• Régis Vaillancourt, Hieke Wagenaar, Cora Fisher, R D Conway, and Joanne Plemel.
• Canadian Forces Health Services, Ottawa, Ontario, Canada. ab672@issc.debbs.ndhg.dnd.ca
• Can J Clin Pharmacol. 2002 Jan 1; 9 (4): 205-13.

BackgroundSince the addition of bupropion slow release (Zyban, GlaxoSmithKline, Mississauga) to the Department of National Defence (DND) smoking cessation program (Butt Out), utilizing bupropion (Zyban) in combination with behaviour modification counselling, the Directorate of Medical policy has received several anecdotal reports from pharmacists and Canadian Forces members attributing significant side effects to the use of Zyban. As a result, the DND wished to assess the benefits versus the risks of using Zyban as part of the smoking cessation program. Subsequently, a retrospective review of the use of Zyban within the Canadian Forces over a one-year period was solicited to assess current policies.MethodsSurveys were sent to Canadian Forces members receiving Zyban between September 1, 1998 and August 31, 1999. Members were questioned about smoking history and current status, perceived effectiveness of bupropion and both positive and negative experiences with the drug. Those reporting side effects and who had consented were contacted for an interview to obtain further details and information regarding the use of medical resources and effects on job performance. Members of the Canadian Forces visiting a doctor due to side effects were asked for permission to review their medical charts.ResultsZyban was dispensed to approximately 1171 members over the one-year period and 357 responded to the survey. The point prevalence smoking cessation rate was 47% at the time of the survey and ex-smokers had been smoke-free for a mean of 181 days. Approximately 91% of ex-smokers and 52% of smokers found Zyban helpful in quitting. Side effects were reported by 252 members and 160 interviews were completed. Forty-three interviewees had seen a doctor because of side effects. Sixteen of the 43 charts were audited. Fifty-two respondents stated that side effects affected their ability to do their primary job. Two individuals were hospitalized for a total of six days.ConclusionsIn light of the demonstrated effectiveness of Zyban and the overwhelming health benefits associated with smoking cessation, it is recommended that the current policies of funding for the DND smoking cessation program be left in place. The impact of Zyban's side effects on job performance and medical resources should be minimized through close monitoring and Zyban prescriptions should be dispensed in two-week quantities.

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