Quit Smoking

Each year about 46% of smokers in the US try to quit, with around 10% of them being successful in the short term1,2. The longer-term success rate for stopping smoking without anything to help is only about 5%3. Smoking cessation medicines increase the success rate and reduce the withdrawal feelings including cravings. There are plenty of options to help you quit including: Nicotine replacement (e.g. Habitrol, Nicorette), counselling, Zyban and now Chantix. As Chantix has only been on the market since May 2006, considerably fewer people will have used it than other drugs to quit smoking. So there is less known about it than for other smoking cessation products that have been around for much longer.

Page Contents

Chantix

Chantix is a tablet to help quit smoking. It contains a medicine called varenicline. Chantix was approved by the FDA in May 2006, and in the US is only available on prescription. Chantrix is started one week before quitting.

Zyban

Zyban is a tablet to help quit smoking. It contains a medicine called bupropion. bupropion is also the medicine in Wellbutrin, which is used for depression. Zyban is started before quitting smoking, with a target date usually in the second week of taking Zyban. Zyban is only available on a doctor's prescription.

Nicotine replacement

Nicotine replacement includes a number of medicines that all contain nicotine and are used to help quit smoking. The nicotine replacement medicines are started at the same time as cigarette smoking stops. Nicotine replacement options include: Commit lozenges, Habitrol patches, Nicoderm CQ patches (16 or 24 hours), Nicorette gum, Nicotrol nose spray or inhaler

Brief comparison of smoking cessation drugs 2,3,4,5,6,7,8

Treatment How used (summary) How effective Common side effects

Chantix (varenicline)

Prescription only.

  • Take by mouth
  • Start with a low dose 1 week before quit date
  • Increase the dose after 3 days and then after another 4 days
  • Continue 12-24 weeks
  • 3 times more successful than with placebo at 1 year
  • About 60% more successful than with bupropion (Zyban) at 1 year
  • nausea (30%)
  • flatulence (gas)
  • constipation
  • abnormal dreams
  • difficulty sleeping
  • headache

Nicotine replacement

Non-prescription
(e.g. Nicorette gum, Nicoderm patches)

Prescription
(e.g. Nicotrol nasal spray)

  • Quit smoking at same time as starting nicotine replacement products
  • Apply a patch for 16 or 24 hours per day
  • Or use a gum, nose spray, lozenge or inhaler regularly to a maximum limit
  • Length of use depends on product, often 3-6 months
  • About 2 times more likely to have quit than with placebo at 3 months
  • About 70% more successful than with placebo at one year
  • Similar in effectiveness to bupropion (Zyban)
  • sleep difficulties (patches)
  • abnormal dreaming (patches)
  • skin reactions (patch)
  • jaw pain (gum)
  • nose irritation (nose spray)

Zyban (bupropion)

Prescription only

  • Taken by mouth
  • Start one week before quitting
  • Start at a low dose
  • Increase in one week
  • Continue 7-12 weeks or longer
  • Quitting with Zyban is about twice as likely as with placebo at 3 months
  • About 1.5 times success rate than with placebo at 1 year
  • bupropion has similar success to nicotine replacement, and lower than varenicline
  • anxiety
  • headache
  • insomnia
  • dry mouth
  • irritability
  • seizures (fits) are rare.
Counselling
  • One-on-one, group, telephone counselling

  • Counselling helps quitting
  • Higher intensity counselling (longer sessions and/or multiple sessions) is better than lower intensity.

More: Smoking Cessation

Why is it hard to stop smoking?

Nicotine has many effects in the body. A key effect for addiction is that nicotine causes release of dopamine in the brain. Dopamine is a pleasure substance, making the person feel good, reducing anxiety, tension and appetite9. Nicotine is stimulating – the user feels more alert after a dose10. But it is also relaxing10. Regular use affects this reward system so that when there is no nicotine dopamine levels fall and withdrawal starts7.

Within 7 seconds of a puff on a cigarette, nicotine has an action in the brain10. Every single puff has a very quick reward in the brain – part of why it is so addictive. Nicotine patches, sprays and gums (e.g. Nicorette, Nicotrol) provide lower levels of nicotine in the blood so have less reward than cigarettes10. Chantix, a new medicine for stopping smoking, is thought to work by causing a small release of dopamine in the brain so withdrawal symptoms are reduced5,11. Chantix also makes smoking less satisfying, this is thought to be because it blocks the nicotine from causing dopamine to be released.

Withdrawal when quitting smoking

Withdrawal starts a few hours after the last cigarette. Symptoms can include: 7,10,12

  • feeling anxious
  • being grumpy
  • being impatient
  • attention deficit
  • feeling restless
  • feeling low or depressed.
  • trouble sleeping
  • hunger
  • trouble concentrating (work-place accidents on National Non-Smoking day are higher than any other day13)
  • wanting/craving a cigarette

Withdrawal symptoms peak in 2-3 days7. Most symptoms improve within 10 days of quitting5. Cravings can last for years7, and this is the biggest problem. Some people who have quit successfully, give in just once to the craving, sometimes years after their last cigarette, and they are back to smoking again. A chronic smoker can't usually be an occasional smoker.

Handy tips to help you quit smoking

On average smokers try to quit eight times before they succeed7. Try your best, feel good about your success – every day without a cigarette. If you can be smoke free for a week, you are 10 times more likely to quit completely than if you can't7. However, if the first time or the second time doesn't work, you aren't alone – many people take a number of attempts but eventually get there.

Counselling helps with quitting smoking2. Find out what counselling is available in your area. Talk to the Quitline 1-800-QUITNOW (1-800-784-8669).

Wait until you are feeling confident. Tell everybody you are stopping. Work out all the benefits of stopping smoking. Reward yourself for success.

Work out the times you normally smoke and how you will avoid picking up a cigarette. Don't go out drinking with mates who smoke until you're really confident you've got it beaten. Work out what you are going to do when you are feeling stressed.

Try to avoid being near cigarettes. Don't keep any for just in case. If your partner smokes, try to quit together. Ask others not to smoke around you or leave their cigarettes lying around. Leave the room when others are smoking.

Avoiding weight gain when you quit smoking

Weight gain is common when stopping smoking. The health benefits of quitting smoking are better than the health risks of extra weight14. But some people don't try to quit smoking because they're worried about weight gain15. In those who have quit, weight gain sometimes causes them to return to smoking15. However, there are several ways to help minimise weight gain.

  • Have healthy snacks easily available, e.g. carrot or celery sticks in the fridge and plenty of fruit
  • Keep fat and sugar intake low
  • Buy a new healthy cookbook to get inspired on cooking healthy meals
  • Think of other things to do when you crave a cigarette that don't involve eating, e.g. have a drink of water, telephone a friend, read a magazine
  • Drinking alcohol is often associated with smoking. Avoid or minimise alcohol to help avoid cravings for cigarettes and reduce weight gain
  • Consider starting an exercise programme at the same time as stopping smoking. Check with your doctor first. Find an exercise you like to do and a buddy to do it with and it will be much easier. Think about a goal to get fit for, e.g. a 10km walk
  • Reward yourself for keeping off the cigarettes with non-food rewards – e.g. a facial or a new book after the first week
  • Use the stairs instead of a lift*
  • Get off the bus or train a stop early and walk the rest of the way*
  • Do usual activities with more energy – e.g. cleaning the house, walking up the stairs*

*Check with your doctor before changing your exercise

Exercise helps to reduce cravings for cigarettes16. Craving reduces both during the exercise and for up to 50 minutes afterwards. Exercise also improves poor concentration – a problem when quitting smoking16.

Zyban may reduce weight gain from stopping smoking, while it is being taken, although weight gain can occur when Zyban is stopped11.

Health benefits of smoking cessation

About half of smokers die early of smoking-related illnesses7. Stopping smoking reduces the risk of these diseases. Stopping smoking helps people live longer. A big study of British Doctors (from 1951 to 2001)17 – found stopping smoking at the following ages gained 3-10 more years of life:

  • 60 years old gained 3 more years
  • 50 years old gained 6 more years
  • 40 years old gained 9 more years
  • 30 years old gained 10 more years

Stopping smoking has many benefits, just a few of them include: 2,4,7

  • Improves health and feeling of well-being
  • Reduces risk of heart attacks
  • Reduces risk of stroke
  • Reduces risk of lung cancer
  • Reduces risk of bladder cancer
  • Saves money
  • Helps physical fitness
  • Sets a good example for children
  • Improves health of babies and children
  • Enhances the sense of smell
  • Stops worrying about quitting

There are still benefits in quitting smoking later in life, even after an illness has been diagnosed. If a smoker has a heart attack and quits smoking after it, he/she live longer than if they hadn't stopped4. If a smoker gets lung cancer, stopping smoking improves quality of life and prolongs survival11. However, the earlier the quitting, the greater the benefit.

Because of the great health gains possible from quitting, smoking cessation is a cost-effective treatment for preventing heart disease. A US guideline from 2000 on treating tobacco dependence noted2: "Tobacco dependence treatments are both clinically effective and cost-effective relative to other medical and disease prevention interventions." The guideline recommended insurance plans include counselling and certain medicines for smoking cessation.

Medical conditions caused by smoking

Smoking causes or contributes to many medical conditions, including: 2,4,5,7,11,18

  • Cancers of the lung, cervix, larynx (voice box), mouth, throat, bladder, pancreas, kidneys and stomach
  • Heart disease, heart attacks and strokes
  • Lung effects including chronic lung disease (e.g. emphysema), pneumonia and worsening of asthma
  • Osteoporosis – this is the weakening of bones. Osteoporosis makes fractures more likely with age, and hip fractures shorten lives
  • Problems with sexual function
  • Increased risk of lung cancer and heart disease in the spouse of the smoker
  • Increased risk of asthma, ear problems, and infections of airways in children of smokers
  • Increased risk of premature delivery and small babies if smoking while pregnant
  • Increased risk of sudden infant death syndrome (SIDS or cot death) in babies
  • Gum disease
  • Aging of skin – more wrinkles
  • Many other conditions, from psoriasis to hyperthyroidism

Smoking cessation help in the US

There are a number of places for smoking cessation help.

  1. Free Quit Line. 1-800-QUIT-NOW (1-800-784-8669)
  2. American Cancer Society
  3. American Heart Association
  4. American Lung Association

Images of smoking cessation drugs

Chantix Drug Name
Chantix
Strength(s)
0.5 MG
Imprint(s)
CHX 0.5
Pfizer
Manufacturer / Distributor
Pfizer U.S.P.G.
Chantix
Zyban Drug Name
Zyban SR
Strength(s)
150 mg
Imprint(s)
ZYBAN 150

Manufacturer / Distributor
GlaxoSmithKline

Additional Resources

References

  1. Gonzales D, Rennard SI, Nides M, et al. Chantix, an α4β2 nicotinic acetylcholine receptor partial agonist, vs sustained-release Zyban and placebo for smoking cessation. JAMA 2006; 296: 47-55.
  2. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. June 2000.
  3. Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD001118. DOI:10.1002/14651858.CD001118.pub2.
  4. Wu P, Wilson K, Dimoulas P, et al. Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 2006; 6: 300.
  5. Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub2.
  6. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub3.
  7. Crane R. The most addictive drug, the most deadly substance: smoking cessation tactics for the busy clinician. Prim Care Clin Office Pract 2007; 34: 117-35.
  8. GlaxoSmithKline. Zyban SR Prescribing Information. May 2007. http://us.gsk.com/products/assets/us_zyban.pdf. Last accessed 25 June 07
  9. Zierler-Brown SL, Kyle JA. Oral varenicline for smoking cessation. Ann Pharmacother 2007; 41: 95-9.
  10. O'Brien CP. Ch 24 Drug addiction and drug abuse. In Hardman JG, Limbird LE (Editors-in-chief). Goodman & Gilman's The Pharmacological Basis of Therapeutics 9th Ed. McGraw Hill New York; 1996: 565.
  11. Ebbert JO, Sood A, Hays JT, Dale LC, et al. Treating tobacco dependence: review of the best and latest treatment options. J Thor Oncol 2007; 2: 249-56.
  12. Shiffman S, Patten C, Gwaltney C, et al. Natural history of nicotine withdrawal. Addiction 2006; 101: 1822-32.
  13. Waters AJ, Jarvis MJ, Sutton SR. Nicotine withdrawal and accident rates. Nature 1998; 394: 137.
  14. Eisenberg D, Quinn BC. Estimating the effect of smoking cessation on weight gain: an instrumental variable approach. HSR: Health Services Research 2006; 41: 2255-66.
  15. Shraim M, Parsons AC, Aveyard P, et al. Interventions for preventing weight gain after smoking cessation. (Protocol). Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006219. DOI: 10.1002/14651858.CD006219.
  16. Taylor AH, Ussher MH, Faulkner G. The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect and smoking behaviour: a systematic review. Addiction 2007; 102: 534-43.
  17. Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years' observation on male British doctors. BMJ 2004; 328: 1519
  18. Sambrook P, Cooper C. Osteoporosis. Lancet 2006; 367: 2010-8.

Disclaimer

This information provides an overview for general educational purposes only. It does not include all information about the medicines and the medical conditions. This information is not intended to cover all directions, precautions, warnings, drug interactions, adverse effects, uses or contraindications. Information provided may be time sensitive. The information on this site has been developed for a US audience. Use outside the US may not be appropriate. Drugs.com has taken reasonable care to ensure quality information is provided, but makes no guarantees that it is complete, accurate or up-to-date. Always talk to your physician, nurse or pharmacist before taking any medicine, and follow their advice. If you have or suspect that you have a medical problem or condition, please contact a qualified healthcare provider immediately. You should never disregard medical advice or delay in seeking it because of something you have read on this site.

Last updated: 2014-07-22

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