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Study of Bupropion Versus Bupropion + Naltrexone for Smoking Cessation

Information source: National Institute on Drug Abuse (NIDA)
ClinicalTrials.gov processed this data on November 27, 2014
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Tobacco Use Disorder

Intervention: Bupropion (Drug); Bupropion + Naltrexone (Drug)

Phase: Phase 2/Phase 3

Status: Recruiting

Sponsored by: University of Minnesota - Clinical and Translational Science Institute

Official(s) and/or principal investigator(s):
Marc E Mooney, Ph.D., Principal Investigator, Affiliation: Univerisity of Minnesota

Overall contact:
Marc E Mooney, Ph.D., Phone: 612-273-9732, Email: moon0078@umn.edu

Summary

The purpose of this study is to compare the effects of bupropion + placebo to bupropion + naltrexone as treatments to help smokers quit.

Clinical Details

Official title: Phase II Randomized, Double-Blind Trial of Bupropion Versus Bupropion + Naltrexone for Smoking Cessation

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Primary outcome:

Biochemically-verified point-prevalence abstinence

Likelihood of progression to a relapse (e.g., return to baseline smoking) following a slip at any time in study.

Treatment completion.

Daily cigarette smoking rate.

Frequency and severity of bupropion and naltrexone side effects.

Secondary outcome:

Attentional bias.

Impulsivity.

Nicotine withdrawal, craving and negative/positive affect.

Detailed description: The purpose of this study is to compare the effects of bupropion + placebo to bupropion + naltrexone as treatments to help smokers quit. Bupropion is an FDA-approved medication for smoking cessation that is believed to provide relief from craving and withdrawal through promotion of two neurotransmitter chemicals, dopamine and noradrenaline. Naltrexone is an FDA-approved medication for the treatment of opiate and alcohol dependence, that appears to function through blocking certain opiate receptors in the brain. It is expected that bupropion + naltrexone will produce higher smoking quit rates than bupropion + placebo. Bupropion alone is effective in alleviating some nicotine withdrawal complaints and craving for nicotine. However, bupropion does not reduce the rewarding effects of slips to smoking. Naltrexone alone is not generally effective as a smoking cessation medication, but it does help to reduce the rewarding effects of slips to smoking. Thus, it may help to prevent full relapse to smoking. In addition, naltrexone can help to reduce craving for cigarettes. It is hypothesized that the differing complementary actions of the two drugs will help smokers more than bupropion alone. In addition to examining smoking quit rates, the proposed study will also look at psychological processes that change during smoking cessation including, nicotine withdrawal, nicotine craving, mood, impulsivity, and attention

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- 18 years and older.

- Smoked at least 10 cigarettes/day for at least 1 year.

- English speaking.

- Females who are of childbearing potential must practice effective contraception and

meet the following criteria:

- Are instructed to avoid pregnancy through 30 days after the last dose of study

medication.

- Have a negative urine pregnancy test at baseline.

- Agree to use of the birth control methods listed: an oral contraceptive agent, an

intrauterine device (IUD), an implantable contraceptive (e. g., Norplant), or an injectable contraceptive (e. g., Depo-Provera) for at least one month prior to entering the study and will continue its use through at least 30 days after the last dose of the study medication. A barrier method of contraception (e. g., condom or diaphragm with spermicide) while participating in the study and 30 days after the last dose of study medication.

- Willingness to reduce alcohol consumption during study to 2 or fewer standard

drinks/day (3 oz. of alcohol or two beers (12 oz.), or two 5 oz. glasses of wine).

- Willingness to not use illicit drugs during study period including marijuana.

Exclusion Criteria:

- Concurrent use of tobacco products (other than cigarettes) or nicotine products.

- Contraindications to use of bupropion (i. e., concurrent use of other forms of

bupropion, MAO inhibitors, anti-depressant medication, seizure disorder or any clinical situation that might increase risk for seizures, past head injury, current or prior diagnosis of bulimia or anorexia nervosa; bipolar disorder).

- Contraindications to use of naltrexone (i. e., past history of opioid abuse or

dependence or evidence of opioid use in the past 30 days; significant hepatocellular injury as evidenced by liver enzyme levels over 3 times normal limits).

- Use of medications whose metabolism or effects may be adversely altered by bupropion

or naltrexone. Medications that contraindicate the use of bupropion include theophylline, procarbazine, carbimazole, nialamide, pargyline, toloxatone, iproniazid, and systemic steroids. Medications that contraindicate the use of naltrexone include opioid analgesics and yohimbine.

- Current use of anti-seizure medications, disulfiram, or any medications that

significantly challenge liver functioning.

- Treatment for drug or alcohol dependence during the last year, or evidence of alcohol

abuse so severe that the patient is judged potentially unable to comply with the protocol.

- Evidence of problem alcohol consumption based on AUDIT.

- Self-reported use of illicit drugs in the past 90 days (including opioids, but

excluding marijuana).

- Suicidal or homicidal ideation.

- Current major depression.

- History of bipolar disorder.

- Recent (within twelve months) myocardial infarction.

- Pregnant or lactating or planning pregnancy during treatment period.

- Having plans to leave the immediate geographical area within 9 months.

- Unwillingness or inability to given written informed consent.

Locations and Contacts

Marc E Mooney, Ph.D., Phone: 612-273-9732, Email: moon0078@umn.edu

Tobacco Use Research Center, University of Minnesota, Minneapolis, Minnesota 55414, United States; Recruiting
Marc E Mooney, Ph.D., Phone: 612-273-9732, Email: moon0078@umn.edu
Marc E Mooney, Ph.D., Principal Investigator
Additional Information

Tobacco Use Research Center Website, Study Page

Related publications:

Ascher JA, Cole JO, Colin JN, Feighner JP, Ferris RM, Fibiger HC, Golden RN, Martin P, Potter WZ, Richelson E, et al. Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995 Sep;56(9):395-401. Review.

Mooney ME, Sofuoglu M. Bupropion for the treatment of nicotine withdrawal and craving. Expert Rev Neurother. 2006 Jul;6(7):965-81. Review.

Lerman C, Roth D, Kaufmann V, Audrain J, Hawk L, Liu A, Niaura R, Epstein L. Mediating mechanisms for the impact of bupropion in smoking cessation treatment. Drug Alcohol Depend. 2002 Jul 1;67(2):219-23.

Shiffman S, Johnston JA, Khayrallah M, Elash CA, Gwaltney CJ, Paty JA, Gnys M, Evoniuk G, DeVeaugh-Geiss J. The effect of bupropion on nicotine craving and withdrawal. Psychopharmacology (Berl). 2000 Jan;148(1):33-40.

Hutchison KE, Monti PM, Rohsenow DJ, Swift RM, Colby SM, Gnys M, Niaura RS, Sirota AD. Effects of naltrexone with nicotine replacement on smoking cue reactivity: preliminary results. Psychopharmacology (Berl). 1999 Feb;142(2):139-43.

Wong GY, Wolter TD, Croghan GA, Croghan IT, Offord KP, Hurt RD. A randomized trial of naltrexone for smoking cessation. Addiction. 1999 Aug;94(8):1227-37.

Krishnan-Sarin S, Meandzija B, O'Malley S. Naltrexone and nicotine patch smoking cessation: a preliminary study. Nicotine Tob Res. 2003 Dec;5(6):851-7.

Williams J, Ziedonis DM. Naltrexone-bupropion combination therapy for protracted abstinence dysphoria. Am J Addict. 2003 May-Jun;12(3):270-2. No abstract available.

Epstein AM, King AC. Naltrexone attenuates acute cigarette smoking behavior. Pharmacol Biochem Behav. 2004 Jan;77(1):29-37.

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King AC, Meyer PJ. Naltrexone alteration of acute smoking response in nicotine-dependent subjects. Pharmacol Biochem Behav. 2000 Jul;66(3):563-72.

Brauer LH, Behm FM, Westman EC, Patel P, Rose JE. Naltrexone blockade of nicotine effects in cigarette smokers. Psychopharmacology (Berl). 1999 Apr;143(4):339-46.

Ahmadi J, Ashkani H, Ahmadi M, Ahmadi N. Twenty-four week maintenance treatment of cigarette smoking with nicotine gum, clonidine and naltrexone. J Subst Abuse Treat. 2003 Apr;24(3):251-5.

Sutherland G, Stapleton JA, Russell MA, Feyerabend C. Naltrexone, smoking behaviour and cigarette withdrawal. Psychopharmacology (Berl). 1995 Aug;120(4):418-25.

Wewers ME, Dhatt R, Tejwani GA. Naltrexone administration affects ad libitum smoking behavior. Psychopharmacology (Berl). 1998 Nov;140(2):185-90.

Covey LS, Glassman AH, Stetner F. Naltrexone effects on short-term and long-term smoking cessation. J Addict Dis. 1999;18(1):31-40.

Lerner AG, Oyffe I, Sigal M. Naltrexone-induced reduction of tobacco intake. J Clin Psychiatry. 1998 Jan;59(1):30-1. No abstract available.

David S, Lancaster T, Stead LF. Opioid antagonists for smoking cessation. Cochrane Database Syst Rev. 2001;(3):CD003086. Review. Update in: Cochrane Database Syst Rev. 2006;(4):CD003086.

Toll BA, Leary V, Wu R, Salovey P, Meandzija B, O'Malley SS. A preliminary investigation of naltrexone augmentation of bupropion to stop smoking with less weight gain. Addict Behav. 2008 Jan;33(1):173-9. Epub 2007 Jun 2.

Plodkowski RA, Nguyen Q, Sundaram U, Nguyen L, Chau DL, St Jeor S. Bupropion and naltrexone: a review of their use individually and in combination for the treatment of obesity. Expert Opin Pharmacother. 2009 Apr;10(6):1069-81.

Starting date: November 2006
Last updated: December 2, 2009

Page last updated: November 27, 2014

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