GETTYSBURG MEDICAL NEWS
The Clinical View
by Dr. P.E. Hoffsten
19 July 2006

A NEW MEDICATION FOR SMOKING CESSATION

            Smoking cigarettes remains the number one cause of self-inflected mortality in the United States.  As a form of suicide it is every bit as effective as poison or jumping off a building but it just takes a little longer.  This is in spite of the fact that the proportion of people in the United States who smoke cigarettes has dropped from 65 percent at the end of World War II, now down to about 21 percent.  While there are laws against heroine and cocaine use because of their drug addicting properties, somehow nicotine addiction has remained as a legal form of drug addiction. It is by far the most common drug addiction in the United States.  Individuals once addicted to nicotine and cigarette smoking experience very real withdrawal symptoms including anxiety, irritability, increased hunger, insomnia, and inability to concentrate.

            The addicting properties of nicotine and these withdrawal symptoms are what make discontinuation of a cigarette habit so difficult.  Individuals who have experienced multiple addictions including heroine, cocaine, or alcohol generally remark that the most difficult habit to break is smoking cigarettes.  The Communicable Disease Center (CDC) that monitors disease patterns in our country has done surveys indicating that 70 percent of smokers would like to quit, but simply can’t manage to achieve this because of their withdrawal symptoms.

            Non-drug related steps to help discontinuation of a cigarette habit include picking a date in which the habit will be stopped.  Prior to that date, rid the house of cigarette lighters and ashtrays.  Change the habits that act as a stimulant to smoke a cigarette.  Send the drapes and the bedspreads to the cleaners and get the rugs cleaned to get the odor of cigarettes out of the house.  On or before the stop date, the person should begin a nicotine replacement program to stop the withdrawal symptoms.  The most common practice today is the use of nicotine patches which have a substantially better success rate than other methods.  Nicotine gum, nicotine lozenges, nicotine nasal spray, and nicotine oral inhalers are also available and work for some smokers but not as successful as the patches.

            Several years ago, a medication called bupropion (Zyban, Wellbutrin) was found to have a significant impact in helping individuals stop smoking.  It was found that the use of the nicotine patch and bupropion together had about a 55 % success rate at six months in helping individuals stop smoking.  The cost of the patch was $2.00 to $4.00 per day and the bupropion was around $4.00 a day making the cost of stopping smoking around $6-8.00 per day.  This was substantially more expensive than smoking cigarettes at a pack per day.

            In the past two months, a new product has come on the market called Chantix (varenicline).  This is a drug developed by the Pfizer drug company.  This drug is taken one milligram twice a day and acts as a nicotine look-alike, preventing the withdrawal symptoms that a person stopping smoking would feel.  This past week there were three articles in the Journal of the American Medical Association devoted to this product along with an editorial.  They all reported significant success in helping with smoking cessation.  One of the articles made a comparison to bupropion and nicotine patches showing that Chantix was more successful than old methods.

            The side effects of CHANTIX are the usual.  They include slight nausea, occasional headache, difficulty sleeping, a change in taste, irritability, abnormal dreams, and feelings of ill ease.  These are probably not really side effects from the drug, but rather side effects from stopping smoking.  They are described as temporary side effects that resolve the further away one gets from the cigarette habit.

            The cost of Chantix is going to be variable.  Surveying several pharmacies in the Pierre area, it appears the cost will probably be about $3.00 per day or about the same as smoking a pack of cigarettes per day.  The difference is that cigarettes can kill you and Chantix does not.

            In my clinical experience, many individuals make a New Year’s resolution or pick a different type of quit date and are able to stop the cigarette habit for days to weeks.  The relapse rate of returning to smoking is more than 60 percent.  After the initial studies with Chantix showing about a 60% rate for 12 weeks, an additional study following out to one year was carried out.  In that study, about 40% of people who had stopped smoking were still abstinent at one year.  This is substantially better than other methods thus far reported in the literature.  As an encouragement to smokers who have often tried to stop smoking, the average person makes a valid effort stopping for days to weeks an average of seven times before permanent cessation is achieved.  If at first you don’t succeed and really want to stop smoking, keep on trying.  Chantix is a new product that may be some additional help.