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|Zyban Zyban

Zyban

Generic name: Bupropion hydrochloride
Brand names: Zyban

Why is Zyban prescribed?

Zyban is a nicotine-free quit-smoking aid. Instead of nicotine, it contains the same active ingredient as the antidepressant medication Wellbutrin. It works by boosting the levels of several chemical messengers in the brain. With more of these chemicals at work, you experience a reduction in nicotine withdrawal symptoms and a weakening of the urge to smoke. More than a third of the people who take Zyban while participating in a support program are able to quit smoking for at least 1 month. Zyban can also prove helpful when people with conditions such as chronic bronchitis and emphysema decide it"s time to quit.

Most important fact about Zyban

About 1 person in 1,000 suffers a seizure while taking Zyban. For this reason, people with epilepsy and certain other disorders should never take the drug. Don"t share Zyban with friends. Only a doctor can decide whether it"s safe for a particular individual.

How should you take Zyban?

Treatment with Zyban begins while you are still smoking. Zyban needs about a week to reach an effective level in your body; so to improve your chance of success, you should not attempt to quit until the second week of treatment. Set a firm date for quitting. If you are still smoking after that date, your odds of breaking the habit will be worse. You should keep taking Zyban for 7 to 12 weeks.

You can use nicotine patches along with Zyban. However, combining the two treatments can raise your blood pressure, so it"s important to tell your doctor if you plan to use both. Do not smoke while using a patch, because too much nicotine can cause serious side effects.

Participating in a counseling or support program will make success more likely. Your doctor can recommend a local program for you.

Swallow Zyban tablets whole. Do not chew, divide, or crush them. Take them exactly as prescribed.

--If you miss a dose...

Do not take an extra tablet to "catch up" for the missed dose. Skip the dose and take your next tablet at the regularly scheduled time.

--Storage instructions...

Store at room temperature in a tightly closed container. Keep out of direct sunlight.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Zyban.

• Side effects include:
  Dry mouth and sleeplessness

These are generally mild and usually disappear after a few weeks. If you have difficulty sleeping, avoid taking Zyban close to bedtime and ask your doctor about reducing your dosage.

Why should Zyban not be prescribed?

Because Zyban has been known to trigger convulsions, no one with a seizure disorder should take Zyban. Also avoid Zyban if you are taking Wellbutrin or any other drug that contains bupropion, Zyban"s active ingredient. The more bupropion you take, the more likely you are to have a seizure.

Zyban"s seizure-triggering potential is greater in people with an eating disorder such as bulimia or anorexia, and in those undergoing abrupt withdrawal from alcohol, sedatives, and tranquilizers such as Librium and Valium. If you suffer from one of these problems, never take Zyban. Avoid it, too, if you are taking a drug classified as an MAO inhibitor, such as the antidepressants Nardil and Parnate. Allow at least 14 days to pass between taking one of these drugs and starting your Zyban therapy.

If bupropion or any other ingredient in Zyban has ever given you an allergic reaction, the drug is not for you.

Special warnings about Zyban

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Because Zyban contains the same ingredient as the antidepressant Wellbutrin, anyone considering the use of Zyban or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Zyban has not been studied in children or adolescents and is not approved for treating anyone less than 18 years old.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Zyban and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Because the chance of a seizure from Zyban rises with the amount in your system, never take more than one 150-milligram tablet at a time, and limit your total daily intake to 2 doses (300 milligrams).

A variety of conditions can predispose you to seizures, including:

Prior head injuries
Prior seizures
Central nervous system tumors
Cirrhosis of the liver
Too much alcohol
Abrupt withdrawal from alcohol, tranquilizers, or sedatives
Addiction to narcotics or cocaine
Use of over-the-counter stimulants or diet pills
Use of diabetes medications
Use of antidepressants, major tranquilizers, steroids, or theophylline

If any of these apply to you, use Zyban with care. If you do have a seizure while taking Zyban, stop taking the drug and never take it again.

Stop taking Zyban and call your doctor immediately if you have difficulty breathing or swallowing; notice swelling in your face, lips, tongue, or throat; develop swollen arms and legs; or break out with itchy eruptions. These are warning signs of a potentially severe allergic reaction.

If you have a liver or kidney condition, make sure the doctor is aware of it. Your dosage may need to be reduced. (If you have severe cirrhosis of the liver, your dosage must be reduced.) Also make certain the doctor knows about any heart condition you may have.

Zyban can interfere with your driving ability. Don"t drive or operate dangerous machinery until you are certain of the drug"s effect on you.

Possible food and drug interactions when taking Zyban

If Zyban is used with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Zyban with the following:

Alcohol
Amantadine (Symmetrel)
Antidepressants such as Norpramin, Pamelor, Paxil, Prozac, Tofranil, and Zoloft
Beta blockers (heart and blood pressure medications) such as Inderal, Lopressor, and Tenormin
Carbamazepine (Tegretol)
Cimetidine (Tagamet)
Cyclophosphamide (Cytoxan)
Heart-stabilizing drugs such as Rythmol and Tambocor
Levodopa (Dopar, Larodopa, Sinemet)
Major tranquilizers such as Haldol, Risperdal and Thorazine
MAO inhibitors such as the antidepressants Nardil and Parnate
Orphenadrine (Norflex)
Phenobarbital
Phenytoin (Dilantin)
Steroids such as prednisone and hydrocortisone
Theophylline (Theo-Dur, Theolair)
Warfarin (Coumadin)

Quitting smoking, with or without Zyban treatment, could change the way your body metabolizes certain drugs, for example, theophylline and warfarin. Make sure your doctor knows all the prescription and over-the-counter medicines you"re taking.

Special information if you are pregnant or breastfeeding

Zyban has not been tested in pregnant women. If you are pregnant or plan to become pregnant, do your best to quit smoking with the aid of counseling and support before turning to drug therapy. For the sake of the baby, you should avoid smoking or taking nicotine in any other form while pregnant.

Zyban appears in breast milk and could affect a nursing infant. Ask your doctor whether it will be better to discontinue the medication or to stop breastfeeding.

Recommended dosage

ADULTS

The usual starting dose is one 150-milligram tablet in the morning for the first 3 days. After that, take one 150-milligram tablet in the morning and another in the early evening. Keep doses at least 8 hours apart. The maximum recommended dose is 300 milligrams daily.

Continue taking Zyban for 7 to 12 weeks. Your doctor may recommend continuing treatment for up to 6 months.

Kidney and Liver Disease

Your doctor may reduce the frequency of your doses to avoid high blood levels of Zyban. If you have severe cirrhosis of the liver, you should take no more than 150 milligrams every other day.

CHILDREN

The safety and efficacy of Zyban have not been established in children under 18.

Overdosage

Information on Zyban overdose is limited. However, any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Zyban overdose may include:
  Blurred vision, confusion, grogginess, jitteriness, light-headedness, nausea, seizure, sluggishness, visual hallucinations