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Despite publication of tobacco-use treatment guidelines in 1996 and updates in 2000 documenting that use of nicotine-replacement therapy, the nonnicotine medication zyban, or counseling all can double cessation rates 3 , coverage of tobacco-dependence treatments by medicaid remains low and is increasing slowly.

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Discuss the risks and benefits of this medicationas well as other ways to quit smokingsuch as nicotine replacement treatmentwith your doctor.

Some of the cholinergic regions of the brain are closely linked to heightened feelings of perception and rewardOnce againinhaled nicotine stimulates these zones and over timethis repeated stimulation can cause feelings of addiction.

It is recommended that treatment is started while the patient is still smoking and atarget stop dateset within the first two weeks of treatment with Zybanpreferably in the second week.

Since monoamine oxidase A and B inhibitors also enhance the catecholaminergic pathwaysby a different mechanism from bupropionconcomitant use of Zyban and monoamine oxidase inhibitorsMAOIsis contraindicatedsee section 4.3as there is an increased possibility of adverse reactions from their co-administrationAt least 14 days should elapse between discontinuation of irreversible MAOIs and initiation of treatment with ZybanFor reversible MAOIsa 24 hour period is sufficient.

Those embarking on a course of Zyban will commence treatment on a low dose of one pill per day for six daysOn day seventhe user will increase their dose to two tablets per dayThe user will also arrange a stop smoking date to take place during the second week of the course.

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