Many of you have recently made a New Year’s resolution to quit smoking. Many of you have already failed. I always tell my patients that regardless of their current health issues, the best thing they can do for their health by far is to put down the cigarettes. So it’s worth re-committing to this goal. Thankfully, we have some treatment options to help people break this awful addiction. The most recent addition to our armamentarium is Chantix (varenicline). What is Chantix? How is it different from other medications?
Chantix is a unique drug in that it actually blocks the nicotine receptor in the brain. This means that when you are taking Chantix, your brain does not experience nicotine in the same way, so it diminishes cravings and decreases the likelihood of withdrawal when you’ve quit. We recommend that you start Chantix before your quit date to start breaking this cycle of addiction. I recommend at least a week. Setting a date and going “cold turkey” is your best chance to succeed at quitting. This is true even for those that don’t use a medication. Those that simply try to “cut back” or taper down their use are almost never successful. You should not use nicotine replacement while on Chantix.
No drug is without potential side effects. Since Chantix hit the market a few years ago, there have been reported cases of people taking this drug becoming agitated, depressed, and even suicidal. It’s not clear that all of these cases were related to taking Chantix, but I always warn people of this potential. You should not start Chantix if you have depression or any other psychological problem that is not controlled. These psychological side effects have also been reported when people have stopped Chantix after being on it for a period of time. I have seen this occur once in my practice, and thankfully it resolved spontaneously. This drug can also cause nausea, stomach upset, and strange or vivid dreams. Not everyone experiences these problems, but some cannot take the medication for these reasons.
The data on Chantix suggests that it is more effective than wellbutrin (Zyban) and/or nicotine replacement (patch, gum, inhaler). Wellbutrin is an anti-depressant that is also used to help smokers quit. The data we have comes primarily from the company that makes Chantix (Pfizer), so we have to interpret it with some caution. Nevertheless, my personal experience with patients has been that many who tried wellbutrin without success will be able to quit while taking Chantix. The manufacturer recommends continuing the drug for about 6 months to get people through the time period that is high-risk for relapse. . If you did have a slip-up and smoke a cigarette while on Chantix, you are less likely to start up smoking regularly again because the nicotine will not get through to the receptor to start the pattern of addiction. Unfortunately, I have not seen good data in long-term cessation rates. In other words, many people don’t stay off cigarettes once they’ve stopped Chantix. My practice experience confirms this.
Despite these drawbacks and potential side effects, for most patients, I think it’s worth a try. Smoking is so toxic to all organs of the body that I feel we need to consider all of our options. Even if you are unable to use Chantix, talk to your doctor about other options, and don’t give up! You may need several attempts, but if you keep trying, one day it will stick, and you will join the ranks of healthier, happier non-smokers.
Shari S. Phillips, M.D.