Quit Smoking Medications: The First Step
You have decided to quit smoking, but in your mind, it is impossible for you to imagine life without cigarettes. Maybe you are a lifelong smoker, and you have developed such an addiction to nicotine that:
- You smoke more than a pack a day
- You smoke even when you are sick
- You smoke 5 minutes after you wake up
- You wake up in the middle of the night to smoke
All of these are signs of a serious dependence on tobacco, and if you fall into every single one or more of these categories, then you should give serious thought to using prescription medication to help you quit smoking. Addiction, after all, is an illness and just like with any other illness you would take medicine to help you get better.
Fortunately, there are a variety of prescription medications available to you if you are serious about quitting smoking. Let’s take a look at some of the more popular ones, how they work, if they have any side effects and if they are effective in helping you quit tobacco.
Types of Quit Smoking Medications
There are several types of medications given to smokers who wish to quit. Some use nicotine to slowly wean patients off the drug, while others do not. Other medications are normally used as anti-depressants but have shown promise in helping smokers quit. Others still are given solely as stop smoking aids.
Nicotine Replacement Therapies
Nicotine replacement therapies used most commonly include patches and gum. These are often available without a prescription, although we recommend that you speak with a doctor before buying them. Other nicotine replacement products still require a doctor’s visit. These may include nicotine lozenges, inhalers, and nasal sprays. The idea behind these drugs is that they supply nicotine in controlled amounts, and then they are slowly lowered to reduce dependency without the nicotine withdrawals common with quitting cold turkey.
Bupropion (also known as Wellbutrin and Aplenzin) started life not as a quit smoking pill but as a treatment for depression.
- Bupropion works by diminishing the chemicals in your brain responsible for producing cravings and withdrawal symptoms.
- Just like with varenicline, treatments with bupropion should begin a few weeks before you actually quit smoking.
- Treatments with bupropion usually last 7 to 12 weeks, although your doctor may prescribe using it after the 12 weeks, just to make sure you do not go back to smoking.
- During the initial phase of your treatment, you should also make use of other quit smoking aids (counseling, making a quit plan) just to shore up the effects of bupropion.
Bupropion and NRTs:
Users of bupropion have found more successful results when pairing the quit smoking pill with other NRTs (nicotine replacement therapy) such as patches or gum.
Since bupropion was previously used to treat depression, anyone using the quit smoking pill for smoking cessation will also get the benefits of its anti-depressive qualities.
Experts warn that you should not take bupropion if any of the following apply to you:
- Previous head trauma
- History of eating disorders
- Bipolar disorder
You should also not take bupropion if you are taking sedatives or older anti-depressant medication.
Side Effects of Bupropion:
Some common side effects of bupropion include:
- Dry mouth
- Mood and behavioral changes, thoughts of suicide
Bupropion is in the same FDA regulation that required varenicline to include a black box warning on its label, which informs users of the “risks of serious mental health events.” However, the same study that showed varenicline to be present in 90% of the cases of self-injury and depression among people using quit smoking pills, bupropion was reported as a factor in only 7% of those same cases.
Varenicline was, at first, thought of as a surefire quit smoking pill:
- 44% of users reported staying “quit” at the end of a 12-week treatment
- After a full year of using varenicline, 22% of users had successfully beaten back their cravings and stayed away from smoking
Initially approved for use as a smoking cessation medication by the FDA in 2006, varenicline works by interfering with nicotine receptors in the brain so that the pleasure derived from smoking lessens along with the symptoms of nicotine withdrawal.
- Starting to take varenicline a few weeks before you quit smoking. This way your body does not experience such severe nicotine withdrawal symptoms once you stop smoking.
- Your dosage of varenicline should increase gradually, after the first 8 days of taking it.
- Treatments with varenicline normally last for 12 weeks, but people who have successfully stopped smoking at this time were given another 12-week treatment to fortify the advances already made.
Varenicline and NRTs:
Varenicline does not contain any nicotine, so it is not a typical NRT (nicotine replacement therapy). There has been no conclusive evidence found that shows taking varenicline along with any NRT, like nicotine gum or the nicotine patch, will increase your chances of quitting tobacco. Neither has it been shown to be dangerous or carry adverse effects, so you should talk to your doctor about whether you should be taking NRTs when you are on varenicline.
Side Effects of Varenicline:
Just like with any prescription drug taking varenicline carries with it a long list of side effects, some of them mild and some of the more serious. Some common side effects of varenicline include:
- Difficulty sleeping, unusual dreams
- Constipation, gas
- Reduced sense of taste
After it was approved, some of the more serious side effects of taking varenicline came to light. The FDA began to receive reports of “related adverse events” which led the agency in 2009 to enforce the placement of a black box warning on its label warning users of serious “mental health events” including:
- Changes in behavior
- Depressed mood
- Suicidal thoughts
In addition, following a 2011 study done by the scientific journal PLoS One, varenicline is now being recommended solely as a last resort treatment for people who are looking to quit smoking, since it has a higher rate of incidents involving suicide and self-harm than other smoking cessation therapies. As Dr. Curt Furberg, one of the authors of the 2011 study stated, “when you try to get people to quit, and if you need a drug, start off with nicotine replacement and then Zyban. If they do not work, then use Chantix”.
Quit Smoking Medications: Other Options?
Aside from varenicline and bupropion, there are a few other medications that, while not necessarily approved by the FDA for smoking cessation, can be taken “off-label,” meaning they are medications prescribed for other illness but can also be used to help you quit smoking. You would, of course, have to talk to your doctor about whether these medications are right for you.
This drug is another member of the antidepressant family; nortriptyline helps reduce symptoms of nicotine withdrawal. It also increases the probability of quitting smoking compared to not taking any medication at all. It also should be started a few weeks before your actual quit day.
Some side effects include:
- Increased heart rate
- Vision trouble
- Difficulty urinating
- Gaining or losing weight
Nortriptyline can also adversely affect you if you suffer from heart disease, also you should not take it when operating heavy machinery or driving.
Clonidine is FDA-approved to treat high blood pressure, but it has also been shown to help people quit smoking. Clonidine can be taken in pill form but also as a patch that you change once a week. Make sure to tell your doctor or pharmacist about any other medications you are taking before they prescribe you clonidine. Some side effects of clonidine include:
- Dry mouth
- Tiredness or weakness
Quit Smoking Medications: Pros and Cons of Prescriptions
Like with any medication, smoking cessation drugs have benefits as well as drawbacks. The primary benefit is that they have been shown to increase one’s ability to stop smoking. Individual results will vary, and no one drug will work for everyone.
There are some drawbacks to prescription medications as well, as they can have side effects of their own. Chantix, for instance, may cause mood swings, insomnia, mental disturbances, and hallucinations. Experts do not recommend for those with a certain anxiety and other mental health disorders. Since smoking is more common among the mentally ill according to the American Psychological Association, this is a serious drawback for many patients.
Antidepressants may also cause some side effects, such as dry mouth and seizures in some individuals. Those with seizure disorders are generally encouraged to avoid these medications.
Another drawback to prescription quit smoking medications is the cost. Many are expensive, especially for patients who do not have insurance. The medications require an investment, but gaining a prescription requires doctor’s visit as well. Sometimes more than one medication may be needed, which will incur additional costs.
It should be noted, however, that the medical costs related to smoking cessation therapies are much lower than those one could expect to pay for lung cancer, heart disease, or treatments for other smoking-related illnesses.
Making the Decision
If you are ready to quit smoking, then there are medications out there that can help you achieve your goal. Just make sure to talk to your doctor or healthcare provider first to find out which medication is the best one for you.