Vaillancourt Régis, Wagenaar Hieke, Fisher Cora, Conway R D, Plemel Joanne
Canadian Forces Health Services, Ottawa, Ontario, Canada.
Can J Clin Pharmacol. 2002 Winter;9(4):205-13.
Since 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.
Surveys 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.
Zyban 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.
In 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.
自从将安非他酮缓释片（畅沛，葛兰素史克公司，密西沙加）添加到国防部戒烟计划（戒烟行动）中，即把安非他酮（畅沛）与行为矫正咨询相结合使用以来，医疗政策局收到了药剂师和加拿大军队成员的多起轶事报告，称使用畅沛会产生严重副作用。因此，国防部希望评估将畅沛用作戒烟计划一部分的益处与风险。随后，有人要求对加拿大军队在一年时间内使用畅沛的情况进行回顾性审查，以评估现行政策。
向在1998年9月1日至1999年8月31日期间服用畅沛的加拿大军队成员发放了调查问卷。询问了成员的吸烟史和现状、对安非他酮有效性的认知以及使用该药物的正面和负面经历。对那些报告有副作用且已同意的成员进行了访谈，以获取有关医疗资源使用情况以及对工作表现影响的更多细节和信息。因副作用去看医生的加拿大军队成员被请求允许查阅他们的病历。
在一年时间里，大约1171名成员领取了畅沛，357人回复了调查问卷。在调查时，点患病率戒烟率为47%，已戒烟者平均已戒烟181天。大约91%的已戒烟者和52%的吸烟者认为畅沛有助于戒烟。252名成员报告有副作用，完成了160次访谈。43名受访者因副作用看过医生。对43份病历中的16份进行了审核。52名受访者表示副作用影响了他们从事主要工作的能力。两人住院，总共住院六天。
鉴于畅沛已证实的有效性以及与戒烟相关的巨大健康益处，建议维持国防部戒烟计划目前的资金政策。应通过密切监测将畅沛副作用对工作表现和医疗资源的影响降至最低，畅沛的处方量应以两周的量发放。
