Bupropion for the treatment of methamphetamine dependence in non-daily users: A randomized, double-blind, placebo-controlled trial

Kingsley Onokalah, PharmD candidate 2015, Mercer University College of Pharmacy

The use of methamphetamine, a potent central nervous system stimulant, increased in the early- to mid-1990s.  In addition to its reinforcing stimulant and euphoric effects, methamphetamine may result in cardiovascular side effects like hypertension, chest pain, cardiovascular collapse, and arrhythmic sudden death.1  Emergency department visits for both illicit and prescribed stimulants increased from 61% in 2009 to 85% in 2011.2

Bupropion, a relatively weak inhibitor of neuronal norepinephrine and dopamine reuptake, is approved for the treatment of depression and for smoking cessation.3,4  A previous study has shown limited efficacy of bupropion for reducing methamphetamine use.  Per Elkashef et al, bupropion may be more effective in reducing the use of methamphetamine in study participants having low-to-moderate use at baseline.5

Title: Bupropion for the treatment of methamphetamine dependence in non-daily users: A randomized, double-blind, placebo-controlled trial
Design Randomized, double-blind, placebo-controlled trial (N= 204)
Objective To test efficacy of bupropion to achieve methamphetamine abstinence in dependent, non-daily users
Study Groups Bupropion (n= 100)

Placebo (n= 104)

Methods Patients seen three times weekly to test urine for presence of methamphetamines and bupropion assays
Duration A 12-week treatment and 4-week follow-up
Primary Outcome Measure Abstinence success (>2 negative urines in each of Weeks 11 and 12)
Baseline Characteristics Average age 39.3 years, 65% male, 69% white
Results Abstinence success (p= 0.32):

Bupropion group: n= 14

Placebo group: n= 20

Adverse Events Common Adverse Events: nausea (8%)
Serious Adverse Events: not reported
Percentage that Discontinued due to Adverse Events: not reported
Study Author Conclusions In this study, bupropion did not significantly increase abstinence in MA-dependent participants, compared to placebo.

Bupropion was not more efficacious than placebo for helping non-daily users of methamphetamine maintain abstinence.  The study authors noted problems with adherence among participants in the bupropion arm.  Future investigators could develop a protocol within their trials that assesses the amount of bupropion in the study participants’ blood and provide counseling to help them adhere to treatment.

References:

  1. Wermuth L. Methamphetamine use: hazards and social influences. J Drug Educ. 2000;30:423–433.
  2. Anderson AL, Li SH, Markova D, et al. Bupropion for the treatment of methamphetamine dependence in non-daily users: A randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend. 2015 May 1;150:170-4. doi: 10.1016/j.drugalcdep.2015.01.036.
  3. Wellbutrin® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2014.
  4. Zyban® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2015.
  5. Elkashef AM, Rawson RA, Anderson AL, et al. Bupropion for the Treatment of Methamphetamine Dependence. Neuropsychopharmacology. (2008) 33, 1162–1170; doi:10.1038/sj.npp.1301481.
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s