Bupropion (Zyban)

A brief overview of smoking and nicotine addiction

Nicotine is a drug that is inhaled from the tobacco in cigarettes. It gets into the bloodstream, and stimulates the brain. Most regular smokers are addicted to nicotine.

If you are a smoker, when the blood level of nicotine falls, you usually develop withdrawal symptoms such as restlessness, increased appetite, inability to concentrate, irritability, dizziness, constipation, nicotine craving, or just feeling awful. These symptoms begin within a few hours after having the last cigarette. If they are not relieved by the next cigarette, withdrawal symptoms get worse. If you do not smoke any more cigarettes, the withdrawal symptoms peak after about 24 hours, and then gradually ease over about 2-4 weeks. So, most smokers smoke regularly to feel 'normal', and to prevent withdrawal symptoms.

About 2 in 3 smokers want to stop smoking but, without help, many fail to succeed. The main reason why so few smokers succeed, even though they want to stop smoking, is because nicotine addiction is strong and difficult to break. This is where bupropion can help.

What is bupropion and how does it work?

Bupropion is a medicine that was first developed to treat depression. It was found that it helped smokers to stop smoking. It is not clear how it works. It alters the level of some chemicals in the brain (neurotransmitters). This seems to relieve the withdrawal symptoms that you get when you stop smoking (such as craving, anxiety, restlessness, headaches, irritability, hunger, difficulty with concentration, or just feeling awful).

How effective is bupropion?

Taking bupropion does increase the chance of quitting smoking. Various studies have looked at this issue. The studies compared bupropion to a similar dummy (placebo) tablet in people who were keen to stop smoking. The results from the studies showed that, on average, about 19 in 100 people who took bupropion stopped smoking successfully. This compared to about 10 in 100 who took the dummy (placebo) tablet. In other words, about twice the number of smokers who take bupropion stop smoking compared to those who don't, and about 1 in 5 smokers who want to stop will do it with the help of bupropion.

How do I take bupropion?

• You need a prescription to obtain bupropion - you cannot buy it at pharmacies.
• Start by taking one tablet (150 mg) each day for six days. Then increase to one tablet twice a day, at least eight hours apart. Do not take more than one tablet at any one time, and not more than two tablets in a day. (If you are elderly or if you have certain liver or kidney diseases, the dose may be different - your doctor will advise.)
• Aim to stop smoking completely on day eight of treatment. This allows bupropion to build up in your body before you stop smoking.
• You should continue the tablets for a further seven weeks. (So, this is eight weeks in total, which is two packs of tablets.)

Bupropion does not 'make' you stop smoking. You still need determination to succeed, and to break the smoking habit. A combination of bupropion with counselling from a nurse, doctor, pharmacist, or other health professional increases your chance of successfully stopping smoking. Therefore, most doctors will only prescribe bupropion to people who really want to stop smoking as part of a 'stopping smoking' programme.

Are there any side-effects?

Most people take bupropion without any problem. Read the packet leaflet for a full list of possible side-effects and cautions. The most common are: a dry mouth (which occurs in about 1 in 10 users) and some difficulty in sleeping (which occurs in about 1 in 3 users). Less common, but more serious possible side-effects include the following:

Drowsiness

If this occurs you should not drive or operate machinery.

A seizure (fit or convulsion)

This occurs in about 1 in 1000 people who take bupropion. Therefore, although this is uncommon, it can be serious, particularly if it occurs when you are operating machinery or driving. The risk of a seizure is increased if you have a history of certain medical conditions, or if you take certain medicines (listed below). Therefore, bupropion is not suitable for all people who wish to stop smoking (see below).

High blood pressure

Blood pressure sometimes goes up in people who take bupropion. You should have a baseline blood pressure reading done before you start treatment and it should be monitored from time to time.

Who should not take bupropion?

You should not take bupropion if you:

• Are under the age of 18.
• Are pregnant or breastfeeding.
• Have ever had epilepsy, a seizure (fit or convulsion), or an unexplained blackout.
• Have ever had anorexia nervosa or bulimia nervosa.
• Have bipolar affective disorder (manic depression).
• Are withdrawing abruptly from benzodiazepines or alcohol dependence.
• Have a tumour of the brain or spinal cord.
• Have had a previous allergic reaction to bupropion tablets.

Also, the dose may need to be reduced if you have some medical conditions, or if you take certain medicines. Tell your doctor or pharmacist if you:

• Have ever had a serious head injury.
• Have diabetes that is treated with insulin or medicines.
• Drink a lot of alcohol.
• Have a liver or kidney disease.

Bupropion combined with certain other medicines can increase the risk of having a seizure. Therefore, whilst you are taking bupropion, tell your doctor or pharmacist if you are prescribed or buy any new medicine. Also, tell a doctor or pharmacist if you are taking any of the following medicines.

• Anti-malarial medicines (for example, chloroquine, proguanil).
• Antihistamines.
• Medicines to treat depression or other mental illness.
• Theophylline, which is a medicine used to treat chest conditions.
• Steroids - taken as tablets or injections.
• Antibiotics.
• Tramadol, which is a strong painkiller.
• Slimming medicines, or other stimulant medicines.

Further help and information

Quit - a charity that helps people to stop smoking.
Quitline: 0800 00 22 00 Web: www.quit.org.uk

Smokefree - information from the NHS
Free smoking helpline 0800 022 4 332 Web: www.smokefree.nhs.uk
For help and advice on stopping smoking, and for details of your local NHS Stop Smoking Service.