Only 5% to 10% of smokers who try to quit succeed. For the rest, the quick onset of withdrawal symptoms—craving, irritability, hunger, and headache—is too much; the brain begins to raise hell and demand a fresh dose of nicotine, which binds to certain receptors and causes the pleasurable release of dopamine.
In the face of 40 years of public-health drumbeating, smoking bans, and social pressure, that’s an amazing failure rate. The profound power of nicotine addiction made it logical to search for ways to chemically intervene. According to the U.S. Public Health Service, antismoking meds can double or even triple your chances of being able to quit. (If you smoke less than 10 cigarettes a day, you’re probably not addicted, and you should talk to your doctor about another course of action to deal with the habit.) Heavy smokers can consider taking prescription drugs such as bupropion (an antidepressant) or varenicline (a “nicotinic receptor partial agonist”).
The idea of relying on a drug to kick a drug habit can make people nervous. Some fear unpleasant and well-publicized side effects; others fear that one addiction will replace another. But given the severity of the tobacco addiction and the likelihood of health damage, experts at the Centers for Disease Control and Prevention and the American Cancer Society (ACS) say it’s a straightforward cost-benefit decision. “If you weigh the options—taking medication versus continuing to smoke—the evidence for using drugs is overwhelming,” says Thomas Glynn, MD, director of cancer science and trends at the ACS. “You should do whatever you can to quit.”
That said, smoking-cessation drugs are hardly a magic bullet. A doubling or tripling of success rates is great, but remember how low the success rate normally is: 5% to 10%. There is no “cure” for smoking; it’s more like managing a lifetime condition.
“Smoking is a chronic disease,” says Matthew McKenna, MD, director of the CDC’s Office on Smoking and Health. “When you use these medications, it is not like taking penicillin for syphilis. The success rates are still relatively modest.”
The good news is that your chances of succeeding increase with each attempt—a phenomenon that Dr. Glynn likens to learning.
What do I need to know about these drugs?
So far, the Food and Drug Administration (FDA) has approved two prescription drugs for smokers.
- Bupropion (Wellbutrin, Zyban) is an antidepressant that has been used to help reduce nicotine cravings for more than 10 years. Nicotine sparks the production of dopamine when it binds to the brain’s nicotinic receptors; dopamine is associated with pleasure and addiction. Bupropion interferes with the nicotine-dopamine process and, as a result, “It helps reduce cravings,” says Steven Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of California, San Francisco.
- Varenicline (Chantix) came onto the market in 2006 after a “priority” FDA review, sped up because the agency saw a “significant potential benefit to public health.” In trials the drug beat a placebo among long-term smokers who had averaged 21 cigarettes a day for about 25 years. Varenicline stimulates the nicotinic receptors in the brain to help reduce withdrawal symptoms, and also helps reduce the pleasure of smoking if the quitter sneaks a cigarette. “It makes smoking less pleasurable,” says Dr. Glynn.
Nortriptyline and clonidine, which are used primarily to treat depression and high blood pressure, respectively, have been used “off-label” to help smokers quit—that is, the FDA has not officially approved them for this use, but some doctors will prescribe them. “These are second-line drugs,” says Dr. Schroeder. “There is some evidence that they work, but they are not nearly as well established as the other drugs.”
Weighing the risks
The CDC estimates that adults who smoke lose an average of 13.7 years off their lives—and that’s a whopping risk that a chronic smoker should keep in mind when deciding on drugs. That said, all drugs have side effects, and drugs that target the brain can affect your behavior as well as your body.
The most common side effects for bupropion are insomnia and dry mouth, but the list includes confusion, weight loss or gain, loss of interest in sex, and more.
For varenicline (Chantix), the most common side effects are nausea and sleep disturbances. However, in February 2008, the FDA issued a warning that Chantix may be associated with “serious neuropsychiatric symptoms,” including suicidal thoughts and behavior, and requested that warnings be more prominent.
In 2009, the FDA noted that both varenicline and bupropion have been associated with “reports of changes in behavior such as hostility, agitation, depressed mood, and suicidal thoughts or actions.” The FDA required the manufacturers to add a boxed warning to the products to alert patients and doctors to the potential risk. If you’re considering either drug, you should discuss it with your doctor.
Indeed, the most important advice is to work closely with a well-informed and involved doctor. Ask if he or she has frequently prescribed the recommended drug, is familiar with the side effects, and will follow your treatment closely.
Combining drugs with other antismoking aids
Nicotine-replacement therapies (NRT)—such as the patch or gum—release small amounts of nicotine into the body while the quitter tries to kick the tobacco habit. There is some evidence that combining an NRT with bupropion is better than using either approach alone. A 1999 study in the New England Journal of Medicine found that bupropion plus the patch boosted a smoker’s chance of success (at 12 months after quitting) to 35.5%. With the drug alone, the success rate was 30%; with the patch alone, 16%. As for Chantix, the effects of using NRT with varenicline are unknown, and the combination is not recommended.
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