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November 17, 1999

Biological Warfare

Author Affiliations

Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor

JAMA. 1999;282(19):1817. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-19-jbk1117

To the Editor: Bupropion hydrochloride, an atypical antidepressant that has both dopaminergic and adrenergic actions, is effective for smoking cessation, being more effective than placebo1 and more effective than the nicotine patch alone.2 Bupropion enhances the response rate of the nicotine patch. Recent guidelines on smoking cessation3 recommend bupropion for smokers who fail treatment with or who do not wish to use nicotine replacement therapy. It is the second-line therapy in part due to adverse effects.4 Principally, these include agitation, dizziness, insomnia, tremor, reduced seizure threshold, dry mouth, nausea, and abdominal pain. A study by Settle4 found that these adverse effects are dose related. Compared with placebo, which had a 4% discontinuation rate, buproprion had a discontinuation rate of 9% at the 300 mg/d dosage and 11% at 450 mg/d dosage. We describe herein a serum sickness–like reaction in a man taking bupropion.