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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.