As all wars do, the war against smoking has left behind battlefields littered with bodies and broken weapons.
Every year, 400,000 Americans’ deaths are blamed on smoking.
Many smokers have tried to beat the habit with behavior-modification programs, acupuncture, hypnosis and nicotine-replacement gums, sprays and patches.
Seventy-five percent of the nation’s 48 million adult smokers reportedly want to quit, but only 2.5 percent succeed in any given year, according to the National Centers for Disease Control and Prevention. The success rate of smoking-cessation products is so abysmal that many insurance companies won’t pay for them.
But that hasn’t stopped the pharmaceutical industry from adding yet another weapon to its anti-smoking arsenal: Zyban, a prescription drug in pill form released with much fanfare July 4.
Within six months, Zyban became the nation’s most popular smoking-cessation prescription product, grabbing 54 percent of the market and racking up more than $53 million in sales, according to Pennsylvania-based industry analyst Scott-Levin Inc.
In Colorado Springs, Colo., for example, pharmacists say Zyban has overtaken the nicotine patch Habitrol as the most popular prescription smoking-cessation product, although its sales lag behind those of over-the-counter nicotine patches.
Despite Zyban’s success in the market, it’s too early to tell whether it’s a medical breakthrough. Preliminary studies show less-than-spectacular results, and the drug causes side effects, some of them potentially serious.
Still, doctors and researchers are excited about its apparent ability to halt the craving for nicotine. They theorize that it affects two brain neurotransmitters–noradrenaline and dopamine–associated with nicotine addiction.
“Zyban is an important advance that will help many people break this powerful addiction to cigarettes,” says Dr. Michael Fiore, director of the Center of Tobacco Research and Intervention at the University of Wisconsin Medical School.
By the end of 1997, more than a quarter of a million people were on the Zyban Advantage Plan, which includes a prescription and a telephone-counseling service, says Bill Chapman, a spokesman for Glaxo-Wellcome, Zyban’s North Carolina-based manufacturer.
What makes Zyban different from other prescription and non-prescription products is that it contains no nicotine.
Smokers use nicotine-laced patches, gums and nasal sprays to gradually wean themselves from the drug.
Zyban, which contains the same chemical as the anti-depressant Wellbutrin, instead aims to reduce the cravings, anxieties and depression associated with nicotine withdrawal.
It costs $80 a month, and most patients stay on the drug for two or three months.
Zyban usually isn’t covered by insurance, despite studies showing it could double a smoker’s chances of quitting.
According to a recent study of 615 smokers published in the New England Journal of Medicine, 23 percent who took Zyban for six weeks were smoke-free a year later compared with 12 percent who took a dummy pill.
Another study showed that 49 percent of Zyban users were smoke-free after a month compared with 36 percent of nicotine-patch users. Participants who used Zyban and the patch in conjunction were 58 percent smoke-free after a month.
But, like most prescription drugs, Zyban has its risks. Common side effects include dry mouth, dizziness and nausea. Less common side effects include blurred vision, drowsiness and insomnia.
The most serious potential side effect is a seizure, which studies show occurs in one out of every 1,000 users. Other side effects that could require medical attention include anxiety, headache and fast or irregular heartbeat.
Zyban is not recommended for anyone who’s been diagnosed with a seizure disorder such as epilepsy or an eating disorder such as bulimia or anorexia nervosa. Neither should it be taken by pregnant or nursing women. Although no studies have been done in pregnant women, the drug has been shown to pass through breast milk.
Also, serious reactions can result from combining Zyban with alcohol and some prescription drugs.
Prospective users should tell their doctors if they drink alcohol or take lithium or any kind of anti-depressants such as Prozac or Elavil.
Despite the risks, Karen Wehnes, director of the Quit Smoking classes at Memorial Hospital in Colorado Springs, has become a big fan of Zyban over the last several months.
