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Question How beneficial is the combination of bupropion and telephone support to help smokers quit? Synopsis We know that physician advice and bupropion can each help people quit smoking. This randomised controlled trial non-blinded ; was conducted in a primary care setting and included 1524 smokers. Both minimal and moderate intensity counselling were assessed along with two dosing regimens of sustained-release bupropion 150 or 300 mg per day ; . Minimal counselling using the Zyan advantage plan consisted of one 5-10 minute scripted phone call the day after the quit date and four progress questionnaires mailed thereafter. Moderate counselling was a telephone support programme based on strategies recommended by the US Preventive Services Task Force and included five scheduled phone calls with individualised content, mailed materials, and access to a toll-free quit line for one year. Thus, there were four groups: minimal counselling with bupropion 150 mg; moderate counselling with bupropion 150 mg; minimal counselling with bupropion 300 mg; and moderate counselling with bupropion 300 mg. The quit rates at 12 months were 24%, 31%, 26%, and 33% respectively. The majority of participants reported some adverse effect, a larger proportion of those were receiving 300 mg than taking 150 mg 76 v 68%; P 0.002 ; . There was a trend for patients taking the 300 mg dose to be more likely to discontinue medication because of adverse affects 31% v 26%; P 0.07 ; . Bottom line Patients wishing to quit smoking will have a good chance of doing so 1 in 3-4 ; if they receive bupropion Zgban ; with a programme of minimal to moderate telephone counselling. Bupropion plus counselling leads to clinically important 12 month quit rates in all groups. Higher doses of bupropion 300 mg daily ; produce only slightly better quit rates while increasing adverse effects and costs. More counselling results in somewhat higher quit rates, an extra 7% absolute difference, compared with minimal counselling. Level of evidence 1b see infopoems levels ; . Individual randomised controlled trials with narrow confidence interval ; Swan GE, McAfee T, Curry SJ, et al. Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial. Arch Intern Med 2003; 163: 2337-44 and adalat.

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The evaluation included the extent of the substitution, the opinions of physicians and pharmacists before and after the intervention, and patients experiences of the substitution. The results show, among other things, that the degree to which prescribers in ngelholm complied with drug recommendations was almost 50 per cent during the trial period Table 2, p 3.
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Again just to remind you, at the time-and this is still the language in the GI portion of the FDA warning label, it describes in terms of looking at GI ulcers, gross bleeding of perforation, that there is one percent of patients if treated for 3-6 months who experience this event, but this occurs in about 2-4 percent of patients if they are treated for one year. So, this is data that we had previously known from other NSAIDs. And, I saw this on a slide earlier today--the kind of information that we had available from other databases, suggesting that there were lots of hospitalizations and lots of deaths associated with this particular adverse event. Some of the baseline demographics then in terms of looking at the CLASS trial, the mean median age was about 60 years; 11 percent of the patients were 75 years or older. These were mostly white females. Approximately 27 percent of the patients had RA; 10 percent had a history of GI bleeding or gastroduodenal ulcers; and about 21 percent were taking aspirin. In terms of looking at the inclusion criteria and exclusion criteria, they were fairly open. Basically you needed to be able to give informed consent; that you required something like this kind of a medicine and that you were not pregnant. On the other hand, that you didn't have any active disease of any signals in terms of looking for hepatic events. The aspirin use in CLASS deserves some comment. It was at less than or equal to 325 mg daily. Again, this was if. A network of pharmacists and pharmacy technicians with an interest in diabetes is set to grow with the launch of a Diabetes UK "smartgroup". The network, which has the backing of the charity Diabetes UK, was launched at the British Pharmaceutical Conference on 27 September by community pharmacist Irene Gummerson. Mrs Gummerson explained that pharmacists attending the Diabetes UK conference in April this year had called for a pharmacy diabetes network PJ, 30 April 2005, p527 ; . "There are pockets of activity all over the country and it would be good to share our experiences and to share information, " she said. Diabetes UK has agreed to facilitate the network as a national resource for all sectors of the profession and it is open to all interested pharmacists and pharmacy technicians. The purpose of the network is to enable members to discuss topics of interest in diabetes and to share relevant documents.To join, pharmacists and technicians should e-mail pharmacydiabetesnetwork-subscribe smartgroups giving their pharmacy sector and one aspect of diabetes that they would like to see addressed. "I hoping that people who join the network will not be lurkers and that they will be willing to share their experiences, " Mrs Gummerson added. Meetings p460 and allegra and zyban, for instance, quit smoking with zyban.

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