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| Medicines to help you quit |
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Reviewed by Dr Gavin Petrie, consultant chest physician
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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:
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nicotine replacement therapy
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buproprion (Zyban)
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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.
NRT products still contain nicotine, which is harmful and
addictive, but they deliver smaller amounts than cigarettes and without many 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.
Most 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, inhaler,
patches and lozenges. All types come in different strengths that you decrease
over time.
The strength at which you start is determined by the number of
cigarettes you smoke a day and when you need your first cigarette.
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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.
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Inhalers 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.
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Lozenges release nicotine as they dissolve in
the mouth. You normally start with one lozenge every one to two
hours.
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Tablets that dissolve under your tongue
(sublingual tablets) can be more discreet than lozenges. You normally start
with one to two tablets per hour up to a maximum of 40 per day.
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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. You should also avoid drinking coffee, soft drinks and fruit juice
15 minutes before each gum, because they can reduce the amount of nicotine
absorbed.
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Nasal sprays deliver nicotine more rapidly
than other NRT products, so are of most use to heavy smokers who suffer strong
cravings. Previously only available on prescription, you can take a maximum two
doses per hour.
Other medication
Smoking and NRT both affect how other medicines work, so if you
take any other medication you should get advice from your doctor or pharmacist
before starting NRT.
NRT is not suitable for certain conditions, for example for
people with severe heart conditions.
Side-effects
As with all medicines, nicotine products may cause side-effects. 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 sneezing, sore throat, runny nose and eyes.
Nicotine from lozenges, gums and inhalers 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 hiccups.
For more detailed information on side-effects and interactions,
read the leaflet that comes with each product:
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Nicorette gum
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Nicorette inhalator
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Nicorette microtab
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Nicorette nasal spray
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Nicorette patches
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Nicotinell gum
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Nicotinell lozenges
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Nicotinell patches
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NiQuitin gum
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NiQuitin lozenges
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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.
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
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Bupropion is only available on prescription, so your GP will
decide whether you are suitable for treatment.
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It should be used in combination with motivational support
techniques.
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Treatment lasts between seven and nine weeks, depending on when
you feel capable of managing without further help.
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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.
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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
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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.
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The most serious side-effects are convulsive fits, which affect
approximately 1 person in 1000.
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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:
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stimulating the same receptors in the brain as nicotine. This relieves the craving and withdrawal symptoms that you can get when you stop smoking.
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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:
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the urge to smoke returned
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they felt irritable
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they felt depressed
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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
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Champix is only available on prescription, so your GP will decide whether you are suitable for treatment.
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As with Zyban, Champix must be used in combination with motivational support techniques.
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Champix tablets should be started one to two weeks before your target stop date.
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The dose is increased gradually over the first week and the medicine is then taken twice a day for 12 weeks.
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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
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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.
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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.
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Based on a text by Marianne Møller, NetDoctor
pharmacist
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Last updated 12.03.2007
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