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Medications/Pharmacotherapy

Certain medications that do not contain nicotine have been found to be helpful at reducing the craving and withdrawal symptoms associated with smoking cessation. They are thought to help deal with the physical aspects of quitting smoking, while individuals work on breaking the mental habit of smoking. These medications are available in prescription form only.

Varenicline Tartrate (Chantix)

General Information

Varenicline Tartrate is a new molecular entity that received approval from the U.S. Food and Drug Administration in May 2006. It acts at the sites in the brain most affected by nicotine and helps users quit smoking in two ways: by providing some nicotine effects to ease withdrawal symptoms, and blocking the effects of nicotine from cigarettes if smoking is resumed. It is not nicotine, but it binds to the nicotine receptors in the brain, just as nicotine does.

Empirical Evidence on Effectiveness

Data presented at the 2005 meeting of the American Heart Association demonstrated varenicline tartrate to be more effective than bupoprion for smoking cessation over the course of a 12-week trial in two double-blind placebo controlled studies involving 2,000 smokers. In both studies, 44% quit by the end of the 12-week treatment period with varenicline tartrate, compared to 30% of those taking bupoprion. Researchers reported quitting response rates to be three times higher with varenicline tartrate than with placebo.³ The researchers concluded that the significant reductions in craving and in some of the rewarding effects of smoking seen with 1mg of varenicline tartrate twice daily may assist in promoting abstinence and preventing relapse.

Figure derived from Chantix webpage. Click here for more information.

Possible Side Effects

• Nausea
• Headache
• Vomiting
• Flatulence (gas)
• Insomnia
• Abnormal dreams
• Dysgeusia (change in taste perception)

Links for Brand Names

Chantix:

Recommended for 12-weeks, a second 12-week course can be helpful to maintain chances in the long term cessation.

Bupropion (Zyban/Wellbutrin)

General Information

Bupropion is an antidepressant believed to act upon norepinephrine and dopamine, two chemicals in the brain known to help regulate aspects of mood, cognition, and behavior. It has been used for the treatment of major depressive disorder, some anxiety disorders, and recently has been utilized as an aide for those attempting to quit smoking. It does not contain nicotine, but it does affect the chemicals in the brain associated with nicotine craving. It can be used in conjunction with other forms of nicotine replacement therapy.

Empirical Evidence on Effectiveness

Research has demonstrated that bupropion SR (sustained-release) tripled the quit rates among women and formerly depressed smokers.⁴ About 25 percent of the women who had taken bupropion SR were still abstaining from smoking a year later, triple the 8.5 percent success for those using a placebo tablet. The women on the placebo pill reported more negative mood than the men in that group, but no gender differences were observed for smokers using bupropion SR. A similar effect on abstinence rates was noted for smokers with a previous history of depression.⁴ Bupropion SR was also found to be effective for smoking cessation among African Americans and may be useful in reducing the health disparities associated with smoking.⁵ Researchers reviewed the evidence over the past decade on bupropion and noted its efficacy in alleviating craving to smoke.⁶

Possible Side Effects

• Dry mouth
• Nausea
• Insomnia
• Dizziness
• Weight loss
• Associated with risk of seizures, which is dose-related

Links to Brand Names

Zyban:

Oral administration, 150 mg sustained release tablets

Wellbutrin:

Same ingredients as Zyban; often prescribed for mood management
Once-daily, extended release tablet
Available in 150 and 300 mg doses

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