Physician Information About: USE OF ZYBAN 

Zyban (Bupropion Hydrochloride) Sustained-Release Tablets:

- Available as a tablet and by prescription only.

*PREPARATION:

-Treatment should be initiated while the patient is still smoking.

-Patients should set a “target quit date” within the first two weeks of treatment, generally in the second week.

*DOSAGE:

-Usual dosage: 150 mg twice daily.

-Start dosing at 150 mg once daily. Increase on day 4 to 150 mg twice daily and maintain for duration of therapy.

-Maximum dosage: 300 mg/day.

-Dose tapering on discontinuation is not required.

*ADMINISTRATION:

-Oral tablets swallowed whole. Patient should not chew, divide, or crush tablets.

-Combination treatment with Zyban and a nicotine transdermal system (NTS) may be used. Add NTS after patient reaches target quit date. Refer to the “nicotine patch” link for more information about NTS.

*DURATION OF THERAPY:

-Duration of therapy is generally 7-12 weeks. If a patient has not made significant progress towards smoking abstinence by the seventh week of therapy, the manufacturer recommends discontinuation of therapy.

*ADVERSE REACTIONS:

-Most common reactions: Insomnia and dry mouth.

-Most common reactions leading to discontinuation of therapy: nervous system disturbances-primarily tremor, and skin disorders-primarily rashes.

-Other side effects: arthralgia, dizziness, constipation, rash, nausea, pruritus, taste abnormalities.

*WARNINGS, CONTRAINDICATIONS AND PRECAUTIONS:

-Warnings:

-Because the use of bupropion is associated with a dose-dependent risk of seizures, clinicians should not prescribe doses over 300 mg/day for smoking cessation. The risk of seizures is also related to patient factors, clinical situation, and concurrent medications, which must be considered in selection of patients for therapy with buproprion.

-Contraindications:

            -Patients with a seizure disorder.

            -Patients taking other medications containing bupropion.

            -Current or prior diagnosis of bulimia or anorexia nervosa.

-Concurrent administration of a monoamine oxidase (MAO) inhibitor or administration of an MAO inhibitor less than 14 days prior to initiation of Zyban.

-Precautions:

            -Pregnancy: not recommended.

            -Nursing mothers: not recommended.

-Use caution with concurrent administration of Zyban and agents that lower seizure threshold (eg. antipsychotics, antidepressants, theophylline, systemic steroids, etc).

-Be aware that the antidepressant Wellbutrin contains bupropion, the same active ingredient in Zyban.

-If combining Zyban with NTS use, monitor for treatment-induced hypertension.

*CONSIDERATIONS FOR THE ADOLESCENT POPULATION (ages 14-17):

-Smoke a minimum of 6 cigarettes/day for 3 months.

-Motivated to quit.

-Have made at least 2 prior quit attempts.

-Weigh at least 90 pounds.

-Advise adolescent and parents of risks (seizure risk = 1/1000; possible allergic reaction).

-No psychiatric disorders or other substance abuse.

-No concurrent use of antidepressant medications, including Wellbutrin with past 4 weeks.

-No current or significant history of CVD.

-No predisposition to/family history of seizures or tic disorders. No current medications/therapies that increase seizure risk.

-No history or current diagnosis of eating disorders.

-Not pregnant; if sexually active, using birth control.

-May be combined with nicotine replacement after quit date.

**Click here for a Printable Patient Handout**

**Click here for FAQ and More Info**

Sources:

-Clinician’s Handbook of Preventive Services, 2^nd edition, International Medical Publishers, 1998, Pages 432-446

**Adapted from “Zyban  (bupropion hydrochloride) Sustained-Release Tablets Product Information”. Glaxo Wellcome Inc. Research Triangle Park, NC. 1997.

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