Bupropion/zonisamide combination to assist smokers to switch from combustible cigarettes to electronic nicotine delivery systems (ENDS)

• Published in: Drug and alcohol dependence Vol. 234; p. 109346
• Main Authors: Rose, Jed E., Willette, Perry N., Botts, Tanaia L., Botts, David R., Behm, Frederique M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-05-2022; Elsevier Science Ltd
• Subjects: Abstinence; Adult; Antidepressants; Bupropion; Bupropion - therapeutic use; Carbon monoxide; Cigarette smoking; Cigarettes; Clinical trials; Convulsions & seizures; Craving; Drug addiction; Drugs; Electronic cigarettes; Electronic Nicotine Delivery Systems; Expired air; Harm reduction; Humans; Nicotine; Nicotine - therapeutic use; Ratings; Reduction; Reinforcement; Seizures; Side effects; Smokers; Smoking; Smoking cessation; Substance Withdrawal Syndrome - drug therapy; Switching; Tobacco Products; Withdrawal symptoms; Zonisamide; Harm reduction; Bupropion; Cigarettes; Electronic nicotine delivery systems; Craving; Zonisamide
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2022.109346

Electronic nicotine delivery systems (ENDS) may offer a much less harmful alternative to combustible cigarettes (CC) for adult smokers unwilling or unable to relinquish nicotine. However, dual use of CC and ENDS undermines potential harm reduction, and progress needs to be made to assist smokers to switch to ENDS. This study explored the promise of a novel treatment combination of the smoking cessation medication bupropion and an FDA-approved anti-seizure medication, zonisamide, to facilitate switching from CC to ENDS. Both medications have been found to reduce craving for CC and possibly offset each other’s side effects.
Twenty-four smokers participated in a 13-week treatment during which they were provided with ENDS, bupropion and zonisamide. Assessments included CC and ENDS use, expired air carbon monoxide (CO), smoking withdrawal symptoms, reward ratings and tolerability/side effects.
33% of participants achieved biochemically confirmed, complete CC abstinence by the end of treatment. Those who did not achieve complete abstinence nonetheless showed a 44% reduction in expired air CO. Craving and other withdrawal symptoms were minimal, and CC smoking satisfaction declined markedly, while satisfaction ratings for ENDS increased over time to overtake those of CC. Side effects were generally mild, and adherence to the medication use was excellent.
The use of combination bupropion/zonisamide to facilitate switching from CC to ENDS is a promising approach that merits follow-up randomized controlled trials. Combining short-term medication approaches with long-term nicotine substitution using ENDS may be a promising strategy to help smokers sustain smoking abstinence in the long term.
•Switching from conventional cigarettes to electronic nicotine delivery systems (ENDS) reduces smokers’ exposure to toxic tobacco combustion products.•A smoking cessation treatment medication, bupropion, can be combined with the anti-seizure medication, zonisamide, to promote switching to ENDS.•This approach could make tobacco harm reduction more successful and help millions of smokers reduce their exposure to cigarette-related toxins.•The two agents could be combined into a single tablet for once-daily administration, enhancing patient adherence.