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Assessing polymorphisms of cytochrome P450 (CYP) enzymes that metabolize bupropion might help to predict efficacy for smoking cessation (JW Psychiatry Nov 19 2007), but the cost-benefit ratio of testing has not seemed dramatic. Because people who metabolize nicotine rapidly have low between-cigarette nicotine levels and poor success in quitting smoking with nonpharmacologic treatments, these researchers investigated whether a marker of nicotine metabolism rate (NMR) would predict quit rates. In a 10-week study, 414 smokers (average, 1 pack/day) were randomized to counseling plus bupropion or placebo. NMR was measured by the ratio of trans-3´-hydroxycotinine to cotinine, two sequential metabolites of nicotine via CYP2A6.
Among the slowest nic…