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CAPLAN: The "Bupropion for Smoking Cessation" Trial From a Family Practice Perspective 

The randomized trial "Bupropion for Smoking Cessation" is in my opinion a flawed study.1 Bupropion hydrochloride, an antidepressant, functions as an anticraving agent. When one craves cigarettes, the craving does not occur while smoking, but when cigarettes are absent. Nicotine 7-mg patches were being administered during the seventh and eighth weeks; this is equivalent to smoking one third of a pack daily, except that the nicotine was being delivered at a steady rate instead of by bolus. . . .

Long-term success is more related to cognitive behavior modification (including stress reduction), which was apparently well conducted in this trial, rather than to whichever specific method is used to achieve initial success. This is a very worrisome finding because the long-term failure rate was high, despite exhaustive therapy and careful selection of candidates. This makes me wonder if long-term use of bupropion would truly be a more useful add-on to treatment.

Financial Disclosure: Dr Caplan owns shares in Glaxo-smithkline.

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