Safety of Zyban in patients with co-existing medical and/or psychiatric conditions
Zyban has been shown to be an effective agent for smoking cessation. However prior studies have primarily involved generally healthy smokers. The purpose of this study was to describe our experience with using Zyban in smokers who have co-existing medical and psychiatric disorders. Subjects were referred by their primary care providers for treatment with Zyban 150 mg twice daily for eight weeks. Subjects had to be smoking at least 10 cigarettes per day and motivated to quit smoking. Exclusion criteria included a presence or history of seizures, anorexia nervosa, bulimia, and current use of a MAO inhibitor or nicotine replacement therapy. Telephone follow-up was performed by a clinical pharmacist on or around the quit date and every other week thereafter for eight weeks. Of the twenty-five subjects screened, twenty-two met both inclusion and exclusion criteria and were treated with Zyban. Ninety-six percent were men with a mean age of 54.0 years (SD=10.1) who smoked a mean of 20.8 cigarettes per day (SD=13.0). Sixty-four percent had co-existing medical conditions, including hypertension, coronary artery disease, and chronic obstructive pulmonary disease. Thirty-seven percent were receiving treatment for psychiatric diagnoses, which included depression, post traumatic stress disorder, and bipolar disorder. Mild adverse effects (dry mouth, insomnia, bad taste in mouth) were noted in approximately 14% of subjects. One subject with bipolar disorder experienced precipitation of his mania on 150 mg twice daily of Zyban, which resolved after reducing his dose to 150 mg once daily. Zyban appears safe for smoking cessation in patients with co-existing medical and psychiatric conditions; however, careful monitoring may be prudent in those with underlying agitation, irritability, and mania.
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