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'I Know I Will Never Smoke Again'

Mar 11, 2003 | Daily Telegraph

Throw out your ashtrays for ever. Tomorrow is No Smoking Day and, once again, aspiring non-smokers are ready to take up the challenge.

Lisa Byrne, 35, who was desperate to give up for the sake of her young children as well as her health and her business she runs a hair and beauty salon knows how they feel.

"I was on more than 40 a day; a real slave to smoking," she says. "For four years I tried everything: nicotine patches, gums, herbal remedies, hypnosis, will power. I made seven or eight determined attempts, but nothing worked."

Until, that is, she tried Zyban (bupropion), the anti-depressant that is the first non-nicotine drug to help smokers stop. Two years later, she remains a non-smoker and says, triumphantly: "I know I will never start again."

Yet, despite many similar success stories, Zyban is the subject of concerns about safety. There have been more than 7,000 reports from doctors of side effects from Zyban treatment, ranging from agitation, shakiness and nausea to sleeplessness, dizziness and blurred vision. About 60 deaths have been associated with Zyban, although no causal link has been established.

Most disturbing was a recent comment by a coroner that Zyban may have been one of the factors in the suicide in 2001 of Nick Hirst, a student from Prestbury, Cheshire. At the time, Hirst was studying at Nottingham Trent University and, according to his mother, was a happy-go-lucky young man who was keen to stop smoking. He managed to, she said, but everything else in life seemed to stop as well.

So, what are hardened smokers to do? Many of those who visit a smoking cessation clinic this week will be advised to try Zyban. Doreen McIntyre, chief executive of No Smoking Day, points out that Hirst died six months after taking Zyban. The coroner also noted, when recording a verdict of suicide, that other factors, including an obsessive personality and heavy drinking, could have contributed to his death.

A causal association between Zyban and suicide, or thought of suicide, has not been established, says GlaxoSmithKline, the maker of the drug. "We remain fully confident in the contribution Zyban makes in helping smokers to stop smoking successfully," a spokesman says.

The 60 deaths in question and more than 7,000 adverse reactions have to be put in perspective, says Amanda Sandford of Action on Smoking and Health.

"The fact is that one in two persistent smokers will die from smoking-related disease, such as heart disease, stroke and lung cancer. The deaths of those taking Zyban might well have occurred anyway or have been related to something else."

Indeed, the drug might save lives. One woman in her sixties who had emphysema was told by her doctor that she would die unless she stopped smoking. She says that Zyban reduced her craving and she eventually stopped smoking.

So how does it work? Zyban both reduces the craving for cigarettes and dulls the physical symptoms of withdrawal - tension, irritability, lack of concentration and restlessness.

The idea is to take one tablet a day for about six days, while still smoking. Then, two tablets are taken each day for about two months. Zyban should not be taken during pregnancy or by anyone who has epilepsy or a history of seizures, among other conditions. It may also interfere with other medication. Always check with your doctor.

Zyban has been used in this country for only a few years, therefore doctors who prescribe it must report every side effect to the Committee on Safety of Medicines.

"This is the process that every drug must go through when it is taken by thousands of people," says McIntyre. "We have to learn more about the patterns of possible reactions and that only comes with widespread use."

Already, more than 600,000 Britons and 10.5 million people worldwide have taken Zyban. Studies suggest that up to 30 per cent remain smoke-free a year later, a slightly higher success rate than for those using nicotine replacement therapy.

Not surprisingly, many people who are thinking of taking Zyban will still feel apprehensive. Lisa Byrne, who was part of a trial group in Manchester supervised by Dr Chris Steele, who runs one of the country's largest smoking cessation clinics, says that careful monitoring and advice helped her. But the treatment was far from plain sailing.

"For the first 48 hours on the drug, I was so shaky, panicky and nauseous that I felt quite worried. 'Should I stop the drug?', I thought. But Dr Steele had told us about all the possible reactions, and I decided to struggle on. Two or three days later, they had calmed down and I had no further side effects."

Rebecca D'Amato, 34, had a more alarming reaction when she was prescribed Zyban about two years ago. She smoked at least 20 cigarettes a day and, like Lisa, had tried everything. "I even spent more than £240 on a hypnotherapist who, after one session, said that I would never smoke again. Two hours later, I was puffing away.

"So I decided Zyban was my way ahead. But within 24 hours, I felt incredibly shaky. It was as if I had been plugged into something.

"I contacted the Zyban helpline and I was advised to see my GP. I was so scared that I stopped using the drug and, within 24 hours, was back to smoking 20 a day."

Rebecca is, however, ready to try Zyban again. Recently, she realised that her severe reaction could be linked with St John's wort, which, until this winter, she has taken to counter seasonal affective disorder.

"There are several drugs that might interfere with Zyban, but I did not know that St John's wort could interact with other anti-depressants."

For those hoping to give up smoking, there have never been so many options available, including advice clinics, stop-smoking counsellors, websites and helplines. Indeed, smoking cessation is one health service that is so well funded more than £23 million a year that there are virtually no waiting lists. "We now lead the world in our approach," says McIntyre.

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