QUITTING SMOKING –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.

Last time we talked about the nicotine lolly pop to stop smoking. This time we are going to focus on the prescription pill Zyban, the newest stop smoking prescription medication call Champix and a product the Dauphin Clinic Pharmacy can compound for you called a Nix Stix.

Before we get to the new products, though, let’s talk a little bit about nicotine replacement. This includes lollipops, gum, patches and the Nix Stix. People often ask 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 if it is safe for you, ask your doctor. Assuming that your doctor says nicotine replacement is safe 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, carbon monoxide and 5000 plus other dangerous chemicals and mutagens in cigarette smoke.

There is a pill to stop smoking called Zyban or the generic name is bupropion. It is available by prescription only. What should you know about it? First it is a pill, not a patch or a gum. It works on a part of your brain and reduces your craving for smoking. It does not have any nicotine in it. In fact, under the supervision of your doctor, you can be on Zyban and a nicotine gum or patch at the same time. With your doctor's supervision, you would start taking Zyban about a week before you quit smoking. This is to build up enough of the drug in your system, that by quit day you should have less cravings to smoke. The mostly commonly reported side effects with Zyban are dry mouth and insomnia

The newest product on the market is called varenicline or Champix. Champix is available by prescription only. Like Zyban, Champix should be started one to two weeks before quitting smoking. As a pharmacist, I find Champix very interesting because it is a partial nicotine agonist. This means it attaches to nicotine receptors in the brain and stimulates them a little, but not as much as nicotine. So this should take the edge off of nicotine withdrawal. Champix also partially 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, up to 30% of patients may experience mild to moderate nausea.

So what is the best product? Whichever one reduces your triggers and cravings, and gets you to quit. Nicotine replacement has been around the longest, and definitely can help you quit. Zyban may delay ( but not eliminate) the weight gain associated with quitting smoking as compared to nicotine replacement. Champix and Zyban were actually compared head to head, and they did both increase a person’s likelihood of quitting compared to placebo. Champix was more effective than Zyban at helping people quit after 12 weeks. However, by one year Champix and Zyban seemed to have about the same number of people still off of cigarettes. They all can work. Let you doctor or pharmacist help you decide which is going to help you the best with your triggers and cravings.

Speaking of triggers and cravings, sometimes smokers have a craving and sticking something like a lollipop or gum in their mouth is inappropriate. What should they do? Well the nicotine patch is too slow for an immediate craving. What if you had a discreet little applicator which you could rub on your wrist and get nicotine immediately? Well at the Dauphin Clinic Pharmacy, we are compounding such a device for patients at the request of their doctors. We call it a Nic-Stix and with a prescription from a patient's doctor, we compound a device that looks like a chap stick tube. The Nic-Stix has 30mg of nicotine in it so is will last 1-4 weeks depending on use, but it also must be kept away from children because it would be toxic if ingested. The Nic-Stix will melt easily, so it should be kept in a cool place, but is small enough to be carried almost anywhere.

Smoking kills three times more people than alcohol, AIDS, illicit drugs, car accidents, suicide and murder all combined. Quitting smoking is very difficult, and it takes the average ex-smoker six serious quit attempts before they succeed, but the results are worth it.

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