervous system toxicity associated with buproprion may aggravate underlying anxiety and insomnia in this population.
In addition to bupropion, several oral non-nicotine replacement therapies have been studied for smoking cessation, including fluoxetine, sertraline, citalopram, and nortriptyline. The first 3 of these drugs have not been particularly useful, but nortriptyline has found use for this indication. Given the very limited data (one published paper) for the population of interest (patients with COPD), how should the practitioner make decisions about the most appropriate drug for promotion of smoking cessation? The purpose of this review was to compare published trials of bupropion and nortriptyline with a view to providing guidance for practitioners treating nicotine-dependent patients with COPD.
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