Section: 20(b) Poisoning, Toxicity and Drug Dependence - Agents used in drug dependence Permitted in sport

Zyban (Modified Release Tablets)

Uses: Selective noradrenaline and dopamine reuptake inhibitor. Treatment of depression. Also for nicotine dependence as an aid to smoking cessation.

Contraindications: Seizure disorders (or history); CNS tumour; abrupt alcohol or sedative withdrawal; bulimia, anorexia nervosa (or history); MAOls (discontinue at least 14 days before starting Zyban); concomitant bupropion containing preparations.

Precautions: History of head trauma; concomitant medications lowering seizure threshold, e.g. antipsychotics, antidepressants, antimalarials, tramadol, theophylline, systemic steroids, quinolones. sedating antihistamines: excessive alcohol, sedative use; diabetes treated with hypoglycaemics or insulin; use of stimulants, anorectics; hepatic, renal impairment; hepatic cirrhosis; history of psychiatric illness esp bipolar disorder; concomitant transdermal nicotine; elderly; pregnancy, lactation, children < 18 years.

Adverse reactions: Fever; chest pain; asthenia; tachycardia; vasodilatation; postural hypotension; increased BP; flushing; syncope; seizures; insomnia; tremor; dystonia; ataxia; parkinsonism; twitching; incoordination; concentration disturbance; headache; dizziness; depression; confusion; hallucinations; agitation; anxiety; irritability; hostility; depersonalisation; abnormal dreams; memory impairment; paraesthesia; anorexia; blood glucose disturbances; dry mouth; GI upset; urinary frequency and/or retention; hepatotoxicity; rash; pruritus; sweating; hypersensitivity reactions; bronchospasm; arthralgia, myalgia; tinnitus; visual disturbance; taste disorder.

Rare: anaphylactic shock; erythema multiforme; Stevens-Johnson syndrome.

Interactions: CYP4::S0 ~ Drugs which lower seizure threshold (see Precautions); drugs affecting CYP2B6 incl orphenadrine. cyclophosphamide, ifosfamide; drugs metabolised by CYP2D6, e.g. antidepressants (desipramine, imipramine. paroxetine), antipsychotics (risperidone, thioridazine), l3-blockers (metoprolol), type 1 C antiarrhythmics (propafenone, flecainide); carbamazepine; phenobarbitone; phenytoin; levodopa; amantadine.

Patient Information: May impair concentration. Take care if driving a vehicle or operating machinery until effects are known. Minimise or avoid alcohol consumption during treatment. Swallow tablets whole, do not crush or chew.

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