12/30/2024

Janusmed kön och genus

Janusmed kön och genus – Bupropion Orion

Janusmed kön och genus är ett kunskapsstöd som tillhandahåller information om köns- och genusaspekter på läkemedelsbehandling. Kunskapsstödet är avsedd främst för hälso- och sjukvårdspersonal. Texterna är generella och ska inte ses som behandlingsriktlinjer. Det är alltid behandlande läkare som ansvarar för patientens medicinering.

För att komma till startsidan för Janusmed kön och genus och för att göra sökningar klicka här.

Tillbaka till index
C C
C C

Bupropion

Bupropion

Klass : C

Produkter

Bupropion Accord, Bupropion Bluefish, Bupropion Ebb, Bupropion Orion, ......

Bupropion Accord, Bupropion Bluefish, Bupropion Ebb, Bupropion Orion, Bupropion Paranova, Bupropion Pharmachim, Bupropion Sandoz, Bupropion Teva, Bupropion Zentiva, Bupropion hydrochloride, Mysimba, Voxra, WELLBUTRIN, Wellbutrin, Zyban
ATC-koder

A08AA62, N06AX12

A08AA62, N06AX12
Substanser

bupropion, bupropionhydroklorid

bupropion, bupropionhydroklorid
Sammanfattning

Kvinnor kan ha fler biverkningar i form av abstinens och trötthet relaterat till rökstopp vid behandling med bupropion. De flesta studier visar att effekten av bupropionbehandling vid rökavvänjning är lika hos kvinnor och män. Inga könsskillnader i bupropions effekt vid depression har visats.

Kvinnor kan ha fler biverkningar i form av abstinens och trötthet relaterat till rökstopp vid behandling med bupropion. De flesta studier visar att effekten av bupropionbehandling vid rökavvänjning är lika hos kvinnor och män. Inga könsskillnader i bupropions effekt vid depression har visats.
Background

There may be different predictors in smoking cessation success between men and women. Predictors for success in smoking cessation in women are higher education [1, 2], no e-cigarette use, early smoking initiation, and low-to-moderate alcohol consumption [1]. Weight gain in women is a predictor for failed smoking cessation [3]. In men, predictors for success are no use of nicotine replacement, current employment, family opinion on smoking [1], no previous depression, and a relative lack of anxiousness, irritability and hopelessness during quitting [2]. Women have greater motivation to quit smoking, according to some studies [4].

Depression is almost twice as common in women as in men [5]. Women have an earlier age of onset and increased duration of depressive episodes. The mechanisms behind these sex differences may be due to several factors such as differences in neurobiology [6, 7], inflammatory markers, diagnostic tools, or health seeking behaviour [8, 9]. Although depression is more prevalent in women, most preclinical studies on depression have used male animals [6] and the clin......

There may be different predictors in smoking cessation success between men and women. Predictors for success in smoking cessation in women are higher education [1, 2], no e-cigarette use, early smoking initiation, and low-to-moderate alcohol consumption [1]. Weight gain in women is a predictor for failed smoking cessation [3]. In men, predictors for success are no use of nicotine replacement, current employment, family opinion on smoking [1], no previous depression, and a relative lack of anxiousness, irritability and hopelessness during quitting [2]. Women have greater motivation to quit smoking, according to some studies [4]. Depression is almost twice as common in women as in men [5]. Women have an earlier age of onset and increased duration of depressive episodes. The mechanisms behind these sex differences may be due to several factors such as differences in neurobiology [6, 7], inflammatory markers, diagnostic tools, or health seeking behaviour [8, 9]. Although depression is more prevalent in women, most preclinical studies on depression have used male animals [6] and the clinical implication of this is unclear. # Pharmacokinetics and dosing Single-dose studies of bupropion in smoking and non-smoking adults (18 men, 16 women) and teenagers (37 males, 38 females) showed shorter half-life in males, and higher AUC and Cmax in male teenagers [10-12]. In healthy volunteers (90 men, 90 women), the AUC was around 13% higher in men [13]. The authors suggested that the protein binding and the metabolism by the CYP2B6 isoenzyme could explain the sex difference [12]. Greater CYP2B6 function in women have been demonstrated in prior pharmacokinetic studies [14, 15]. However, the described sex differences in pharmacokinetics may not be clinically relevant, and no sex differentiation in dosing has been suggested by the pharmaceutical company [16]. # Effects **Smoking cessation** Two RCTs (482 men, 475 women) [17, 18] and one survey study (94 men, 129 women) [19] comparing bupropion treatment with nicotine replacement therapy or cognitive behavioural therapy showed no difference in smoking cessation between men and women. In two RCTs of supportive counselling combined with varenicline 2 mg/day (in all 228 men, 209 women), bupropion 300 mg/day (in all 252 men, 179 women) or placebo (in all 253 men, 197 women), the smoking cessation frequency was similar in men and women [20, 21]. However, there are also studies showing a higher quit rate in men than in women. Two RCTs showed that women were less likely to quit smoking on bupropion (224 men, 380 women) and had higher risk of relapse (629 men, 875 women) [22, 23]. An observational study of a 6-week cognitive behavioural program with opportunity to add nicotine replacement therapy, bupropion or varenicline (552 men, 730 women), showed that women were 1.5 times more likely to continue smoking than men despite similar baseline characteristics and treatments. The patients were followed up for 52 weeks [24]. In a double-blind trial excluding responders to one week nicotine patch treatment, smokers were randomized to varenicline (46 men, 62 women) or a combination of varenicline + bupropion (55 men, 58 women). The quit rate with the combination of varenicline + bupropion was higher in men (odds ratio compared to monotherapy for successful quitting 4.3 in men and 0.9 in women) [25]. **Depression** Pooled data from ten RCTs in patients with major depressive disorder (in total 943 men, 1179 women) showed similar degree of improvement of depressive symptoms in men and women treated with bupropion [26]. # Adverse effects In a RCT of smoking cessation discomfort, volunteers highly motivated to quit were randomized to treatment with monotherapy (nicotine lozenge, nicotine patch or bupropion), combined therapy (lozenge+patch or lozenge+bupropion) or placebo (in total 412 men, 592 women). Compared to men, women experienced more cessation fatigue and had a stronger association between craving and cessation fatigue [27]. No sex differences in self-harm were observed in cohort study during 1.5 years of 80 660 smokers (approximately equal sex distribution) who were prescribed nicotine replacement therapy, varenicline or bupropion [28]. # Reproductive health issues Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan). # Other information A Swedish study of smokers treated with varenicline (8639 men, 9287 women) or bupropion (8674 men, 9252 women) showed that the rate of cardiovascular events per 1000 person years was higher in women than in men six months after treatment with varenicline (4.9 men, 9.1 women) or bupropion (5.8 men, 8.6 women) [29]. No comparison to non-treated smokers was performed. Most studies show that any smoking cessation medication (varenicline, bupropion or nicotine replacement therapies) was more common in women than in men [28, 30-34]. Although utilization of antidepressants is higher in women in general, utilization of bupropion in depression is higher among men. This difference may partly be explained by the adverse effect profile related to bupropion (weight gain, less sexual adverse effects) compared to SSRI, and therefore may be preferred by men [35, 36].
Försäljning på recept

Fler kvinnor än män hämtade ut tabletter innehållande bupropion (ATC-kod N06AX12) på recept i Sverige år 2023, totalt 39 860 kvinnor och 25 386 män. Det motsvarar 7,6 respektive 4,8 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 25–49 år hos båda könen. I genomsnitt var tabletter innehållande bupropion 1,6 gånger vanligare hos kvinnor [37]. Bupropion används vid olika indikationer och då saknas könsuppdelade användningsdata. Fler kvinnor hämtade ut tabletter innehållande kombination av bupropion och naltrexen (ATC-kod A08AA62) på recept i Sverige år 2023, totalt 3 319 kvinnor och 822 män. Det motsvarar 0,6 respektive 0,2 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 35–59 år hos båda könen. I genomsnitt var tabletter innehållande kombination av bupropion och naltrexon 4,6 gånger vanligare hos kvinnor [37].
Referenser
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  3. Kuo CW, Lin CF, Chen CY, Wang RH, Chou CY, Cheng HJ et al. Body-Weight Gain in Women During Smoking Cessation Is a Sex-Specific Predictor of 6-Month Abstinence: A Retrospective Cohort Study. Front Public Health. 2022;10:872220.
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  5. Nationella riktlinjer för vård vid depression och ångestsyndrom 2021. Socialstyrelsen [www]. Socialstyrelsen. [updated 2021-04-01, cited 2021-05-14].
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Uppdaterat

Litteratursökningsdatum: 5/23/2024

Litteratursökningsdatum: 5/23/2024
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