Bupropion in Promoting Smoking Cessation in Pregnant Women

Inclusion Criteria

• Currently smoking on average 3 or more cigarettes per day for the preceding 7 days with a breath CO of at least 5 ppm and wants to quit smoking
• Pregnant at 13-26 weeks gestation (to maximize safety and the likelihood of receiving 10 weeks of treatment)
• Able to speak and read English at a 6th grade level or higher, using the Slosson Oral Reading Test (SORT)
• Committed to remaining in the geographic area for at least 3 months postpartum
• Able to sign written informed consent and commit to completing the procedures involved in the study
• Methadone or buprenorphine-maintained women must be in methadone or buprenorphine treatment for a minimum of 2 weeks prior to entering the study. Their 2 most recent urine drug screens, consecutive and administered at least one week apart, must both be positive for methadone or buprenorphine and negative for drugs of abuse other than cannabis. Participants who screen positive for other drugs at either time point will not be enrolled in the study until they meet this criterion

Exclusion Criteria

• During the last 90 days from screening visit, meets any criteria for a Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) diagnosis of drug or alcohol dependence—excluding tobacco or cannabis dependence and, for methadone or buprenorphine maintenance patients, opioid dependence—AND either evidences ongoing use of illicit drugs other than cannabis or continues to abuse or misuse prescription drugs such as central nervous system (CNS) stimulants
• Pregnant with triplets or higher order multiples
• Has an unstable psychiatric disorder (i.e., suicide risk moderate or severe, as reflected by a score of > 9 on the Mini-International Neuropsychiatric Interview (MINI) section B (suicidality) or a suicide attempt during the preceding year, psychiatric hospitalization within the last 3 months; current psychotic disorder based on the MINI)
• Current or past bipolar disorder as determined by a study psychiatrist or psychologist based on assessment with the MINI, relevant information from the medical record and, when warranted, direct clinical evaluation
• Current, regular use of psychotropic medication, inhibitors of CYP2B6 (e.g., ticlopidine, clopidogrel), inducers of CYP2B6 (e.g., ritonavir, lopinavir, efavirenz), anticonvulsants (e.g., carbamazepine, phenobarbital, phenytoin), beta-blockers (e.g., metoprolol), Type 1C antiarrhythmics (e.g., propafenone and flecainide), drugs that require metabolic activation by CYP2D6 to be effective (e.g., tamoxifen), drugs that lower seizure threshold (e.g., antipsychotics, tricyclic antidepressants, theophylline, or systemic corticosteroids), levodopa or amantadine
• Current unstable medical problems or potential inability to tolerate study treatment (e.g., threatened abortion: current persistent hyperemesis gravidarum [HEG] requiring intravenous fluids [to be rescreened when HEG is stabilized/resolved and no electrolyte abnormalities are evident]; hypertension with evidence of end organ dysfunction or on more than 2 medications at the start of the pregnancy); arteriovenous malformation; acquired immunodeficiency syndrome (AIDS); laboratory evidence of hepatic impairment (e.g. viral hepatitis with serum transaminase levels more than twice the upper limit of normal) ; renal impairment (e.g., elevated creatinine or creatinine clearance < 75 cc/hr), metabolic disorders (e.g., hypoglycemia, hyponatremia) or end organ damage from any chronic medical condition (e.g. abnormal pulmonary function tests), glaucoma, or other significant medical problems that in the opinion of a study obstetrician makes the risk of study participation unacceptable
• Known major fetal congenital malformation—as determined by the study obstetrician—diagnosed prior to study randomization
• History of seizure disorder
• Current use of a smoking cessation medication in addition to the study medication, such as nicotine replacement therapy
• Current or history of bulimia or anorexia nervosa
• Current use of tobacco products other than cigarettes (e.g., electronic [E]-cigarettes)
• Current clinically significantly abnormal laboratory evaluations that are not adequately controlled by standard of care treatment
• History of severe head injury (i.e., with loss of consciousness)
• Any medical condition or concomitant medication that could compromise subject safety or treatment, as determined by the principal investigator and/or study physician
• Inability to provide informed consent or judged by the principal investigator and/or study physician to be an unsuitable candidate for a clinical drug trial