Instruct patients to discontinue Zyban and consult a healthcare provider if they develop an allergic or anaphylactoid/anaphylactic reaction (e.g., skin rash, pruritus, hives, chest pain, edema, and shortness of breath) during treatment.There are reports of arthralgia, myalgia, fever with rash and other serum sickness-like symptoms suggestive of delayed hypersensitivity.The following adverse reactions are discussed in greater detail in other sections of the labeling:Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.Adverse reactions were sufficiently troublesome to cause discontinuation of treatment in 8% of the 706 subjects treated with Zyban and 5% of the 313 patients treated with placebo. Occasionally, a blood test may be done to check for thyroid problems or other conditions that may be associated with poor sleep. There are no controlled trials assessing the safety of bupropion in patients with a recent history of myocardial infarction or unstable cardiac disease.Antidepressant treatment can precipitate a manic, mixed, or hypomanic episode. Treatment with Zyban (150 or 300 mg per day) was more effective than placebo in helping subjects achieve 4‑week abstinence. “Prescribed Bupropion (Zyban) for my depression associated with Bipolar II Disorder. Established and emerging treatments for various sleep disturbances are reviewed, with emphasis on applications for light therapy and adapted cognitive behavioral therapy. In these trials, Zyban was used in conjunction with individual smoking cessation counseling.The first trial was a dose‑response trial conducted at 3 clinical centers. The goal of therapy with Zyban is complete abstinence.Discuss discontinuing treatment with Zyban after 12 weeks if the patient feels ready but consider whether the patient may benefit from ongoing treatment. The risk of adverse reactions may be greater in patients with impaired renal function. All pregnancies, regardless of drug exposure, have a background rate of 2% to 4% for major malformations, and 15% to 20% for pregnancy loss. Consider these risks before initiating treatment with Zyban. Protect from light and moisture.Advise the patient to read the FDA-approved patient labeling (Medication Guide).Instruct patients, their families, and/or their caregivers to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. You should also tell your healthcare provider about any symptoms you had during other times you tried to quit smoking, with or without Zyban. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression.All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Zyban is chemically unrelated to nicotine or other agents currently used in the treatment of nicotine addiction.