Family doctor

USE: To help to quit smoking cigarettes

Zyban was first made to treat depression, but was then found to be useful in helping quitting smoking, regardless of whether or not the person trying to quit is depressed. Zyban tablets are usually taken before stopping smoking, with a stop smoking date set in the first fortnight of taking them. They are taken for at least seven weeks and can be taken for longer to prevent going back to smoking. Zyban is sometimes used with a nicotine patch system (e.g. Nicotinell, Habitrol, Nicabate or Nicorette) . Talk to your doctor or pharmacist about whether you can use both together.

Studies have shown that patients who used Zyban to quit smoking were two to three times more likely to not be smoking a year later than those who used placebo (sugar or pretend pills). This rate may possibly be even better if used with a nicotine patch as well.

Dose

Start with one tablet (150 mg) taken each day, then after three days take one tablet (150 mg) twice a day. Or take as your doctor has prescribed.

Cautions:

Do not use if:

• You know you are extra-sensitive or allergic to this medicine
• You have seizures including epilepsy
• You have or have had bulimia or anorexia nervosa (eating disorders)
• You are taking a particular type of antidepressant called a monomania oxidase inhibitor (MAOI)
• You are already taking bupropion
• You are pregnant or breastfeeding

Take special care:

• If you have liver problems including cirrhosis, or kidney (renal) problems &endash these tablets may not be taken as often, or your doctor may recommend you do not take them at all. You would need to keep a special watch out for side effects such as keeping awake at night, dry mouth or seizures as these might happen with a build up of Zyban in the body.
• If you have a history of head injury
• If you have a brain tumour
• If you have a history of seizures including epilepsy
• If you are on other medicines which can cause seizures
• If you have an alcohol problem or have recently come off alcohol or sedatives suddenly
• If you are diabetic
• If you are taking a stimulant, or if you are using a stimulating-type medicine for weight loss
• If you are elderly
• If you have bipolar disorder (manic depression)
• If using with a nicotine patch regular blood pressure tests are recommended

Zyban is not recommended for children under 18 years.

Side effects:

Zyban can sometimes cause difficulty in concentration or dizziness, so do not drive or use machinery unless you are fairly certain it is not affecting your reactions.

The two most common side effects are insomnia (staying awake at night) and dry mouth.

Other side effects include:

• Increased blood pressure, sometimes to quite high
• Faster heart beat, postural hypotension (feel dizzy if you stand up suddenly), reddened skin
• Seizures &endash in 1 person in 1000 taking the medicine
• Tremor, headache, dizziness, depression, confusion, anxiety, restless, difficulty concentrating
• Fever, chest pain, weakness
• Reduced appetite
• Stomach upset
• Rash, itching, sweating
• Noises in the ears, problems with vision and change in taste
• Extra-sensitivity can include an itchy rash, swelling of the face and breathing passages and tightening of breathing passages . See a doctor quickly if you get any of these signs.

There may be other side effects, so if you have any unexpected symptoms while taking this medicine, tell your doctor or pharmacist.

Interactions:

Stopping smoking can affect some other medicines, e.g. theophylline (Theo-dur, Nuelin).

Medicines that interact with Zyban may include:

• Orphenadrine (Disipal)
• Cyclophosphamide
• Ifosfamide
• Some antidepressants : do not use with MAOIs at all, and take care with desipramine, imipramine and paroxetine
• Some antipsychotics including risperidone and thioridazine
• Beta-blockers (often used for the heart) e.g. metoprolol
• Some medicines for irregular heart beat e.g. propafenone, flecainide
• Some medicines for epilepsy e.g. carbamazepine, phenobarbitone, phenytoin
• Levodopa (for Parkinsons Disease)

There may be other medicines as well that may interact with Zyban. Your pharmacist or doctor will be able to check for you if your medicines will be fine with Zyban.

Patient information:

• Follow the instructions on the label of the medicine or as directed by your doctor.
• If you are on other medicines check with your doctor or pharmacist that they are fine with Zyban before you start taking it.
• Do not take more than the recommended dose.
• If you get any of the extra-sensitive problems e.g. skin rash, swelling of face or any difficulty breathing (see under side effects) talk to a doctor quickly.
• Set a quit date and tell people around you when you are quitting. This will help to make you more resolved, and support from your friends, family and workmates will help.
• Think about the times that you usually smoke, e.g. in the car, when having a coffee, when having an alcoholic drink, and be prepared for these times and change your routine because it will be hard otherwise to do these things without a cigarette. For example change from coffee to tea or a cold drink, avoid alcohol for a few weeks (alcohol can also weaken your resolve), or change your alcoholic beverage, go for a walk in the morning when you would normally have your first cigarette. If you normally take your morning and afternoon tea breaks with other people who smoke, join the non-smokers instead for a few weeks. Your smoking buddies won't mind if it is going to be good for your quitting attempt. These ideas may make quitting easier.
• Write a list of all the benefits of not smoking, e.g. the money you will save, the health benefits, the health benefits for people around you, the better taste that food will have, increased fitness. These can help keep you positive about quitting.
• Give yourself treats after the first day, the first week, the first month, the second month and so on. This will give you something to look forward to and you will deserve a reward.
• It is common for many people to take several quit attempts before they actually manage to give up . Take each day as it comes and if you don't succeed first time around remember what went wrong and try to avoid it for next time. You'll probably find it easier second time around.
• Work out what you are going to do if you have to deal with stress. A lot of people who have successfully quit even for years will have a very stressful event in their lives and go back to smoking. Even one cigarette can get you hooked again so don't be tempted.
• To help to avoid weight gain drink plenty of water, have low fat snacks like carrot sticks easily available, and start an exercise programme, even a 20 minute walk three times a week will be very beneficial and it will be easier now that you are smoke-free.
• Zyban requires a prescription and will probably not be free (in New Zealand a packet of 30 tablets will cost around $110).