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It's so easy to start and so hard to stop. If you have already decided to quit smoking, it is a good idea to take all measures to ensure success. The good news is that in addition to traditional “Cold turkey” techniques, there are also medications to relieve symptoms.
It is best to discuss this with your doctor first, because he (or she) is aware of your medical condition. This will enable your doctor to prescribe the best and most effective smoking cessation medication for you. While most smoking cessation medications may seem harmless, they may be unsuitable for your physical condition.
There are prescription medications that have been shown to help smokers quit smoking. Some medicines can be used in conjunction with nicotine replacement therapy. You often have to start there in the weeks before your withdrawal (the day you plan to stop).
Smokers who are heavily dependent on nicotine should consider nicotine replacement or drug therapy to help them quit smoking. Signs of severe dependence are:
- Smoking more than 1 pack per day
- Smoking within 5 minutes of waking up
- Smoking even when you are sick
- Waking up at night to smoke
- Smoking to relieve the symptoms of withdrawal symptoms
The more of these signs, the more severe the dependence.
Several studies have shown that varenicline can increase the chances of smoking cessation compared to not taking drugs, at least in the short term. (Some studies have also shown that nicotine replacement tablets can help.)
Talk to your healthcare provider if you think you may want to take any of these medications to help you quit smoking. You need a prescription.
Varenicline (also called Champix®) is a prescription medicine designed to help people avoid cigarettes. It works by disrupting the nicotine receptors in the brain. This means that it has 2 effects:
- It diminishes the pleasure a person has from smoking.
- It reduces the symptoms of nicotine withdrawal.
You usually start taking a tablet about a month to a week before your Stop Day. Take it after meals with a full glass of water. The daily dose increases during the first 8 days of taking it. If you have problems with the higher doses, a lower dose can be used while trying to quit.
Varenicline is normally prescribed for 12 weeks, but people who quit during that time can receive another 12 weeks of treatment to increase their chances of staying off the tobacco. It's important to keep up with other support systems during this time and for at least a few months after you stop smoking.
Tell your healthcare provider about any medical conditions and allergies you have before starting varenicline, even if you are pregnant.
Side effects of varenicline
Reported side effects of varenicline include:
- Sleeping problems, unusual dreams or sleepwalking
- Changes in taste
- Skin rash
- Heart or blood vessel problems (usually in people who already have these problems)
- Changes in mood or behavior, such as depression, hallucinations, delusions, aggression, hostility, agitation, anxiety, panic, or even suicidal thoughts.
Talk to your healthcare provider about what to expect while taking this medicine and what you or others can do if you or others notice possible side effects. Make sure to let your healthcare provider know if you've ever had depression or other mental health problems, or if you start to feel depressed or have thoughts of suicide.
Use of varenicline along with replacement therapy or bupropion for smoking cessation
It is being investigated whether varenicline can be used concomitantly with nicotine substitutes. Some studies have shown that the use of varenicline along with substitutes is well tolerated and safe, but others have found that it has no long-term benefits in helping people stop taking varenicline. More research is therefore needed.
Research is also being conducted on using both varenicline and bupropion at the same time. While combining the drugs with the use of varenicline alone can be a benefit, more research is needed to understand if it can cause more serious side effects.
Bupropion is also known under the brand names Zyban®, Wellbutrin® or Aplenzin®. It is a prescription antidepressant that helps reduce cigarette cravings and symptoms of nicotine withdrawal. It does not contain nicotine. This medicine interacts with chemicals in the brain associated with nicotine hunger. Bupropion works best if you start it 1 or 2 weeks before you stop smoking. The usual dose is one or two 150 mg tablets per day.
If you still don't smoke after taking bupropion for a period of 7 to 12 weeks, your doctor or health care professional may continue to prescribe that medicine to avoid going back to smoking. Stay on top of other substitutes during this time and for at least a few months after you stop smoking.
This medicine should not be taken if you have any of the following conditions:
- Seizures (this medicine can cause or make seizures worse)
- Heavy alcohol consumption
- A serious head injury
- Bipolar (manic-depressive) illness
- Anorexia or bulimia (eating disorders)
You should also not take it if you are on sedatives or if you have recently taken a monoamine oxidase inhibitor (MAOI, an older type of antidepressant).
Tell your doctor about any medical conditions and allergies you have before starting bupropion, even if you are pregnant.
Side effects of bupropion
Reported side effects of bupropion include:
- Dry mouth
- Dry nose
- Sleep problems and nightmares
- High bloodpressure
- Feeling depressed, anxious, excited, hostile, aggressive, aggressive, overexcited or hyperactive, or confused, or even in combination with suicidal thoughts.
If you are on bupropion, call your healthcare provider if you feel depressed or start thinking about suicide. Also make sure to ask what to expect while taking this medicine what to do if you or others notice possible side effects.
Bupropion can lead to drug interactions and should not be used with certain other medications or supplements. Make sure your healthcare provider is aware of everything you are taking, such as prescription medications, vitamins, herbs, supplements, and any medications you take when you need them, such as acetaminophen (Tylenol) or aspirin. Also make sure to tell any doctor or health care giver that you are taking bupropion.
If you plan to use a prescription drug to end your tobacco or cigarette use, talk to your healthcare provider first so you know exactly where and when to start and how to use the drug. Also learn all about the reported side effects. Write a note in your calendar to remind you when to start taking the medicine.
Are Champix and Zyban the same?
Champix (varenicline) and Zyban (bupropion) are both used as smoking cessation medications.
The Wellbutrin brand of bupropion is used to treat depression.
While Zyban is an antidepressant, Champix is a partial agonist selective agent for nicotine-containing acetylcholine receptor subtypes.
Although they are different, the side effects of both prescription drugs are similar such as dry mouth, trouble sleeping (insomnia), headache, nausea, stomach pain and constipation.
Both Zyban and Champix can interact with alcohol, theophylline, blood thinners and insulin. Champix may also interact with other smoking cessation medicines.
Other drugs for smoking cessation
For those who cannot use any of the above approved drugs to help smokers quit smoking, or for those who have not been able to stop using them, other drugs have been shown in studies to be successful as well. They are also recommended by the Ministry of Health for this type of use. These medicines are only available with a prescription and are not recommended for pregnant women, teenagers, or people who smoke less than 10 cigarettes a day.
This is an older antidepressant that helps to reduce tobacco withdrawal symptoms. It has been found to increase the chances of success in quitting smoking compared to people who are not on medication. It usually takes 10 to 28 days for a person to quit smoking to have a stable level of this medicine in their body.
Some people have side effects such as a fast heart rate, blurred vision, problems urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when they stand up. This medicine can affect a person's ability to drive or operate machinery and cannot be used with other medicines. Talk to your doctor about this.
If you decide to start taking this medicine, make sure your doctor and pharmacist know exactly what other medicines you are taking before starting this medicine. Also, make sure you know how to use it and how to taper off when you're ready to quit. The dose of nortriptyline should be decreased slowly, because the drug cannot be stopped suddenly without the risk of serious consequences. People with heart disease should use this medicine with caution. Make sure to tell all your healthcare providers that you are taking this medicine.
Clonidine is another older drug that has been shown to help people quit. It has been approved by the Ministry of Health to treat high blood pressure. When used to quit smoking, it can be taken as a tablet twice a day or it can also be applied as a patch to the skin that needs to be changed once a week.
If you plan to use this medicine, make sure your healthcare provider and pharmacist know exactly what else you are taking before you start taking it. The most common side effects of clonidine are constipation, dizziness, drowsiness, dry mouth, and unusual tiredness or weakness. There are rarely more serious side effects, such as allergic reactions, a slow heart rate and very high or very low blood pressure. Your healthcare provider can monitor your blood pressure while you are on this medicine. The medicine may affect your ability to drive or operate machinery.
You can start using clonidine up to 3 days before you stop smoking, but you can also start using it on the day you stop. However, it is not recommended to stop suddenly. The dose should be reduced over a few days to avoid a rapid increase in blood pressure, agitation, confusion or tremors.
Other drugs being studied to help smokers quit smoking
A drug called cytisine has shown good results and is being studied in the United States.
Naltrexone is a medicine used to help people with alcohol and opioid abuse disorders. The studies look at ways to combine it with varenicline to help people quit smoking, especially smokers who are also heavy drinkers.
Anti-smoking vaccines given as injections are also being tested and studied.
So far these new options appear to be safe, but larger studies are needed to show that they work before the Department of Health can approve these smoking cessation drugs.