Zero Treatment Plan

The thought of never smoking another cigarette may frighten you as much as it encourages you. That’s OK.

It means you are facing the fact that you might soon be smoking your last cigarette. The thought of never smoking another cigarette may frighten you as much as it encourages you. That’s OK. We know that smoking cigarettes has been a source of pleasure, and maybe even comfort, over the years. Cigarettes may be killing you but they are difficult to quit for a reason.

However, you are here because something about how cigarettes are destroying your health, damaging your relationships, or putting children and others at risk, has finally kicked in. The good news is that with your physician-prescribed plan below, you have a great shot at being smoke free.
Your physician has reviewed your medical information and has prescribed bupropion (generic Zyban) as part of your smoking cessation program. This medication doubles the chance you soon will be smoking your last cigarette.

Withdrawals, and other symptoms that make quitting so difficult, can be reduced with the medication your doctor has prescribed. Read about it, learn all you can, and take control of this process. It should only be used as directed, only if all contraindications do not exist (please, read them carefully), and only if you are committed to the effort.

For Your Doctor

If you have any of these conditions and it has not been shared with your doctor, please do so now.

- History of seizures
- Suicidal thoughts or a history of a suicide attempt
- Pregnancy or plans to get pregnant
- Breastfeeding
- Recent head injury
- Brain tumor or abnormal blood vessels in the brain
- Anorexia or bulimia
- History of mental illness in you or your family (e.g., depression, psychosis, bipolar disorder, manic depression)
- Diabetes requiring medication
- Glaucoma
- Recent heart attack, congestive heart failure, unstable heart disease
- Irregular heartbeats (arrhythmia)
- Slow heart rate
- High blood pressure
- Kidney disease
- Liver disease
- Allergy to bupropion or any of its components
- Weight loss
- Tourette Syndrome
- All medications taken now and within the past two weeks
- History of drug addiction
- Allergy or negative reaction to bupropion or any of its components, or to bupropion preparations under different names or any of their components (e.g., Aplenzin, Buproban, - Forfivo XL, Wellbutrin SR, Wellbutrin XL, Zyban, Zyban Advantage Pack, Budeprion XL)

Ways to Quit Smoking

  1. Cold Turkey: The sudden cessation of smoking with the intent of quitting permanently. It is the most common method smokers use. Cold turkey alone works only 4% to 7% of the time.
  2. Tapering: Tapering is the gradual reduction of cigarettes smoked or smoking less of each cigarette. It is no more effective than going cold turkey with nicotine patches. (Ann Intern Med 2016;164(9):585-592)
  3. Nicotine Replacement: Nicotine increases the success rate by 50%. It stages quitting by allowing the habit of smoking to be broken before nicotine use is discontinued.
  4. Medications: Medications added to going cold turkey increases the success rate to 25%. Three drugs are approved by the FDA for smoking cessation: nicotine replacement meds, bupropion (Zyban), and varenicline (Chantix).
  5. Counseling: Counseling, whether in person, by telephone, or by text messaging, increases the likelihood of success.
  6. Combination Therapy: This means going cold turkey (or tapering) and adding one or all of the following: nicotine replacement, counseling, and medication. Success rates can be increased by 4 fold when all three smoking cessation aids are combined: medication (varenicline, bupropion), nicotine replacement, behavior modification.

Why is smoking addictive?

Smoking is a Chemical Addiction (Nicotine).

Nicotine works by tricking the brain into using it just like chemicals (called neurotransmitters) normally found in the brain. Nicotine is similar to acetylcholine, which sends messages from one nerve in the brain to another. Acetylcholine can increase heart rates, breathing, and muscle movements.

Since nicotine stimulates the same nerves as acetylcholine, it too is a stimulant. When someone smokes they get an immediate energy boost. Think caffeine.

Nicotine also increases the release of dopamine, the chemical of “wellbeing and pleasure.” How many drugs can deliver a sense of wellbeing while also improving mental clarity and providing a physical jolt?

But that isn’t all nicotine does.

Nicotine is the only drug that can be a stimulant or a relaxant. It depends on your mood when you smoke. If smoked rapidly (high nicotine dose), it is a stimulant. If smoked slowly (low nicotine dose), it is a depressant. That is incredibly seductive. Within 10 to 20 seconds of lighting up, smoking gives you what you need most, at the very moment you need it—in seconds. No wonder it is so hard to quit.

Lastly, it is a known fact that the likelihood of a drug being abused is associated with how quickly it takes effect. Smoking delivers nicotine to the brain in seconds, which makes it highly addictive.

Researchers agree, “Nicotine-positive effects on mood and cognition are strong reinforcements for smokers that contribute to their addiction, and cigarette smoking is particularly addictive because inhaled nicotine is absorbed through the pulmonary venous rather than the systemic venous system, and thus reaches the brain in 10-20 seconds. As the likelihood that a substance will be abused depends on the time between administration and central reinforcement, tobacco smoking can easily become addictive.” (Role of nicotine pharmacokinetics in nicotine addiction and nicotine replacement therapy: a review, The International Journal of Tuberculosis and Lung Disease. 2003, 7 (9): 811–9. PMID 12971663)

Your Medications

Your doctor has created a plan that incorporates a prescription for bupropion and for nicotine gum. Zyban (bupropion) has been proven effective for smoking cessation, especially when combined with a nicotine replacement product (i.e., nicotine patch). Bupropion is the generic medication found in Zyban and other medications, and it’s far less costly. Nicotine gum is a generic version of Nicorette.

Read everything below. It is a summary of some of the information in the PDR and other sources. It is by no means complete. You must read the full package insert when it arrives with your medicine. You can access the PDR directly, as well. Keep all the literature handy in case your medical status changes and you need to refer back to it.
Let’s start with nicotine gum.

NICOTINE GUM

Nicotine gum is an over-the-counter medication that is available without a prescription to people over the age of 18 but, make no mistake, nicotine gum is medicine. That is why you must keep it away from children and even keep the used portions away from children and pets.

Nicotine gum is a very effective medication and, when used properly, it can nearly double the success rate of quitting smoking when combined with behavior modification.

BUPROPION (ZYBAN GENERIC)

Why is it so important that all your healthcare providers, including your pharmacists, are fully informed and coordinated about every aspect of your care?

There are hundreds of medications that can interact with bupropion. Most are not severe, but some can be life threatening. Even over-the-counter medications should be checked for interactions. All your providers should be kept informed of any medication that is added, dropped, or changed in your regimen.

The Physician Desk Reference (PDR) lists the medications that can interact with bupropion, along with the contraindications to its use. The PDR is referenced because it is comprehensive and must be read in its entirety. Contraindications can be absolute, act as relative warnings about drug interactions, and inform patients and healthcare providers how certain conditions can affect the metabolism of bupropion, either increasing or decreasing the amount in the blood. Certain conditions can also make side effects more likely to occur. Some medications might make it more likely for bupropion to cause a seizure and bupropion might make medications less likely to work or more likely to cause side effects of their own.

Learn more about bupropion, its potential benefits, and its potentional side effects here

Ready for your online doctor visit?