Using Chantix to Quit Smoking

Chantix (active ingredient varenicline) is one of only two prescription medications that are FDA-approved to help people quit smoking.  (Bupropion, marketed as Zyban, is the other.)  Unlike nicotine replacement products like the patch, neither of these medications contain nicotine. 

Effectiveness

Like other medications, the effectiveness of Chantix (varenicline) was also examined using meta analytic techniques.  (Metanalysis is a a statistical research technique used to combine the outcomes from multiple high-quality studies to get the most accurate answer.)  The effectiveness was similar to Zyban: about twice as many people who got Chantix were able to quit and stay quit compared to people who got a placebo or 'fake' medicine.  In these studies, the participants in both the treatment group and in the control group were on a behavioral plan in addition to the drug or placebo.

(In head-to-head studies comparing the effectiveness of varenicline and bupropion, Chantix appeared to have a slight edge.  It's worth noting that these studies were conducted by its manufacturer, Pfizer.)

A Note About Effectiveness

The most effective of all of the stop smoking aids or drugs have shown about a 'doubling' effect.  That means that if you use an 'effective' medication or aid, on average you are about twice as likely to quit successfully as someone who tries to quit without it.  What it DOES NOT mean is that the medication alone will "make" you quit. 

For example, only about 5% of people who try to quit cold turkey are successful.  So if you use a medication that doubles your chances and then try to quit cold turkey, your chance of quitting successfully ― even WITH the medication ― is only about 10%.

I mention this here because it's important to understand what the word 'effective' means when it comes to quit smoking medications, including varenicline.  The bottom line is, to increase your chances of quitting successfully, you'll need to combine whatever you choose with the best quit smoking plan or program you can find.  See 'My Recommendations' below for more advice and links related to this.

How It Works

Unlike bupropion, varenicline was developed specifically to help people quit smoking.  It works by both mimicking and blocking the effects of nicotine in the brain.  It may seem odd that both mimicking and blocking the effects of nicotine could work to help people quit, but it actually makes sense.  By mimicking the effects of nicotine, varenicline may reduce some of the withdrawal symptoms (although by no means all of them) that people experience when they quit.  And by partially blocking the effects of nicotine, it helps to reduce the 'reward' of nicotine intake, making at a little bit easier to give it up.

Warning: The information below may fall into the category of 'Way More Than You Wanted to Know' about varenicline.  If you're not interested in a technical explanation of the mechanism of action, feel free to skip ahead to 'How to Use Chantix'.

OK, here's the technical part:  The brain has neurotransmitter receptor cells that have been labeled 'nicotinic' receptors because they are stimulated by nicotine.  Varenicline acts on these cells as an 'agonist,' which means that it binds to these cells and stimulates them in a similar way to nicotine.  (The effects are not as strong as nicotine, however.)  Because the drug is in effect 'parked' at the receptor sites on these cells, it also partially blocks nicotine from activating them, thereby reducing the effect of nicotine in the brain from smoking, and helping to reduce the 'reward' associated with smoking.

A note about addiction:  One of the reasons smoking is so psychologically addictive is because the method of delivery - smoke - has an immediate effect on your system.  In other words, you are 'rewarded' right after the behavior - not 5 minutes later, or half an hour later.  Psychological research shows that rewards or punishments that follow the action quickly have a much greater effect than rewards or punishments that are delayed.  So the act of lighting up is immediately rewarded, and it becomes a very strong behavior, making it very difficult to quit. 

Applying that principle to the action of  varenicline, it's clear that its effectiveness is related to the fact that 1) varenicline [partially] mimics the effect of nicotine, but in a steady, all-the-time way, NOT as a response to lighting a cigarette, and 2) it [partially] blocks the effects of real nicotine, so that the act of lighting up a cigarette doesn't feel as 'rewarding' as before. 

Keep in mind that the 'reward' of nicotine in the brain is only one part of the physical and psychological addiction to nicotine and smoking more generally.  There are many other aspects of smoking dependence that should be addressed by psychological and behavioral techniques designed to help eliminate their effects.

If you're interested in digging even further into the technical details of Chantix, you can look at the clinical pharmacology of Chantix here (enter 'chantix' into the search box).

How to Use Chantix

Using Chantix (varenicline) is not complicated.  Your doctor will probably give you instructions to help you gradually 'ramp up' your dosage during the first week or so until you're on a 'full' dosage of a 1 mg tablet in the morning and one in the evening.  The ramp up process helps minimize side effects from the drug.  Chantix should be taken after eating and with a full glass of water.

Generally, you doctor will advise you to plan your quit date to coincide with the ramp up to the full dosage - so quit date should fall a week or so after you begin taking Chantix, although some people need a few weeks for Chantix to work best.  Initially you'll probably take it for about 3 months, and provided you quit smoking, your doctor may prescribe another three months' worth to help you solidify your success, for a total of 6 months maximum.

BTW, if your doctor's recommendations differ from what I've described above, of course you should follow your doctor's recommendations.  The information above is how Chantix is 'usually' used, based on the manufacturer's testing and recommendations.  Your doctor's recommendations, on the other hand, should be tailored to your specific situation.  That said, don't hesitate to ask your doctor questions if there is something you don't understand.  Especially if your doc is doing something different from the norm, it may help you to understand why s/he has made that decision for you.  I always say, an informed patient is a healthier, happier patient! 

Also, keep in mind that, like other quit smoking medications, Chantix is just ONE element of a successful quit smoking attempt.  You'll want to combine it with the best behavioral program for quitting you can find, to maximize your chances for success.  (See My Recommendations below for more on this.)

Side Effects

The most common side effect of varenicline is nausea (feeling sick to your stomach).  For most folks it is fairly mild and doesn't last, but for some people it can be more severe.  If you have bad nausea using this drug, reducing your dose might help - check with your doctor.  Other side effects include sleep disturbances, including insomnia and strange dreams,  headaches, constipation, vomiting, and being gassier that usual. 

Varenicline hasn't been tested on pregnant or breastfeeding women, or on children, so it is unknown whether it could have harmful effects in these circumstances.

Before your doctor prescribes Chantix to help you quit smoking, you should be sure to let him or her know if you:

  • have kidney problems or get kidney dialysis.

  • are pregnant or plan to become pregnant.

  • are breastfeeding.

  • are taking any other medications, including vitamins or herbal supplements. 

Pros and Cons

What are the pros and cons of using Chantix (varenicline) to help quit smoking? 

 Pros:

  • The success rate for Chantix is at least as good as other 'effective' quit smoking aids such as nicotine replacement products or bupropion (Zyban).

  • Unlike nicotine replacement products, Chantix allows you begin the treatment a week or two prior to your quit attempt.  This allows you to integrate a quit smoking program with the treatment while you are still smoking, and may help you with a natural tapering or 'nicotine fading' technique that can help minimize nicotine withdrawal symptoms.

  • It's easy to use ― it is simply a pill that you take a couple of times a day.  (However, don't be fooled into thinking that the pill will do the job all by itself.)

Cons:

  • Chantix (varenicline) requires a doctor's prescription, so it may be less convenient than some of the other options.  Cost to you depends upon whether you have insurance that will cover the doctor visit and all or part of the cost of the prescription. 

  • As with most medications, varenicline has some side effects and risks associated with it, and is not recommended for people with certain conditions.  (See side effects, above.)

My Recommendations

Chantix is one of only two prescription quit smoking medications that have been shown to be effective, so if you're considering using prescription medication to help quit smoking, it's certainly worth exploring this option with your doctor.  It appears to be at least as effective as Zyban (bupropion), and doesn't have the seizure risk that is associated with bupropion.  For these reasons (as well as the 'pros' listed above), I would consider Chantix the first choice for prescription medication options. 

Don't forget to choose or devise a behavioral strategy for eliminating the psychological dependence, too.  Although Chantix should help reduce some of the 'reward' effect via its action on brain chemicals, for most people it is not a 'magic pill' that will 'make' you quit.  Increase your chances of success by supporting your quit attempt with the best behavioral/psychological program you can find. 

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