About Zyban (bupropion)
Zyban
This drug Zyban, containing buproprion hydrochloride,
is destined for those wishing to stop smoking.
It is only available on prescription. It has been
prescribed in the USA for a number of years, at higher
doses, as an antidepressant. Although it turned out not
to be particularly effective at treating depression, it
was found to contain a substance which reduces craving
for tobacco. Since then, a number of
have shown the effectiveness of this product in stopping
tobacco addiction.
Functioning
The exact way in which bupropion works is not completely understood.
It has an effect on the levels of neurotransmitters such
as noradrenalin and dopamine. Zyban reduces the desire
to smoke, the feelings of pleasure experienced while smoking,
and the symptoms of nicotine withdrawal. It also limits
the weight gain which frequently occurs following stopping
smoking.
Users
It is intended for smokers who have decided to stop smoking
and who are addicted to tobacco. This medicine requires
medical support and follow-up as well as a plan for stopping
smoking. It is more particularly indicated for those who
show negative interactions using nicotine replacement
products, for those who have failed to quit using nicotine
replacement products on a number of occasions and for
those who have a history of depression. It
is for the doctor treating you to decide the pharmaceutical
aid best suited to your needs and expectations.
Efficacy
The success rate for Zyban after one year is between 20% and
30%. In comparison, certain combinations of nicotine substitutes
(patch and gum or patch and nasal spray) have been shown
to be similarly effective, with an abstinence rate between
18% and 27%.
Counter-indications
There are a number of counter- indications for Zyban which
must be respected: hypersensitivity to the product, epilepsy,
cerebral tumours, serious eating disorders (bulimia nervosa,
anorexia nervosa), alcohol withdrawal, sedatives and illegal
drugs, certain medications (MAOIs or monoamine-oxidase
inhibitors).
There are also situations where it is possible to use
Zyban with caution, often at a reduced dosage, if the
doctor considers that the advantages of Zyban outweigh
the risks: kidney failure, liver failure, alcoholism,
head trauma, sleeplessness, taking certain medicines (anti-depressants,
neuroleptics, theophyllines, tramadol, anti-malarials,
quinolones, oral or injectable corticosteroids). Only
your doctor is able to prescribe Zyban. Keep him/her informed
of all the medicines you are taking, in case he
or she needs to adjust your treatment.
Undesirable
effects
- Insomnia in 25 to 30% of cases
- Dry mouth
- Restlessness, anxiety, irritability
- Depression
- Shaking
- Headaches
- Dizziness
- Increased heart rate (tachycardia), chest pains
- Abdominal pains, nausea, constipation
- Rash
- Eczema and swelling of lips, throat and tongue (angioedema)
- Very rarely - seizures (risk of 1 in 1000)
Important
: Many of these side effects can be attributed to nicotine
withdrawal in itself.
Treatment
In agreement with your doctor, Zyban must first be taken 7
to 14 days before the date on which you have decided to
stop smoking, this provides enough time to allow the substance
to start working.
- For 6 days, you will take one
150mg tablet of Zyban each morning
- From the 7th day of treatment
onwards, you will take 2 tablets a day, one
tablet when you get up and one at the beginning of
the afternoon, for a period of 6 weeks.. You must
allow a gap of 8 hours between the first and second
dosages. Never take a tablet in the evening (insomnia)
and if you’ve forgotten to take one it is better to
wait till the following morning for the next tablet.
In total you will be taking the tablets for 7 to 9
weeks.
- Do not stop taking the tablets, even if there are
lasting or serious side-effects, without talking to
your doctor. It is possible to reduce the dose to
1 tablet per day. This will greatly reduce the side
effects but remains almost as effective at stopping
smoking.
Pregnancy
and breastfeeding
Like many medicines, there is little data on the effects of
Zyban on human beings during pregnancy. There is no known
toxic effect of Zyban on the development of the baby during
pregnancy, notably no birth defects. Although it is preferable
to use it outside pregnancy it is still possible to administer
it during pregnancy. Talk about it with your gynaecologist
and together you should work out the best solution: you
need to take account of the poisonous effect of smoking
during pregnancy, which is itself well documented, as
smoking increases the risks of miscarriage and premature
birth. If you are planning on getting pregnant, you should
allow about 1 week for Zyban to disappear from the bloodstream
after you have stopped taking it. As the active ingredient
in Zyban passes into maternal milk, breastfeeding whilst
taking Zyban is not recommended.
Combination
with nicotine replacement therapy
Zyban can be used with nicotine replacement
products, but this has not been proven scientifically
to produce any greater effectiveness.
Price
For 7 weeks of treatment, i.e. 92 tablets, the cost is about
285 Swiss francs or between €130 and €142 depending on
the country. This treatment equates to a daily consumption
of about 20 cigarettes, depending on the price of the
packet. In Switzerland, this medicine is only available
on prescription and is restricted to those over 18 years
of age. It is not reimbursable under the basic health
insurance package but is sometimes taken care of by top-up
insurance cover.
Controversy
There have been reports in the media concerning Zyban which incite controversy and
concern amongst the public. Here is the opinion of Dr J-P Humair, faced with different
statements and controversies which have appeared recently in the media: :
The recent announcement in the UK concerning the fatal dangers
of Zyban is typical of the distortion of health-related information
which often occurs in the media. The fact that there have been “57
deaths during or after taking Zyban” 'has been transformed into
the more catchy news that « 57 deaths [have been] caused by Zyban ».
Going back to the original sources, and based on the available data concerning Zyban, I would like to make the following points:
- The 57 deaths are only notifications to the British Medicines Control Agency of deaths of persons who were taking or had recently been taking Zyban
- These notifications are a normal control procedure in respect of all medicines and their number is always slightly higher shortly after the introduction of a new medicine
- These notifications are the subject of investigations which have so far not shown any causal relation between these deaths and Zyban.
- Most of the deceased already had an illness or disease explaining the death, and a large number of these was due to smoking.
- Even those who had stopped smoking (with or without Zyban) could have developed a new smoking-related disease as the risk only diminishes little by little over the years.
- All of the studies carried out to date show no difference in the number of deaths of smokers using Zyban and those taking a placebo.
- This medicine has been used for stopping smoking in the USA and Canada for at least 5 years and no death has been shown to have been caused by Zyban, this is also the case for Wellbutrin which contains the same substance at a higher dose for the treatment of depression.
- Even if these deaths were attributable to Zyban (which is not at all the case), the risk would still be tiny (57/400'000, or 0.014%) and in no way comparable with the enormous risk of death caused by smoking, which is 50% !!!
50%!!!
Finally it should be remembered that the media are often more interested in selling their news than in public health, even if it means throwing the population into a panic. On the other hand, one should seriously doubt the impartiality of the media on the subject of smoking, as they are financially very dependant on the tobacco industry whose adverts they carry.
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You can the reports written by our users concerning Zyban.
References
-Hurt RD, Sachs DPL, Glover EB, et al.
A comparison of sustained-release bupropion and placebo
for smoking cessation. N Engl J Med 1997; 337: 1195-202.
-Jorenby DE, Leischow SJ, Nides MA et al. A controlled
trial of sustained release bupropion, a nicotine patch
or both for smoking cessation. N Engl J Med 1999 ; 340:
685-91. -Dale LC, Glover ED, Sachs DPL, et al. Bupropion
for smoking cessation - predictors of successful
outcome. Chest 2001; 119:1357-64.
E.
Laszlo et J.P Humair
(English translation by S.M Davis)
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