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Bupropion (Zyban®)
Bupropion (Zyban®)
A S U M M A RY F O R H E A L T H C A R E P R O F E S S I O N A L S
This summary provides a quick reference guide to using bupropion for smoking cessation. It provides information on efficacy, what to
say to people who want to use it, prescribing and adverse effects. For full prescribing information healthcare professionals should refer
to the New Zealand Formulary http://nzformulary.org/
Background
Bupropion (Zyban®) is an atypical anti-depressant that has been found effective for aiding smoking cessation. It acts to reduce the
severity of withdrawal symptoms thereby increases the chances of stopping smoking long-term.1 Zyban is fully funded in New Zealand
as a smoking cessation treatment and is available on prescription without special authority.
Evidence of effica cy
A Cochrane systematic review shows that use of bupropion for 7-12 weeks significantly increases long-term quit rates compared with
placebo (19% vs. 11%, Risk Ratio = 1.69, 95% CI: 1.53-1.85). 1
Prescribing bupropion HCL SR (Zyban) 150 mg tablets
 Zyban should be started at least 1 week prior to the target quit date.
 Days 1-3: one tablet daily
 Day 4 onwards: take one tablet twice daily, keeping at least 8 hours between each dose
 Patients should be treated for at least 7 weeks, but discontinuation should be considered if the patient has not made significant
progress towards abstinence by the seventh week of therapy.
Things to tell your pa tients
 It’s not a magic cure, but it will make quitting easier.
 Smoke as normal for the first week, then aim not to have a single puff from your quit day (day 8) onwards.
 Headache, dry mouth, and difficulty sleeping are the most common side effects, but are usually tolerable.
 Sometimes people experience drowsiness when they start taking medications like Zyban. Patients should be advised not to drive or
use heavy machinery if they experience this effect.
Contraindications
 Current seizure disorder or any history of seizures
 Use of Monoamine Oxidase Inhibitors within 14 days
 A known central nervous system (CNS) tumour
 Hypersensitivity to any ingredients in Zyban
 Abrupt alcohol or sedative withdrawal
 Bulimia, anorexia nervosa (or history)
Cautions
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Use extreme caution in patients with severe hepatic cirrhosis, a reduced dosing frequency is recommended.
Treatment of patients with renal impairment should be initiated at reduced frequency and/or dose.
Zyban must not be used in patients with predisposing risk factors for seizures unless there is a compelling clinical justification for
which the potential medical benefit of smoking cessation outweighs the potential increased risk of seizure. In these patients, a
maximum dose of 150mg should be considered for the duration of treatment. Predisposing risk factors for seizures include: use of
medicines known to lower the seizure threshold (e.g. antipsychotics, antidepressants, antimalarials, tramadol, theophylline, systemic
steroids, quinolones and sedating antihistamines); excessive use of alcohol or sedatives; history of head trauma; diabetes treated
with hypoglycaemics or insulin; use of stimulants or anorectic products
Depression, rarely including suicidal ideation, has been reported in patients undergoing a smoking cessation attempt, including
during early stages of treatment. Patients should be advised accordingly.
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Bupropion (Zyban®)
The safety of Zyban for use during pregnancy has not been established. Use of Zyban should only be considered during
pregnancy if the expected benefits are greater than the potential risks.
Zyban is excreted in human breast milk; mothers should be advised not to breast feed while taking Zyban.
The safety and efficacy of Zyban in patients under 18 years of age have not been established.
Drug interactions
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Anoretic drugs
Citalopram
Carbamazepine
Phenobarbitone
Phenytoin
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Levodopa
Amantadine
Ritonavir
Alcohol
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Drugs affecting CYP2B6 (e.g. orphenadrine,
cyclophosphamide, ifosfamide, ticlopidine, clopidogrel)
Drugs affecting CYP2D6 substrates (e.g.
antidepressants, antipsychotics, metoprolol, flecainide)
Adverse effects
Dry mouth, insomnia, headache, rash. Seizure has been rarely reported. The risk of seizure is similar to other antidepressants.2 Refer to
the New Zealand data sheet for Zyban for a complete list of known adverse effects.
Additional Information
 New Zealand Smoking Cessation Guidelines: www.moh.govt.nz/moh.nsf/indexmh/nz-smoking-cessation-guidelines
 Best Practice Update on Smoking Cessation: http://www.bpac.org.nz/magazine/2010/december/smoking.asp#pharmaco
 For the full prescribing information on Zyban, please see the New Zealand Formulary http://nzformulary.org/
Frequently a sked questions
How does the efficacy of bupropion compare to other medications for smoking cessation?
Bupropion is equally effective as nicotine replacement therapy and nortriptyline in helping people to stop smoking. Varenicline has
been shown to be more effective than bupropion.
Can bupropion be used in people that are taking other anti-depressants?
The datasheet recommends that bupropion should not be used in patients with predisposing risk factors for seizures unless there is a
compelling clinical justification for which the potential medical benefit of smoking cessation outweighs the potential increased risk of
seizure. The concurrent use of anti-depressants is a predisposing risk factor for seizures.
Is bupropion that best choice of smoking cessation treatment for people with a history of depression?
There is no evidence to suggest that the use of bupropion will protect against depression following smoking cessation. Choice of smoking
cessation product should be guided by patient preference and any contraindications or cautions. People with a history of depression
should be monitored for depressed mood following smoking cessation.
References
1. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews
2007(1):CD000031.
2. Oke A, Adhiyaman V, Aziz K, Ross A. Dose-dependent seizure activity associated with fluoxetine therapy. QJM 2001;94(2):113-4.
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