Want To Stop Smoking? New Medicines May Actually Help

world no tobacco dayToday (May 31) is World No Tobacco Day and a good time for all smokers to sit back, take a deep breath and think about quitting their habit. I’m very happy to report that your family doctor finally has a couple good prescription options for you. The usual Rx for years had been a varying combination of counseling therapy + nicotine patches/gums + bupropion pills. It worked for some people but wasn’t hugely effective. Then a few years ago came a new medicine, called Chantix in most countries (generic name is varenicline) and I’ve had more success with this medicine than anything else I’ve tried in my ten years of family medicine practice. There are many studies showing how well it works, including a 2008 Public Health review which said varenicline helped triple your odds of quitting smoking, and at 6 months after quitting 33% were still smoke-free; those are impressive numbers for such an addictive drug. And just this month yet another study came out that shows its effectiveness. Here’s the full abstract, a bit dry to read but important:

Background: The use of varenicline tartrate alleviates postquit withdrawal discomfort, but it also seems to reduce the “reward” associated with smoking. The current treatment schedule, which commences 1 week before quitting, relies primarily on the first mechanism. We set out to determine whether increasing the prequit medication period renders cigarettes less satisfying and facilitates quitting.

Methods: One hundred one smokers attending a stop-smoking clinic in London, United Kingdom, were randomly allocated to receive varenicline for 4 weeks before the target quit date (TQD) or to receive placebo for 3 weeks before the TQD, followed by varenicline for 1 week before the TQD. In both groups, standard varenicline treatment was given for 3 months after the TQD. Measures included smoking satisfaction and smoke intake before quitting, urges to smoke and withdrawal discomfort after quitting, and sustained abstinence from the TQD to 3 months.

Results: Varenicline preloading reduced prequit enjoyment of smoking (P = .004) and smoke intake (P < .001), with 36.7% of participants reducing their cotinine concentrations by more than 50% (reducers). Varenicline preloading did not affect postquit withdrawal symptoms, but it increased 12-week abstinence rates (47.2% in the varenicline arm vs 20.8% in the placebo arm, P = .005). The effect was particularly strong among the reducers in the varenicline arm (66.7% in reducers vs 22.6% in nonreducers, P = .002). Varenicline preloading was well tolerated.

Conclusions: Although several issues remain to be clarified, varenicline preloading can generate a substantial reduction in ad lib smoking and enhance 12-week quit rates. Current treatment schedules may lead to suboptimal treatment results. Trials with longer follow-up periods are needed to corroborate these findings.

The bottom line here is that impressive 12-week improvement of 47% of medicine-takers still not smoking, versus only 20% of the placebo-takers still abstinent.

Of course, these medicines are prescription-only because they do have side effects, and they may not be the best option for everyone. But they varenicline was a big advance in medical therapy, and I urge all smokers — or loved ones of smokers — to talk to your family doctors about these newer options.

For more information on World No Tobacco Day, please check out the World Health Organization’s website.


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4 thoughts on “Want To Stop Smoking? New Medicines May Actually Help”

  1. I just saw this in a newsletter…

    Pfizer Did Not Report Chantix Side Effects Correctly

    “Adverse event data from the third quarter of 2010 show the risks of serious psychiatric side effects of Chantix, the smoking-cessation drug, were previously underestimated because Pfizer apparently failed to correctly submit hundreds of these episodes to the FDA, according to an analysis by the Institute for Safe Medicine Practices, a non-profit that regulary reviews the FDA adverse event database.

    Notably, the ISMP found 150 cases of completed suicides, some of which dated back to 2007, that were not reported promptly as suicides within 15 days as required. Instead, the drugmaker apparently coded the suicides as “expected adverse events” among 26,000 such events, and added these to a quarterly periodic report, which is how less important, non-serious side effects are sent to the FDA.”

    Full article here
    http://www.pharmalot.com/2011/05/pfizer-did-not-report-chantix-side-effects-correctly/

    Well, you do say Chantrix has side effects! Let’s be clear about the range of side effects. We’re not talking itchy skin here. Some can be permanently debilitating or lead to death. My wish is that doctors would be a little more circumspect when considering medications- especially newer ones. This protects you, of course, the doctor, and the patient, too. Get educated, give info and straight talk, then the patient can make up their own minds as to the “Risk-Benefit Ratio”

    best,
    Liora Pearlman

  2. I’m not “against” this drug, I swear! I just keep seeing things in newsletters and think the average Joe should really have an informed decision before deciding to take it.

    http://ntr.oxfordjournals.org/content/early/2011/06/07/ntr.ntr103.abstract

    new study- 14% of Chantix users were still not smoking at 24 weeks. Not a great success rate…the marketing materials by Champix people measure smoking status at 12 weeks, showing a higher “success” rate.

    as of May 19, 2011, the U.S. FDA has now received a total of 272 reports of completed suicides among Chantix users.

    Total adverse event reports up to 35,000- roughly 10,000 were serious, disabling or fatal, with 1,055 serious events being reported during the 3rd quarter of 2010.

    full article here
    http://whyquit.com/pr/061411.html

  3. Yes, there is some concerning new data these last few weeks, enough so that I will publish a followup piece soon. Overall, I still feel the benefits outweigh the risks.

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