Topics of Interest SMOKING CESSATION AT NATURE'S HEALTHCARE Welcome to the smoking cessation program at Nature's Healthcare. We are glad you have decided to stop smoking, and we are glad you have chosen us to help you. We're sure you know the dangers of smoking, as well as the benefits of quitting. We also know that just knowing about the dangers of smoking is not always enough to allow you to stop. You may have tried to stop in the past, only to restart. You may be entering this current effort with various feelings of frustration and uncertainty. We are happy to offer you a drug approved by the FDA to assist you in your effort to stop. This drug is called Zyban. Zyban has been shown to increase the chances of a successful attempt to stop as compared to placebo, and as compared to the nicotine patch. Since Zyban does not contain nicotine, the nicotine patch can be used along with Zyban. Greatest success is seen in patients involved in a comprehensive smoking cessation program, in which support is given along with guidance in behavior modification. Zyban is generally well tolerated, with most patients experiencing no side effects. The most common side effects are insomnia and dry mouth. Rarely, high blood pressure can develop requiring discontinuation of treatment. Approximately 1 to 3 patients per thousand are reported to have an anaphylactic ("allergic") reaction, with severe skin irritation and difficulty breathing that requires treatment. Zyban has been associated with a small risk of seizures. At doses used for smoking cessation, the risk of a seizure is approximately one per thousand. During the medical history, risk factors for a seizure can be identified, and Zyban would generally not be given to such patients. These risk factors would include the use of other medications associated with seizures, a history of a head injury, trauma, etc. Treatment with Zyban is started by taking a 150 mg tablet in the morning, regardless of meal time, even while you are still smoking. If you experience no side effects after 4-5 days, the dose is increased to a 150 mg tablet in the morning and in the evening. Insomnia can be avoided by not taking Zyban late at night. After beginning Zyban, you should pick a "quit date" to stop smoking. This is generally chosen sometime in the second week, when the medication has taken effect to suppress the craving to smoke. It also minimizes the physical symptoms associated with nicotine withdrawal. Treatment is generally continued for 12 weeks, with the ultimate goal being complete abstinence. Most patients who successfully stop have done so by week 7. Follow up is recommended every 2 weeks. We are glad you are here, and we look forward to supporting you in your decision to quit smoking.

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