Bupropion and Smoking Cessation

Mr. A was a 41-year-old man with a 20-year history of chronic, undifferentiated schizophrenia who had smoked three to five packs of cigarettes a day for 11 years. Two years of individual cognitive behavioral and motivational enhancement treatment resulted in only transient, limited reduction in cigarette use. In the 3 months preceding Mr. A’s trial of sustained-release bupropion, he brought 100–157 empty cigarette packs per month to the clinic; the carbon monoxide in his expired air was 54 ppm. Nicotine replacement therapy was contraindicated because of multiple cardiovascular risk factors, combined with inability to reliably agree to reduce cigarette use while using nicotine replacement therapy. One week after starting sustained-release bupropion, at a dose of 150 mg/day, he reported that he no longer had such a strong urge to smoke and stopped smoking entirely; 3 months later, the carbon monoxide in his expired air measured 3 ppm. During this period, his clozapine dose was gradually decreased from 550 to 300 mg/day, and he reported less sedation and drooling and appeared more alert and less disheveled. His psychotic symptoms remained under control, his weight remained unchanged, and he began his first paying job in 18 years. He discontinued the sustained-release bupropion after 7 months and remained abstinent from smoking at 11 months.