September 20, 2013

Smoking Cessation Medications

smoking cessationIn previous posts we reviewed the harmful effects of smoking and explored tips to quit smoking. Today we’ll look at smoking cessation medications touted to improve the odds of successfully quitting smoking. There are three medications currently FDA approved for smoking cessation and a couple of others that are used though not specifically approved for smoking cessation.

The medications approved for smoking cessation include nicotine replacement drugs, bupropion (Zyban), and varenicline (Chantix).  Bupropion is also marketed as an antidepressant/antianxiety drug under the name of Wellbutrin.  Nortriptyline and cytisine are drugs used for smoking cessation (though not specifically approved). Nortriptyline is an antidepressant.

How Smoking Cessation Drugs Work

Nicotine replacement therapy works by reducing withdrawal cravings associated with smoking cessation. Nicotine is a prime ingredient in cigarettes and cessation of smoking can cause withdrawal symptoms that makes quitting smoking difficult. Nicotine replacement preparations provide a continuous flow of therapeutic nicotine to the body for 16-24 hours. The dosage of the nicotine is then reduced gradually over 8 to 10 weeks as the cravings for nicotine diminish enabling smokers to quit.

Smoking stimulates the release of  dopamine. Zyban increases levels of  dopamine and norepinephrine in the brain and reduces nicotine cravings and withdrawal symptoms related to smoking cessation. The exact mechanisms by which it works for smoking cessation and depression are not known (that’s always comforting).

Chantix works by attaching to nicotine receptors and blocks them from being stimulated. It also stimulates dopamine but at a lower level than nicotine does.

Are Smoking Cessation Drugs Effective?

That depends on your definition of effectiveness. To be FDA approved drugs have to outperform a placebo or “sugar pill” (a pill with inactive ingredients) in a clinical trial, and also be considered safe. This means that a FDA approved drug may not work in a majority of the patients to whom it is prescribed, it just has to work better than a placebo. And, that’s what we see with smoking cessation drugs.

Smoking cessation drugs are 80% to 100% more effective than placebos which sounds impressive. But, they do not appear to be more effective than quitting cold turkey which has success rates up to 77% (though sometimes it takes a few attempts to quit).

In smoking cessation clinical trials placebos have been found to be effective in 2% to 18% of smokers. Depending on the length of the trial the effectiveness of smoking cessation drugs has ranged from 10% to 44%. On average smoking cessation drugs are 80% to 100% more effective (100% more effective means twice as many people quit smoking) compared to placebo.

Smoking cessation drugs do not appear to be more effective than quitting cold turkey or simply gradually quitting, but for those who cannot quit on their own they do provide an alternative. Most studies show that approximately 80% of successful quitters of smoking have done so on their without medications.

 

 

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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