1. Nico-hosp-intro 1.1 Smoke-free hospital European Training guide From: Nicomède DGS France Bupropion (Zyban®) NHC(CH 3 ) 3 COCHCH 3 HCl Cl Non-nicotine drug Total inhibitor of recaptured noradrenaline and partial inhibitor of recaptured dopamine Helps motivate patient to quit tobacco Reduces withdrawal symptoms More effective than NRT on available studies Combination of NRT and Bupropion is more effective than each individual treatment Contra-indication if past history of convulsion Side effects

2. Nico-hosp-intro 1.2 Smoke-free hospital European Training guide From: Nicomède DGS France Bupropion : dose response Abstinence after 6 weeks p  0.001 3020100 Placebo(n=153) 13,7% 18,3% 24,4% 10,5% % abstinents Bupropion 300 mg/d (n=156)Bupropion 150 mg/d (n=153)Bupropion 100 mg/d (n=153) Source : Hurt et al, N Engl J Med 1997.

3. Nico-hosp-intro 1.3 Smoke-free hospital European Training guide From: Nicomède DGS France Comparative study: Bupropion vs NRT Source : Jorenby NEJM 1999, 340, 685 NB : In this study the dose of NRT is not optimal 0% 20% 40% 60% 80% 100% 0 3 612 26 52 weeks Placebo patch Bupropion+ patch Abstinence Side effects Buproprion 11,9% NRT 6,6%

4. Nico-hosp-intro 1.4 Smoke-free hospital European Training guide From: Nicomède DGS France Bupropion comparative study One year total abstinence Jorenby et al, N Engl J Med 1999. % abstinents 9,8% 18,4% 22,5% 5,6% 3020100 Bupropion + nicotine patch (n=245) Bupropion 300 mg/j (n=244) Nicotine Patch 21 mg/j (n=244) Placebo(n=160) p <0.001

5. Nico-hosp-intro 1.5 Smoke-free hospital European Training guide From: Nicomède DGS France Bupropion: Initial Dosage 7 to 9 weeks treatment

6. Nico-hosp-intro 1.6 Smoke-free hospital European Training guide From: Nicomède DGS France Bupropion: Contra-indication Hyper sensitivity to Bupropion or pill compound Actual or past history : Seizure Anorexia nervosa or bulimia Maniac-depressive psychosis Liver cirrhosis Patient with CNS tumour Alcohol cessation programme or use of benzodiazepine Conta-indicated treatment with MAOI Caution : Seizure risk with Bupropion = 1/1000

7. Nico-hosp-intro 1.7 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation with Bupropion: adverse event reactions % p atients Placebo (n=159) Nicotine patch 21 mg/d (n=243) Bupropion 300 mg/d (n=243) Bupropion and nicotine patch (n=244) 5 10 15 20 25 30 35 40 45 50 0 Adverse reactions occurring in more 5% of cases with active treatment or placebo in the Jorenby study. from: Jorenby et al, N Engl J Med 1999. Insomnia Purities Rhinitis concentration difficulties Dry mouth Nausea Local irritation Vertigo dysmenorrhoea Anxiety Constipation