Intervenciones farmacológicas en cesación tabáquica en pacientes con trastorno bipolar Pharmacological interventions for smoking cessation in patients with bipolar disorder

Autores/as

  • Pablo González-Domenech Departamento de Psiquiatría, Facultad Medicina, Universidad de Granada. Grupo de Investigación en Psiquiatría y Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada
  • María Domingo-Rubio Departamento de Psiquiatría, Facultad Medicina, Universidad de Granada
  • Joaquín Camacho-Tapia Departamento de Psiquiatría, Facultad Medicina, Universidad de Granada
  • Jesús García-Jiménez Departamento de Psiquiatría, Facultad Medicina, Universidad de Granada. Grupo de Investigación en Psiquiatría y Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada. Servicio de Psiquiatría, Hospital Universitario San Cecilio, Granada
  • Luis Gutiérrez-Rojas Departamento de Psiquiatría, Facultad Medicina, Universidad de Granada. Grupo de Investigación en Psiquiatría y Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada. Servicio de Psiquiatría, Hospital Universitario San Cecilio, Granada
  • Sara Jiménez Fernández Departamento de Psiquiatría, Facultad Medicina, Universidad de Granada. Grupo de Investigación en Psiquiatría y Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada. Servicio de Psiquiatría, Hospital Universitario Virgen de las Nieves, Granada

DOI:

https://doi.org/10.20882/adicciones.2438

Palabras clave:

trastorno bipolar, abandono del tabaco, tratamiento farmacológico, vareniclina, terapia sustitutiva con nicotina bipolar disorder, smoking cessation, pharmacological treatment, varenicline, nicotine replacement therapy

Resumen

Introducción: El trastorno bipolar (TB) es una enfermedad mental crónica asociada a un mayor riesgo de mortalidad prematura. El consumo de tabaco es altamente prevalente en esta población y contribuye de forma relevante a la morbimortalidad física. Objetivo: Analizar críticamente la evidencia disponible sobre las intervenciones farmacológicas para el abandono del tabaco en pacientes con TB. Métodos: Se realizó una revisión narrativa estructurada en PubMed, The Cochrane Library y Web of Science, incluyendo estudios publicados entre enero de 1985 y marzo de 2025. Se incluyeron estudios originales que evaluaban tratamientos farmacológicos para la cesación tabáquica en pacientes con TB diagnosticado según criterios DSM o CIE. Debido a la heterogeneidad clínica y metodológica, no se realizó metaanálisis. Resultados: Se incluyeron 15 estudios. La mayoría evaluaron pacientes con TB dentro de cohortes psiquiátricas más amplias. La vareniclina mostró mayores tasas de abstinencia que el placebo, con odds ratios aproximadas entre 3,0 y 8,1, y fue superior al bupropión y a la terapia sustitutiva con nicotina (TSN) en varios estudios de gran tamaño. El bupropión y la TSN fueron generalmente más eficaces que el placebo, aunque con resultados menos consistentes. Los tratamientos fueron, en general, bien tolerados, sin aumento de eventos adversos neuropsiquiátricos graves. Conclusiones: Las intervenciones farmacológicas, especialmente la vareniclina, parecen efectivas y generalmente seguras para el abandono del tabaco en pacientes con TB. No obstante, la evidencia es heterogénea, lo que subraya la necesidad de estudios específicos en esta población.
Background: Bipolar disorder (BD) is a chronic mental illness associated with increased premature mortality. Tobacco use is highly prevalent in BD and contributes substantially to physical morbidity. Objective: To critically appraise the evidence on pharmacological interventions for smoking cessation in patients with BD. Methods: A structured narrative review was conducted in PubMed, The Cochrane Library, and Web of Science, including studies published between January 1985 and March 2025. Original studies evaluating pharmacological smoking cessation treatments in patients diagnosed with BD according to DSM or ICD criteria were included. Due to clinical and methodological heterogeneity, no meta-analysis was performed. Results: Fifteen studies were included. Most trials evaluated patients with BD within broader psychiatric cohorts. Varenicline showed higher abstinence rates than placebo, with odds ratios ranging approximately from 3.0 to 8.1 in randomized trials, and was superior to bupropion and nicotine replacement therapy (NRT) in several large studies. Bupropion and NRT were generally more effective than placebo, although results were less consistent. Treatments were generally well tolerated, without increased severe neuropsychiatric adverse events. Conclusions: Pharmacological interventions, particularly varenicline, appear effective and generally safe for smoking cessation in BD, especially when combined with behavioral support. Evidence remains heterogeneous, highlighting the need for BD-specific trials.

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Publicado

2026-06-02

Número

Vol. 38 Núm. 2 (2026)

Sección

Originales