Biological Warfare

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.