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1.
Am J Perinatol ; 27(8): 655-62, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20232280

RESUMEN

We evaluated the efficacy, safety, and biological mechanisms of digoxin immune Fab (DIF) treatment of severe preeclampsia. Fifty-one severe preeclamptic patients were randomized in double-blind fashion to DIF ( N = 24) or placebo ( N = 27) for 48 hours. Primary outcomes were change in creatinine clearance (CrCl) at 24 to 48 hours and antihypertensive drug use. Serum sodium pump inhibition, a sequela of endogenous digitalis-like factors (EDLF), was also assessed. CrCl in DIF subjects was essentially unchanged from baseline versus a decrease with placebo (-3 +/- 10 and -34 +/- 10 mL/min, respectively, P = 0.02). Antihypertensive use was similar between treatments (46 and 52%, respectively, P = 0.7). Serum sodium pump inhibition was decreased with DIF compared with placebo at 24 hours after treatment initiation (least squares mean difference, 19 percentage points, P = 0.03). DIF appeared to be well tolerated. These results suggest DIF prevents a decline in renal function in severe preeclampsia by neutralizing EDLF. Sodium pump inhibition was significantly improved. Further research is warranted.


Asunto(s)
Antihipertensivos/administración & dosificación , Fragmentos Fab de Inmunoglobulinas/administración & dosificación , Preeclampsia/tratamiento farmacológico , Adulto , Antihipertensivos/efectos adversos , Cardenólidos/sangre , Digoxina/inmunología , Método Doble Ciego , Femenino , Humanos , Fragmentos Fab de Inmunoglobulinas/análisis , Pruebas de Función Renal , Preeclampsia/sangre , Preeclampsia/diagnóstico , Preeclampsia/fisiopatología , Embarazo , Resultado del Embarazo , Saponinas/sangre , ATPasa Intercambiadora de Sodio-Potasio/antagonistas & inhibidores , Resultado del Tratamiento , Adulto Joven
2.
J Clin Psychopharmacol ; 26(5): 482-8, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16974189

RESUMEN

In this double-blind, multicenter study, bupropion XL, a norepinephrine-dopamine reuptake inhibitor, and venlafaxine XR, a serotonin-norepinephrine reuptake inhibitor, were compared with regard to sexual functioning, efficacy, and tolerability. A total of 348 sexually active adult outpatients with depression were randomized to receive bupropion XL (titrated to a target dose of 300-450 mg/d) or venlafaxine XR (titrated to a target dose of 150-225 mg/d) for 12 weeks. Total scores on the primary dependent variable, the Changes in Sexual Functioning Questionnaire (self-report), increased for subjects receiving bupropion XL and decreased for those treated with venlafaxine XR; the mean change scores differed significantly between groups from week 2 onward. Among subjects with normal pretreatment sexual functioning, Changes in Sexual Functioning Questionnaire total scores remained essentially unchanged for the bupropion XL group but were decreased significantly for the venlafaxine XR group; mean change scores also differed between groups from week 2 onward. Although the therapies resulted in similar change on the 17-item Hamilton Depression Rating Scale, remission rates were significantly higher among those treated with bupropion XL (46%) versus venlafaxine XR (33%) (odds ratio, 1.93; 95% confidence interval, 1.07-3.46). Aside from adverse effects of venlafaxine XR on sexual function, both treatments were reasonably well tolerated. In conclusion, in this patient population (ie, relatively young, sexually active outpatients), bupropion XL was at least as effective as venlafaxine XR and had a significantly more favorable sexual side effect profile.


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Bupropión/uso terapéutico , Ciclohexanoles/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Disfunciones Sexuales Fisiológicas/inducido químicamente , Disfunciones Sexuales Psicológicas/inducido químicamente , Adulto , Antidepresivos de Segunda Generación/efectos adversos , Bupropión/efectos adversos , Ciclohexanoles/efectos adversos , Trastorno Depresivo Mayor/psicología , Método Doble Ciego , Femenino , Humanos , Masculino , Cooperación del Paciente , Escalas de Valoración Psiquiátrica , Resultado del Tratamiento , Clorhidrato de Venlafaxina
3.
Artículo en Inglés | MEDLINE | ID: mdl-16027765

RESUMEN

BACKGROUND: Bupropion has been available in the United States since 1989. Initially a thrice-daily immediate-release formulation, a twice-daily sustained-release formulation followed in 1996, and, in August 2003, a once-daily extended-release formulation was introduced. On the 15th anniversary of its introduction, we undertook a review of the background/history, mechanism of action, formulations, and clinical profile of bupropion. DATA SOURCES: Major efficacy trials and other reports were obtained and reviewed from MEDLINE searches, review of abstracts from professional meetings, and the bupropion SR manufacturer's databases. Searches of English-language articles were conducted from June 2003 through August 2004. No time limit was specified in the searches, which were conducted using the search terms bupropion, bupropion SR, and bupropion XL. DATA SYNTHESIS: Bupropion inhibits the re-uptake of norepinephrine and dopamine neurotransmission without any significant direct effects on serotonin neurotransmission. Bupropion is an effective antidepressant with efficacy comparable to selective serotonin reuptake inhibitors and other antidepressants. It is well tolerated in short-and longer-term treatment. Headache, dry mouth, nausea, insomnia, constipation, and dizziness are the most common adverse events. Seizure and allergic reactions are medically important adverse events associated with bupropion and are reported rarely. Among all the newer antidepressants in the United States, bupropion appears to have among the lowest incidence of sexual dysfunction, weight gain, and somnolence. Although not U.S. Food and Drug Administration approved for these indications, bupropion has also been used as an adjunctive treatment to reverse antidepressant-induced sexual dysfunction and to augment anti-depressant efficacy in partial responders and non-responders to other agents. CONCLUSION: Bupropion has played and will continue to play an important role as a treatment for major depressive disorder in adults, as well as for other related disorders.

4.
Am J Health Behav ; 28(5): 456-63, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15482975

RESUMEN

OBJECTIVE: To assess the efficacy of bupropion SR on smoking abstinence using a "slips allowed" analysis. METHODS: Retrospective analysis, which did not consider brief episodic "slips" as a return to regular smoking, of data from a multicenter, randomized, doubleblind, placebo-controlled relapse prevention study. RESULTS: Using a slips-allowed analysis, median time to relapse on bupropion SR was 65 weeks versus 30 weeks on placebo. This is compared to 32 and 20 weeks, respectively, using a traditional analysis not allowing for slips. CONCLUSION: Bupropion SR is efficacious for the prevention of smoking relapse. A slips-allowed analysis may provide a more clinically relevant assessment of efficacy.


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Bupropión/uso terapéutico , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar , Fumar/epidemiología , Adolescente , Preparaciones de Acción Retardada/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Estudios Retrospectivos , Prevención Secundaria , Encuestas y Cuestionarios
5.
Expert Opin Pharmacother ; 5(4): 727-34, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15102559

RESUMEN

The sustained-release (SR) form of bupropion is an effective treatment for smokers who are trying to give up. As it is a prescription drug, the use of bupropion SR has brought smoking cessation back to the physician's office. Another unique feature of the use of bupropion SR for smoking cessation is that it is started before the smoker quits. Few head-to-head trials have compared bupropion SR with other medical treatments. However, trials have been conducted in a wide range of patient and treatment settings. These include community volunteers, patients with chronic obstructive pulmonary disease and cardiovascular disease, relapsed smokers, individuals with a history of depression, women and the elderly. Beyond randomised clinical trials, the effectiveness of bupropion has been shown in clinical practice and managed-care settings.


Asunto(s)
Bupropión/uso terapéutico , Inhibidores de Captación de Dopamina/uso terapéutico , Cese del Hábito de Fumar/métodos , Fumar/tratamiento farmacológico , Administración Cutánea , Anciano , Bupropión/administración & dosificación , Bupropión/efectos adversos , Preparaciones de Acción Retardada , Inhibidores de Captación de Dopamina/administración & dosificación , Inhibidores de Captación de Dopamina/efectos adversos , Femenino , Humanos , Masculino , Nicotina/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Prevención del Hábito de Fumar , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Tabaquismo/tratamiento farmacológico , Aumento de Peso
6.
Nicotine Tob Res ; 5(1): 99-109, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12745511

RESUMEN

Some studies have shown that female smokers and smokers with a history of depression have an increased risk of relapse following smoking cessation treatment. This study examined the efficacy of bupropion sustained-release (SR) and the nicotine patch for smoking cessation in subgroups of smokers at possible risk for relapse. Data for this study were from a previously published randomized, double-blind, placebo-controlled clinical trial in which 893 smokers were randomized to four treatment conditions: placebo tablet + placebo patch, placebo tablet + 21 mg/24-hr nicotine patch, 300mg bupropion SR + placebo patch, and 300mg bupropion SR + 21 mg/24-hr nicotine patch. Study medication continued for 8 weeks after the quit day; brief individual cessation counseling was provided during weekly clinic visits. In comparison to the placebo tablet, bupropion SR approximately tripled 1-year non-smoking rates among women and previously depressed individuals. In contrast, the nicotine patch did not significantly improve cessation rates for any group. We conclude that bupropion SR is a first-line treatment for smoking that has the potential to benefit all smokers, especially women and the previously depressed.


Asunto(s)
Depresión/psicología , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar , Administración Cutánea , Bupropión/administración & dosificación , Depresión/epidemiología , Inhibidores de Captación de Dopamina/administración & dosificación , Femenino , Humanos , Masculino , Nicotina/administración & dosificación , Recurrencia , Factores de Riesgo , Fumar/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos
7.
Addict Behav ; 27(4): 493-507, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12188588

RESUMEN

The aim of this study was to identify predictors of successful relapse prevention in smokers receiving long-term sustained-release bupropion. Smokers (N= 784) who were interested in stopping smoking were enrolled in a 7-week, open-label bupropion phase. Abstinent subjects at the end of treatment and eligible to proceed (N= 429) were randomized to active bupropion or placebo through Week 52 and then followed for an additional year. The best overall predictor of less relapse to smoking was assignment to active bupropion. In aggregate, the results indicate that bupropion can be prescribed to diverse populations of smokers with expected comparable results. There was a medication effect that was independent of any predictor except older age and those who gained no or minimal weight during the open-label phase. Predictors of successful relapse prevention included lower baseline smoking rates, a Fagerström Tolerance Questionnaire score of < 6, and initiation of smoking at an older age. These data should encourage others to perform similar pharmacologic relapse prevention studies with this or other pharmacotherapies.


Asunto(s)
Bupropión/uso terapéutico , Cese del Hábito de Fumar , Prevención del Hábito de Fumar , Adulto , Anciano , Bupropión/administración & dosificación , Preparaciones de Acción Retardada , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevención Secundaria
8.
Am J Prev Med ; 22(4): 234-9, 2002 May.
Artículo en Inglés | MEDLINE | ID: mdl-11988379

RESUMEN

BACKGROUND: Recent data suggest that women smokers respond differently than men to cessation pharmacotherapies, particularly nicotine replacement therapy (NRT). Lower abstinence and higher relapse rates are often reported for women treated with NRT. Gender effects for those treated with non-nicotinic, bupropion-hydrochloride sustained release for relapse prevention have not been studied. METHODS: Data from a multicenter relapse-prevention (RP) trial of bupropion (November 1995-June 1998) were analyzed for gender differences. Men and women smokers (N=784) were treated with open-label bupropion for 7 weeks. Those abstinent at Week 7 (n=432) were enrolled in the double-blind relapse-prevention phase and randomized to placebo or continued bupropion for 45 additional weeks. RESULTS: Differences in point-prevalence abstinence rates between men (61.8%) and women (55.6%) in open-label bupropion (Week 7) were not significant. In the RP-phase Week 52, continuous abstinence rates for men and women were 37.8% and 36.4% (bupropion) and 36.6% and 29.9% (placebo), respectively; point-prevalence abstinence rates for men and women were 54.1% and 55.9% (bupropion) and 42.9% and 41.3% (placebo), respectively. Abstinence rates and time to relapse were superior for both men and women who received longer treatment. Gender differences within treatment groups were not significant. Median time to relapse was equal for men and women within each treatment group: Week 32 for bupropion and Week 20 for placebo. CONCLUSIONS: Our data suggest that bupropion is a promising pharmacotherapy for preventing relapse, particularly for women.


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Bupropión/uso terapéutico , Cese del Hábito de Fumar/métodos , Adulto , Antidepresivos de Segunda Generación/administración & dosificación , Bupropión/administración & dosificación , Consejo , Preparaciones de Acción Retardada , Esquema de Medicación , Femenino , Humanos , Modelos Logísticos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Distribución por Sexo
9.
Clin Ther ; 24(4): 540-51, 2002 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12017399

RESUMEN

BACKGROUND: Most (>50%) smokers who attempt to stop smoking relapse within the first year of abstinence. The effect of continued use of pharmacotherapy for smoking cessation on relapse rates is unknown. Bupropion sustained-release (SR) is the first non-nicotine-based therapy that is effective for achieving abstinence from smoking. OBJECTIVE: This analysis explored the factors involved in relapse to smoking in patients who had successfully stopped smoking using bupropion SR. These patients were participants in a double-blind, placebo-controlled trial of bupropion SR for the prevention of relapse to smoking. METHODS: Participants who had stopped smoking with 7 weeks of open-label bupropion SR were randomly assigned to receive double-blind treatment with either bupropion SR or placebo for 45 weeks. The primary efficacy outcome of the main study was the rate of relapse to smoking. The analyses presented here examine the levels of reported cigarette craving and, in those participants who returned to smoking, the reasons associated with relapse, using patient-completed questionnaires. RESULTS: Craving was cited most frequently as a factor contributing to relapse in those participants receiving placebo (cited by 49.2% of relapsers) but significantly less frequently by participants receiving bupropion SR (cited by 22.4% of relapsers) (P < 0.05). Results from patients' diaries showed no differences between bupropion SR and placebo in terms of "craving in the past 24 hours" but significantly lower scores for "craving right now" for bupropion SR at weeks 11 and 12 (P < 0.05). Results at scheduled visits showed that "craving in the past 24 hours" was significantly less with bupropion SR compared with placebo at weeks 12, 20, and 48, and "craving right now" was significantly less with bupropion SR compared with placebo at weeks 12, 16, 20, 24, 48, and 52 (P < 0.05). CONCLUSIONS: Craving continues to be a significant concern for individuals even after they have successfully stopped smoking. Bupropion SR appears to reduce reported cravings, which may contribute to the overall reduction in the rate of relapse observed with this pharmacotherapy.


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Bupropión/uso terapéutico , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Fumar/psicología , Adulto , Antidepresivos de Segunda Generación/administración & dosificación , Bupropión/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Masculino , Cooperación del Paciente , Recurrencia , Resultado del Tratamiento
10.
Am J Health Behav ; 26(3): 213-20, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12018757

RESUMEN

OBJECTIVE: To examine previous use of nicotine replacement therapy (NRT) on the smoking-cessation efficacy of bupropion sustained release (SR). METHODS: Secondary analysis of a parallel-group, randomized, double-blind, placebo-controlled study. Smokers who had, based on self-report, no previous history of NRT (N = 453) or who had used NRT at least once (N = 440) were randomized to receive placebo, bupropion SR, nicotine transdermal system (NTS), or a combination of bupropion SR and NTS. RESULTS: Bupropion SR showed similar efficacy in participants with or without previous use of NRT. CONCLUSION: Bupropion SR is effective in promoting smoking abstinence regardless of prior NRT use.


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Nicotina/uso terapéutico , Cese del Hábito de Fumar/métodos , Tabaquismo/tratamiento farmacológico , Administración Cutánea , Adulto , Método Doble Ciego , Femenino , Humanos , Funciones de Verosimilitud , Masculino , Persona de Mediana Edad , Nicotina/administración & dosificación , Resultado del Tratamiento , Estados Unidos
11.
Artículo en Inglés | MEDLINE | ID: mdl-15014680
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