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

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. Key words: smoking, bupropion, nortriptyline, chronic obstructive pulmonary diseas