Randomized Trial Assessing the Effectiveness of a Pharmacist-Delivered Program for Smoking Cessation

Considering how accessible pharmacists are and how well suited they are to interact with patients obtaining smoking cessation medications, pharmacists can be instrumental in delivering programs to patients and hopefully improve quit rates for smokers. This study explored the idea of utilizing a pharmacist team (a licensed clinical pharmacist and APPE students) in order to deliver a smoking cessation program face-to-face. The researchers compared outcomes from this approach with that of a method that involved brief telephone assistance to patients aiming to quit smoking. Outcomes were measured through the 7-day point prevalence quit rates, Fagerstrom Test for Nicotine Dependence scale, Perceived Stress Scale, and Center for Epidemiological Studies Short Depression Scale, as well as questionnaires regarding self-efficacy, motivation to quit smoking, and withdrawal symptoms. Biological measures of smoking, including cotinine levels, were also assessed. In addition to the two interventions, participants had a choice to receive either bupropion IR (Zyban®) tablets or nicotine patches.

The group receiving face-to-face treatment from the pharmacist team had a quit rate of 28% confirmed by the 7-day point prevalence and cotinine levels, while the standard care group receiving phone calls had a quit rate of 11.8%. Pharmacist-delivered face-to-face care seems to be beneficial in improving outcomes for those wanting to quit smoking. Perhaps collaborative practice agreements that allow pharmacists to prescribe smoking cessation medications can be developed to help improve quit rates. Pharmacists can be uniquely suited to this approach as they are so accessible and can help patients through all the aspects of taking smoking cessation medications– dispensing, counseling, and monitoring for efficacy, safety, and adherence.

 

Dent LA, Harris KJ, Noonan CW. Randomized trial assessing the effectiveness of a pharmacist-delivered program for smoking cessation. Ann Pharmacother. 2009; 43:193-201.

Role of Bupropion Plus Naltrexone for the Management of Obesity

Obesity has been and still is a concern among the American population.  By the American Medical Association, obesity is a recognized disease state and is a risk for chronic diseases such as diabetes and osteoarthritis.  Lifestyle modifications including exercise and healthy diet are pertinent in treatment, however, if obesity is not cured which includes a high BMI of at or above 30 kg/m2, intervention of pharmacologic treatment may be necessary.  One of such treatments is branded as Contrave, which is bupropion plus naltrexone and is FDA indicated for chronic weight management.  This article reviews the clinical evidence in that regard.

There is evidence that suggests bupropion may help with weight loss by itself, however, working in conjunction with naltrexone, naltrexone can increase bupropion’s effect on the POMC neurons in the hypothalamus to cause appetite suppression.  It blocks the mu-receptors and results in an increased activity of POMC neurons leading to weight loss.

Five articles were included in this study as a data source.  In the clinical trials evaluated, it can be noted that there is substantial evidence that supports the efficacy of bupropion plus naltrexone, compared to placebo, in obesity management.  Results from these trials show that the average weight loss was 6.8% from baseline and 4.3% from baseline with the placebo subtracted.  About 66% and 42% of patients randomized to treatment also respectively lost 5% and 10% of weight from baseline.  Adverse effects which include nausea and constipation were the most common reason patients stopped the medication during the trials.  Dry mouth, vomiting, dizziness, and heartache were also experienced.  A limitation is that this drug’s efficacy hasn’t been studied in the Hispanic, African American, and Asian populations.

Since weight management medications are becoming more popular in the treatment of obesity, it is valuable that this review was done on these clinical trials to show the efficacy.  This also may lead to the possibility of a generic formulation.  In the future I hope to see an established efficacy of the drug in other racial populations.

J Pharm Technol. doi:10.1177/8755122515624220 (published 11 January 2016).