Zyban (bupropion hydrochloride), produced by Glaxo SmithKline, is
Zyban reduces the cravings and withdrawal symptoms associated with quitting smoking by altering two neural pathways in the brain - dopamine and noradrenaline. These two neurotransmitters are believed to play a key role in nicotine addiction.
There have been only two published studies on Zyban, both in the New England Journal of Medicine. The first study of 615 (non-depressed) smokers showed 23.1% patients treated with Zyban were not smoking at one year, compared to 12.4% with placebo.1
The second study of 893 smokers undertook a direct comparison with NRT. This study found that Zyban is almost twice as effective as a nicotine patch.2
Results from these two multi-centre studies show that Zyban is an effective aid to smoking cessation and demonstrate that patients treated with Zyban have a greater chance of quitting smoking than patients treated with placebo or a nicotine patch.
However, The Cochrane Review, which reviews evidence-based studies points out that NRT has been shown to be effective in helping smokers to quit in over 80 studies and has very benign side-effects. The early results for anti-depressants such as bupropion (Zyban) are very promising but there is not enough published evidence to recommend bupropion in preference to NRT or vice versa.3
Zyban will be available on normal NHS reimbursable prescriptions. It is up to each local health board to advise its GPs on whether the drug should be prescribed. Thus, GPs cannot prescribe the drug until they receive the go ahead from their local drugs evaluation panel. It is then up to each doctor's individual clinical judgement whether or not to prescribe Zyban to a patient.
At 5 July 2000, Zyban is available in the health board areas of Lanarkshire and Ayrshire and Arran.
The other health boards are currently deciding whether Zyban will form part of their stop smoking services.
The situation in relation to the availability of NRT on NHS prescription is more complex.
Only those NRT products introduced since 1997 can currently be prescribed by doctors (although Health Boards could challenge their prescription)
Zyban is safe and effective when used correctly. It can be used by adult smokers but should be prescribed with caution for elderly patients and patients with hepatic or renal insufficiency. Zyban should not be used in pregnancy or while breast-feeding. It should not be prescribed to under-18s.
Zyban should not be prescribed to smokers with epilepsy, those with a current or previous seizure disorder, a current or previous eating disorder (bulimia or anorexia nervosa), severe hepatic cirrhosis or a history of bipolar disorder.
The most common side effects include dry mouth, insomnia, headaches, dizziness, depression and sweating.
Zyban is intended for those smokers who are motivated to quit.
The recommended dose of Zyban is a 150mg tablet twice a day.
Patients should start taking Zyban while they are still smoking and set a 'quit date' in the second week of treatment.
Patients should take Zyban for two months.
Zyban is taken as a two-month treatment course at the basic NHS price of £87-50. (60 tablets cost £42.85 per month).
Both Zyban and NRT products have an important role to play in helping smokers to quit and will meet smokers' needs in different ways. The products have also been shown to be effective when used in combination.2
GPs will be able to recommend the most suitable product for each individual smoker.
Note: additional guidance was issued by the Committee on Safety of Medicines on 30th May 2001, in the light of concerns over the safety of the drug.
1. Hurt et al. A comparison of sustained release bupropion and placebo for smoking cessation. New England Journal of Medicine 1997; 337 (1195-1202.)
2. Jorenby et al. A controlled trial of sustained release bupropion, a nicotine patch, or both for smoking cessation. New England Journal of Medicine 1999; 340 (685-691)
3. The Cochrane Review 1999 (Issue 3)