Taking Chantix to Stop Smoking: Do The Benefits Still Outweigh The Risks?

A few weeks ago I wrote a piece discussing options for smoking cessation, and I specifically plugged varenicline, known as Chantix in most countries (“Champix” here in China), as being perhaps the most effective tool we doctors can now offer. Since my posting, a few drug warnings have come out, and it begs the question: do the benefits still outweigh the risks? I say yes — I would still recommend for most people, but first let’s look into the new data.

The FDA recently added a box warning on the packaging, discussing varenicline’s increased risk of serious psychiatric symptoms. This June, there were some new warnings from the US FDA that taking Chantix slightly increases risks for heart attacks. And just last week comes a larger study which confirms this risk. More specifically (from the NY Times article):

The new study, known as a meta-analysis, compiled data from 14 random, blinded, placebo-controlled clinical trials that tracked cardiovascular outcomes. It found 52 out of 4,908 people taking Chantix had serious cardiovascular events, a rate of 1.06 percent, compared with 27 out of 3,308 people taking a placebo, a rate of 0.82 percent. While the absolute difference is only 0.24 percent, the weighted, relative difference is 72 percent.

Here’s another way to look at it: “doctors could expect to get one extra cardiac event associated with Chantix for every 28 smokers they treated with the drug. The researchers also estimated one additional person would quit for every 10 treated with Chantix.”

What About The Side Effects of Not Stopping Smoking?

So there’s the hard data: 0.82% of the placebo group had an event, and 1.06% of the Chantix users had an event. This is the data we docs need to be telling patients. Honestly, I find the absolute difference of an increased 0.24% to be very small, and if I were a smoker I would take the chance. After all, what about the “side effects” of not stopping smoking? Smoking itself is one of the major causes of heart disease! Not to mention all the deaths from lung cancers, chronic emphysema and other cancers. Let’s compare that absolute risk of 0.24% versus the facts of smoking:

  • A smoker’s cumulative risk of dying from lung cancer before age 85 years was 22.1% for a male smoker and 11.9% for a female current smoker, in the absence of competing causes of death. For nonsmokers: a 1.1% probability (men) of European descent, and 0.8% in women. (source)
  • Smokers under 40 are five times more likely to have a heart attack. (source)
  • Male and female smokers lose an average of 13.4 to 14.3 years of life, respectively (source)

Let’s repeat that, in a way I would say to my mostly male smokers:

“You have a 0.24% absolute risk of a cardiovascular event on this medicine. You have a 22% risk of dying from lung cancer from continuing smoking. You decide.”

Even the FDA tries to keep the risks in perspective:

Smoking is an independent and major risk factor for cardiovascular disease, and smoking cessation is of particular importance in this patient population. The known benefits of Chantix should be weighed against its potential risks when deciding to use the drug in smokers with cardiovascular disease.

If my patient were a pack-a-day smoker for 30 years and wanted to quit, I still would recommend Chantix to them if they had no major psychiatric history. But this issue is now hotly debated among doctors, many of whom indeed want this drug pulled off the market. The excellent cardiovascular blog theheart.org has a nice review of this week’s controversy, including some of these highlights:

…In an accompanying editorial, Dr Taylor Hays (Mayo Clinic, Rochester, MN), who has been involved in clinical trials of varenicline, writes: “Although these results suggest a measure of caution should be taken in prescribing varenicline for tobacco dependence treatment, the small absolute risk of cardiovascular events associated with varenicline treatment is outweighed by the enormous benefit for reducing cardiovascular morbidity and mortality that can be achieved with successful smoking abstinence.”

Independent observer Dr Robert Bonow (Northwestern University, Chicago, IL) tended to side with Hays. He commented to heartwire: “The effects of smoking are so horrific that the benefits of stopping outweigh the risks of this drug in my view.”…

…Singh notes that while 1 in 10 people on Chantix quit smoking, the number needed to harm is 28. “There is not a great difference there.” He added: “We don’t know if the cardiovascular risk with Chantix stops after the drug has been discontinued. We have only looked at one-year’s data—when the patients were actually taking the drug. And we showed a 72% increased risk of cardiovascular events. We don’t know what happens later on.” He also noted that the actual cardiovascular risk with Chantix may be even greater as more people in the Chantix arm stopped smoking and so should have had an immediate reduction in risk.

“We all know the harms of smoking, and I am not disputing the need to quit. But I would advocate using a different method to help you quit. There are lots of other aids out there that work without increasing cardiovascular risk.”

Furberg reinforces this view. He commented to heartwire: “Quitting smoking is exceedingly important. If Chantix was very effective at getting people to quit smoking, you might argue in favor of its continued use, but it is only modestly effective. With Chantix, for every 10 people who take it, 9 have relapsed after a year. And we don’t know what happens to the 10th person after a year. So the efficacy is weak. And the adverse events are piling up.”…

My bottom line: smoking is a terrible disease and worldwide killer, and I still think varenicline is a very useful tool to get people to quit — although the side effects are more serious than we previously thought, and each patient needs to make their own decision.


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7 thoughts on “Taking Chantix to Stop Smoking: Do The Benefits Still Outweigh The Risks?”

  1. I was a pack-a-day smoker for around 25 years … until a few months back, thanks to Dr Richard.

    One of the changes I wanted to make in my life was to live healthier and quit smoking. I spoke to Dr Richard about this and he recommended using Chantix.

    I had read some of the negative reports about Chantix and spoke to Dr Richard about my concerns. Together we came up with a plan of action.

    I started using Chantix, but keeping an eye for any possible side-effects. If I found any, I would let Dr Richard know.

    There were only two side effects for me – both I could cope with. The first was the ‘flu-like symptoms’ which lasted a few days. The second was insomnia, but I suffer from this anyway, so I can’t really blame the Chantix for this.

    I did not have the vivid dreams, any weird psychological thoughts, no suicidal ideations, no anger and the like while on Chantix. I felt totally normal.

    After a week on Chantix, I gave up on my chosen date. The first day was incredibly difficult. It felt like an electric current was passing through my body!

    And yes I did have cravings – many cravings. But the difference with Chantix is that I could resist the cravings. It definitely made a huge difference compared to previous attempts to quit.

    I was glad that I took the day off work on quitting day. You would probably need to do the same as the withdrawal is not pleasant.

    At the end of the first day I rewarded myself by buying a pizza (which I seldom buy, so is a treat).

    Over first 10 days after quitting, I did have minor cravings. These were mostly psychological instead of physical e.g. smoking after a meal, smoking while walking to the bus.

    Another thing I mentioned above were the ‘rewards’. Before quitting, I set myself a few milestones. When I reached each milestone I would treat myself as a reward.

    My milestones were:

    1) end of the first day – medium pizza
    2) end of the first week – bar of my favourite imported chocolate
    3) end of the first month – eat out in a nice expensive restaurant
    4) end of the third month – bought some electronics I wanted
    5) end of the sixth month – trip to a spa
    6) end of first year – trip to Hainan Island

    Now going on nearly 4 months of no smoking, I am still going strong. I have zero cravings now – even when others smoke around me. One big bonus is that my home and clothes no longer stink of stale smoke.

    My breathing is so much better and there is now no coughing when getting up in the morning. My sense of smell and taste is also way better than before.

    I am no longer taking Chantix. I decided to stop when I felt like I didn’t need it. I was a little worried about stopping, but this was painless.

    One of the side-effects of quitting is the usual weight gain. I expected this to happen, so when it did it did not make me feel bad. I am now working on getting the weight off – my next battle!

    If you are considering quitting smoking, then I highly recommend trying the Chantix route. Just make sure that you work closely with your healthcare provider and keep monitoring yourself during the treatment period.

    Thanks Dr Richard!

    1. You’re more than welcome; I’m glad I was able to help you. As I mentioned before, each smoker’s case is different, but as long as you and your doctor know and discuss the side effects, then this medicine can really change your life…

  2. Dr Richard,
    i’m currently in shanghai and i’ve been to various pharmacies looking for champix but it seems no one has the medication. would you know where they would carry champix in shanghai?
    thanks so much!
    martin

  3. found it! no prescription necessary…

    Shanghai No.1 Pharmacy
    Address 616 Nanjing Dong Lu, near Zhejiang Zhong Lu.

    南京东路616号, 近浙江中路

    Phone 6322 4567

    1. Wow, I’m sure it’s totally illegal for a pharmacy to be selling a potentially dangerous prescription medicine like this, without a prescription. As I mention in my article, side effects are potentially severe and should be monitored. This stuff is definitely not OTC! Our hospitals all carry Chantix, including in Shanghai. You can find our Shanghai hospital and clinics information at our website: http://www.unitedfamilyhospitals.com/en/sh/patientsVis/patientserv/0/0/605.html

  4. My husband took it 5 years ag, had a major reaction, and has never been the same since. Not worth it one bit!!!!
    I feel like it ruined my life.

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