Efficacy and safety of bupropion for smoking cessation and reduction in schizophrenia: systematic review and meta-analysis.

Background: The benefits and harms of bupropion as an aid for smoking cessation in schizophrenia remain uncertain.

Aims: To summarise the current evidence for efficacy and safety of bupropion as treatment for nicotine dependence in schizophrenia.

Method: Systematic review and random-effects meta-analysis of randomised controlled trials (RCTs) comparing bupropion with placebo or alternative therapeutic control in adult smokers with schizophrenia.

Results: Twenty-one reports from seven RCTs were included. Biochemically verified self-reported smoking cessation rates after bupropion were significantly higher than placebo at the end of treatment (risk ratio (RR) = 2.57, P = 0.004) and at 6 months (RR = 2.78, P = 0.05). Expired carbon monoxide level was significantly lower with bupropion at the end of therapy (P = 0.002) but not at 6 months (P = 0.37). There was no significant difference in positive (P = 0.28) or negative symptoms (P = 0.49) between the bupropion and the placebo group.

Conclusions: Bupropion increases the rates of smoking abstinence in smokers with schizophrenia, without jeopardising their mental state.