Medicines to help you quit - Lloydspharmacy.com Health

Reviewed by Dr Gavin Petrie, consultant chest physician

Medicines can double your chances of quitting - although this is still a 20 per cent success rate at 12 months, rather than 10 per cent.

There are three types of pharmaceutical products to help you quit:

nicotine replacement therapy
buproprion (Zyban)
varenicline (Champix).

What is nicotine replacement therapy?

Nicotine replacement therapy (NRT) is the name given to stop-smoking medicines that release nicotine into the bloodstream to help counter cravings and reduce other physical withdrawal symptoms when you quit (nausea, headaches, irritability, dizziness).

These products don't give you the same sort of buzz as you get from cigarettes, but they do reduce cravings. NRT isn't meant to replace smoking, but to slowly wean you off nicotine.

You can use NRT to relieve cravings once you have stopped smoking completely. Some of the products can also be used to help you cut down the number of cigarettes you smoke before you give up completely.

NRT products still contain nicotine, which is harmful and addictive, but they deliver smaller amounts than cigarettes and without any of the other harmful substances in tobacco, such as tar and carbon monoxide.

The idea is to help you through the early phase when you need the most help and slowly reduce your dependency on nicotine.

All forms of NRT can be purchased over-the-counter from any pharmacy, but it is also available on prescription. This means if you qualify for free prescriptions, you can get NRT for free on the NHS.

What's the difference between the products?

NRT comes in the form of chewing gum, nasal spray, mouth spray, inhalator, microtabs, lozenges and patches. You decrease the amount you use over time, either by using lower strengths of the products, or by using them less frequently.

The strength at which you start is determined by the number of cigarettes you smoke a day and when you need your first cigarette.

Nicotine patches are worn on the skin and deliver a regular dose of nicotine over 16 or 24 hours. The long-lasting action means they can be worn around the clock and can therefore help to prevent cravings. If you get strong cravings to smoke as soon as you wake up, a 24 hour patch may be best for you.
Inhalators look like pens and can help if you miss the physical action of smoking. You insert a cartridge into the device and inhale nicotine vapour through the mouthpiece, normally starting with 6 to 12 cartridges a day.
Lozenges release nicotine as they dissolve in the mouth. You normally start with one lozenge every one to two hours.
Microtabs are tablets that dissolve under your tongue (sublingual tablets). They can be more discreet than lozenges. You normally start with one to two tablets per hour, up to a maximum of 40 per day.
Chewing gums are used when you would normally reach for a cigarette. The gum needs to be chewed in the special way described in the pack, not like normal chewing gum.
Nasal spray is used to give more rapid relief from cravings. Previously only available on prescription, it delivers nicotine more quickly than all the other NRT products. You can use it once in each nostril up to twice an hour.
Mouth spray is a new option for use when you would normally reach for a cigarette. You spray it directly into the mouth to provide fast relief from cravings. You can start with one or two sprays up to twice an hour, up to a maximum of 64 sprays in 24 hours.

If you choose to use lozenges, microtabs, gums or mouth spray, you should avoid drinking coffee, soft drinks and fruit juice 15 minutes before using them, because acidic drinks like these can reduce the amount of nicotine absorbed from the mouth.

Other medication

The components of tobacco smoke can affect how other medicines work, so if you take any other medication you should get advice from your doctor or pharmacist before giving up smoking, whether you're using NRT or not.

Side effects

As with all medicines, nicotine products may cause side effects, though sometimes these may be difficult to distinguish from withdrawal symptoms associated with stopping smoking. Common side effects with all products are headache, nausea and dizziness.

In addition patches can cause skin rashes and irritation and the nasal spray can cause nosebleeds, sneezing, sore throat, runny nose and watery eyes.

Nicotine from lozenges, microtabs, gums and inhalators may irritate the mouth and throat and cause dryness.

These products can also increase the production of saliva at the start of treatment, and excessive swallowing of nicotine in this saliva can cause nausea, indigestion and hiccups.

For more detailed information on side effects and interactions, read the pages below and the leaflet that comes with each product:

Nicopass lozenges
Nicopatch
Nicorette gum
Nicorette inhalator
Nicorette microtab
Nicorette nasal spray
Nicorette patches
Nicorette quickmist
Nicotinell gum
Nicotinell lozenges
Nicotinell patches
NiQuitin gum
NiQuitin lozenges
NiQuitin patches.

Can you become dependent on NRT?

Because nicotine is the addictive substance in tobacco, there is a risk you may become dependent on the nicotine replacement products. But the risk of this is small compared to the much greater risks of continuing to smoke. It's also a much easier habit to break than smoking.

This is why it's important to follow the instructions on the products and gradually reduce the amount of NRT you use after 8 to 12 weeks.

There is a lower chance of becoming dependent on nicotine patches, because these products release nicotine slowly and constantly through the skin, so there is less fluctuation in nicotine levels in your blood.

What is Zyban?

Bupropion is a prescription-only medicine that was originally intended as an antidepressant.

Its ability to help people stop smoking came about by chance when participants in the early clinical trials lost their desire to smoke.

Launched in the UK in 2000, it's sold under the brand name Zyban, and helps approximately one in five people who take it to give up smoking.

It's not known exactly how Zyban works, but it's thought to interrupt the areas of the brain that are associated with addiction and the pleasurable effects of nicotine.

This reduces the desire to smoke and dampens the physical symptoms of nicotine withdrawal.

Pros and cons

Zyban is an alternative to NRT and doesn't contain nicotine. As a relatively new drug, doctors and pharmacists have less experience with it than with NRT.

Like all medicines, it has side effects, which may put some people off using it. There are also some people who aren't suitable for this type of medicine.

How to use Zyban

Bupropion is only available on prescription, so your GP will decide whether you are suitable for treatment.
It should be used in combination with motivational support techniques.
Treatment lasts between seven and nine weeks, depending on when you feel capable of managing without further help.
On the first six days you take one tablet daily. From day seven, you take two tablets a day, with an interval of at least eight hours between doses.
It takes one week for the medicine to reach its maximum effect. For this reason, it's recommended you start taking the drug one to two weeks before you quit smoking.

Side effects of Zyban

Common side effects include fever, nausea, agitation, anxiety, dry mouth, headache, skin rashes and constipation. It can also intensify the sleep problems that many people encounter when they stop smoking.
The most serious side effects are convulsive fits, which affect approximately 1 person in 1000.
Zyban should not be used by people with epilepsy, liver problems or with eating disorders such as bulimia and anorexia.

For more detailed information on side effects and interactions, read the leaflet that comes with this medicine.

What is Champix?

Champix is a prescription-only medicine. Launched in December 2006, the tablets contain the active ingredient varenicline.

Varenicline works by:

stimulating the same receptors in the brain as nicotine. This relieves the craving and withdrawal symptoms that you can get when you stop smoking.
blocking nicotine's action on these receptors. This means you won't get any enjoyable effect from nicotine if you do have a cigarette.

Pros and cons

Like Zyban, Champix is an alternative to NRT and doesn't contain nicotine.

In clinical trials reported so far, more people have quit successfully with Champix than with Zyban. Champix has not yet been compared to NRT.

On the negative side, some people found that after they stopped taking Champix:

the urge to smoke returned
they felt irritable
they felt depressed
they had sleeping difficulties.

Gradually lowering the dose at the end of treatment may help to reduce these problems.

Like all medicines, Champix has side effects, which may put some people off using it. There are also some people who aren't suitable for this type of treatment.

How to use Champix

Champix is only available on prescription, so your GP will decide whether you are suitable for treatment.
As with Zyban, Champix must be used in combination with motivational support techniques.
Champix tablets should be started one to two weeks before your target stop date.
The dose is increased gradually over the first week and the medicine is then taken twice a day for 12 weeks.
If you have successfully managed to stop smoking at the end of 12 weeks, your doctor may offer you a further 12-week course of treatment. This has been shown to slightly increase the chance of remaining smoke-free after one year.

Side effects of Champix

Nausea is the most common side effect, usually in the first few weeks of treatment. It should improve as you continue to take the tablets.
Other common side effects include headache, difficulty sleeping, abnormal dreams, increased appetite, taste changes, dry mouth, drowsiness, tiredness, dizziness, and gut disturbances such as constipation, diarrhoea or indigestion.

For more detailed information on side effects and interactions, read the leaflet that comes with the medicine.

Based on a text by Marianne Møller, NetDoctor pharmacist

Last updated 02.06.2011

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