The antidepressant drug Zyban is one of the newest – and reportedly one of the most effective – weapons in the anti-smoking arsenal.
What is Zyban?
‘Zyban’ is the drug’s trade name. The active ingredient is bupropion hydrochloride. Bupropion was originally designed as an antidepressant medication (marketed as Wellbutron), but which has been found to have an additional important function: it suppresses the urge to smoke in many people addicted to nicotine.
How does Zyban work?
The way Zyban works is imperfectly understood, but it seems to affect the part of the brain associated with addiction, and increases levels of certain neurotransmitters (chemicals involved in transmitting messages between the nerve cells). Zyban is thought to increase the availability of two of these neurotransmitters, noradrenaline and dopamine, which moderate mood and control various other brain processes. The result is that Zyban simulates the effects of nicotine, and thus dampens the urge to smoke. Zyban also reduces the physical symptoms of nicotine withdrawal.
Zyban is considered to be as effective as nicotine replacement therapy (NRT) methods like the patch in helping smokers quit. Some studies show that approximately a third of smokers who take Zyban to help them quit aren’t smoking one year after treatment, which is higher than the success rate for NRT, and considerably higher for smokers attempting to quit ‘cold turkey’.
What does taking Zyban involve?
Zyban can only be obtained on prescription, because there are a number of sound medical reasons why you should take the drug with a doctor’s knowledge. Your doctor needs to decide if you are a suitable candidate for Zyban before prescribing it. Certain pre-existing medical conditions and other medications could make taking Zyban risky. For example, it shouldn’t be used by people with epilepsy, diabetes or eating disorders, or who are taking certain other antidepressants or psychiatric drugs. Zyban is also not recommended for pregnant or breast-feeding women. When you discuss Zyban with your doctor, be sure to also run through your medical history and mention any medications (both prescription and non-prescription) you may be taking.
A course of Zyban typically lasts seven to twelve weeks, depending on how confident you feel about staying off cigarettes. You may need to stay on Zyban for longer – up to a maximum of six months. You take one 150mg tablet per day for the first three days, and two tablets per day at minimum intervals of eight hours from the fourth day onwards. Sixty 150mg Zyban tablets (a month’s supply) costs about R290.
It takes about a week before Zyban has full effect, so it is recommended that you start the course one to two weeks before your smoking ‘quit date’, to give the drug time to reach sufficiently high levels in your body to start working.
How does Zyban fit in with other quit-smoking strategies?
The current expert consensus is that Zyban is most effective as an anti-smoking aid if used in conjunction with a smoking cessation support programme, whether this involves a course, group or counselling.
Zyban can be used in combination with NRT, but you must consult your doctor first, because there are associated health risks. Particularly, the risk for high blood pressure is increased, so your blood pressure should be monitored regularly. It’s very important not to smoke while using NRT together with Zyban: this can result in excessively high nicotine levels and serious associated side effects.
Advantages and disadvantages of Zyban
Zyban has the advantage that, unlike NRT, it contains no nicotine, which is a harmful substance – even when taken for the ultimately healthful purpose of quitting smoking.
However, Zyban, like other anti-depressants, is a potent drug that acts on the brain in ways not yet fully understood. Although Zyban is considered to be very safe, doctors don’t have the benefit of several years’ experience with the drug – as they do with NRT.
Zyban may also cause side effects, which include dry mouth, sleeping problems, agitation, anxiety, skin rashes, shakiness, headache, increased sweating, constipation and fatigue. The most serious, but rare, potential side effect is seizures, which affect about 1 in 1000 people.
Taking Zyban safely and correctly
- Take Zyban exactly as prescribed. Swallow the tablets whole with water – don’t chew or break them. Never exceed the prescribed dose: this increases the risk of seizures, and other medical problems. If you miss a dose, don’t take two doses close together; it’s important to keep at least an eight-hour gap between doses. Don’t take tablets too late at night if you’re having trouble sleeping.
- Given the potential serious medical consequences of taking Zyban, you should never offer to let a friend ‘try’ some of your supply of the drug to see if it helps them stop smoking! Apart from the risk, Zyban will only take effect if a course is followed conscientiously over the required time period.
- Zyban is not recommended for children and teenagers under age 18, as there is insufficient information regarding its safety and efficacy for this age group.
- Avoid any other products that contain bupropion or caffeine, and don’t drink excessive amounts of coffee or other caffeinated beverages.
- Avoid high alcohol intake while taking Zyban, but taper off your intake prior to going on the drug.
- Stop taking the tablets and call your doctor if
- side effects persist or get worse, or seizures occur
- you show any signs of an allergic reaction to the drug, such as rash, hives or difficulty breathing.
Nicotine is a stimulant