Bupropion for cocaine users
The article by Heidi Magyar, MS, ARNP, “Bupropion: Off-label treatment for cocaine and methamphetamine addiction” (Pearls, Current Psychiatry, July 2010, p. 52) was quite interesting. Over the last 2 decades studies assessing the efficacy of bupropion for cocaine and methamphetamine addiction treatment have had conflicting results, with more negative than positive findings. There have been at least 4 studies since 2006, some of which have found statistically significant results when comparing bupropion with placebo in specific subgroups.
A double-blind, randomized, placebo-controlled trial by Shoptaw et al1 that used bupropion or placebo combined with cognitive-behavioral therapy showed no statistically significant difference. A study of 106 methadone-maintained patients carried out by Poling et al2 evaluated 4 treatment conditions: contingency management and placebo, contingency management and bupropion, 300 mg/d, voucher control and placebo, and voucher control and bupropion. The contingency management and bupropion group was the only one that showed a significant decrease in cocaine use. Su et al3 found that in mice prenatal bupropion exposure could enhance cocaine sensitivity.
In the case of methamphetamine treatment, a double-blind placebo-controlled study by Elkashef et al4 randomized patients to either placebo or bupropion, 300 mg/d. Initial generalized results showed no statistically significant difference, but a mixed model regression analysis that adjusted for sex, baseline level of methamphetamine use, and severity of depression showed significantly increased abstinence, mainly in male patients and those with low-to-moderate methamphetamine use at baseline.
Adegboyega Oyemade, MD
Southern Illinois Healthcare Foundation
1. Shoptaw S, Heinzerling KG, Rotheram-Fuller E, et al. Bupropion hydrochloride versus placebo, in combination with cognitive behavioral therapy, for the treatment of cocaine abuse/dependence. J Addict Dis. 2008;27(1):13-23.
2. Poling J, Oliveto A, Petry N, et al. Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population. Arch Gen Psychiatry. 2006;63(2):219-228.
3. Su SW, Cherng CF, Lin YC, et al. Prenatal exposure of bupropion may enhance agitation, anxiety responses, and sensitivity to cocaine effects in adult mice. Chin J Physiol. 2007;50(1):1-8.
4. Elkashef AM, Rawson RA, Anderson AL, et al. Bupropion for treatment of methamphetamine dependence. Neuropsychopharmacology. 2008;33(5):1162-1170.