QUITTING SMOKING –SOMETHING OLD AND SOMETHING NEW Part 2

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

The experts who study how people make decisions say there are 5 stages of change: precontemplation, contemplation, preparation, action and maintenance. Last time we were talking about the 5 stages of change and how they apply to quitting smoking. We left off with Stage 3 – Preparation or “I’ve made up my mind to do it, but now I need a plan.”

Stage 4 – Action – I’m actually doing it!
You have quit smoking! That’s amazing! Now, not to rain on your parade, but there are going to be bumps on the road. Also, if you have gone cold turkey, you may be now wishing you had a little help. Let’s review the products out there to help you stay quit.

Smoking Cessation products fall into three categories: nicotine replacement, antidepressants and nicotine receptor modifiers.

Nicotine replacement is still the most common smoking cessation aid. Whether it is a gum, lozenge, lollipop, patch, inhaler, etc. we are actually giving you back nicotine. It works like this. You quit smoking. Although there are thousands of compounds in the cigarette smoke that you inhale, we think the one that causes addiction is nicotine. So, after your last cigarette, the amount of nicotine in your body falls. Your body says, “I WANT MORE NICOTINE. SMOKE! NOW!” So if you give your body nicotine in the form of a patch, lollipop, etc. the craving goes away, or at least gets less intense.

People do ask about if the various nicotine replacements are safe. This is understandable as nicotine is a dangerous toxin. It raises blood pressure, increases heart rate and other nasty things. My standard answer is if you aren’t sure, ask your doctor. If your doctor gives says nicotine replacement is okay for you, I feel comfortable saying nicotine replacement is safer that smoking. If the various nicotine replacements are used properly, they give you less nicotine than cigarettes and they don’t give you the tar, cyanide, arsenic, and many, many other chemicals in cigarette smoke.

So what about buproprion? Its brand name is Zyban. Ideally, you should start using Zyban about 2 weeks before you quit smoking. That gives it time to build up in your system. However, if you have already quit, and ask your doctor about Zyban now, it still could help. It was originally marketed as an antidepressant, and an interesting thing happened, less of the depressed patients taking buproprion in the trials smoked than those taking sugar pills. So it was re-branded for smoking cessation. (FYI the brand name of the antidepressant is Wellbutrin). We don’t know exactly how it helps people stop smoking, but we do know that as an antidepressant, one of the brain chemicals it effects is dopamine. We know dopamine is involved with the reward center in your brain and that the reward center is involved with addiction. So my favorite theory says that through dopamine, Zyban effects the reward center in your brain and that slowly makes you want to smoke less and less. Under doctor’s supervision, Zyban can be used with nicotine replacement as well. The mostly commonly reported side effects with Zyban are dry mouth and insomnia. There is a rare but serious side effect with Zyban that makes a patient more likely to have a seizure.

The newest product is called varenicline or Champix. Again, Champix should be started one to two weeks before quitting smoking. Champix is interesting because it is what is called a partial nicotine agonist. It attaches to nicotine receptors in the body and stimulates them a little, but not as much as nicotine. So this should take the edge off of nicotine withdrawal. Champix also blocks the nicotine receptors, so patients get fewer pleasurable effects from smoking. It is not a good idea to use champix with nicotine replacement. There is no evidence it works any better and increases the chance of nausea. Speaking of nausea, 30% of the trial patients experienced mild to moderate nausea, compared to only 10% on placebo.

So what is the best product? Whichever one gets you to quit. Champix might be more effective than Zyban. One study found it more effective at 12 weeks, but that advantage seems to have disappeared by 1 year.

Stage 5 – Maintenance – Staying Quit
Okay you have quit. You have battled through the cravings, mood swings and other nastiness of the first 7 to 14 days. Now you have to focus on changing habits. If you used to smoke after supper, now you should schedule a walk. If you used to smoke with a group of ladies over coffee, you should tell them you won’t be seeing them for a while. You will keep running into triggers that will make you want to smoke. You will need to be creative in avoiding them, or doing something else instead of smoking. The reason most smoking cessation products say you should take them for 12 weeks is that we think that is how long it takes to change a habit. The actual withdrawal is probably over in the first week. It takes much longer to change your lifestyle.

Relapse – Oops I smoked again.

Don’t panic, and don’t beat yourself up. Just because you smoked one, two or a pack of cigarettes doesn’t mean you have failed and should start smoking again. Figure out what the trigger was. Figure out what you are going to do differently next time that trigger happens. There will be bumps in the road. But, if you stay smoke free, it will be good for your health.

As always if you have any questions or concerns about these or other products, ask your pharmacist.