House Call: Saying No to Smoking: When You Need More than Willpower

From OncoLog, November 2008, Vol. 53, No. 11

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Saying No to Smoking: When You Need More than Willpower

If you smoke, quitting is one of the most important things you can do. Smoking greatly increases your risk of cancer, emphysema, stroke, heart disease, and other ailments that can ruin your health and shorten your life.

Prescription medications reduce nicotine cravings and withdrawal symptoms without the use of nicotine.

Of course, you probably already know that smoking is bad for you. But what you may not know is that there are more medicines than ever to help you quit. While overcoming a smoking addiction is never easy, you may not have to rely on willpower alone.

Here is a look at your options for medication.

Nicotine replacement therapies

These quitting aids include the well-known patches, gums, and lozenges that slowly wean you off tobacco. They are called nicotine replacement therapies because they provide controlled doses of nicotine, which is the substance that keeps you physically addicted to smoking. Nicotine replacement therapies are considered relatively safe because they don’t contain the cancer-causing chemicals and other harmful compounds found in tobacco.

Nicotine replacement therapies allow you to lower the nicotine dose over time, which should help reduce both your cravings for smoking and the symptoms of physical withdrawal. Multiple studies have shown that nicotine replacement therapy can double your chance of quitting smoking.

Over-the-counter aids such as patches, gum, and lozenges are widely available at drug stores, general merchandisers, and grocery stores. You can also ask your doctor about a prescription for other types of nicotine replacement therapy, including nasal sprays and inhalers.

One drawback of nicotine replacement therapies is that they do contain nicotine, which can cause side effects in some people. Pregnant women and some other patients should not use nicotine replacement therapies without a doctor’s supervision.

Non-nicotine drugs

Your doctor may recommend a non–nicotine-based medication instead. In recent years, two medications have been introduced that reduce nicotine cravings and withdrawal symptoms without the use of nicotine. As with nicotine replacement therapies, studies have shown that smokers who take non-nicotine drugs are more likely to quit than those who don’t take any medicine. You need a prescription to obtain these drugs, which should be taken daily for several months as directed by your doctor.

Nicotine patches, gums, and lozenges let you lower the nicotine dose over time.

Bupropion (Zyban) can help reduce cravings and withdrawal symptoms for smokers (although doctors aren’t quite sure how the drug works). Bupropion is also marketed as an antidepressant under the name “Wellbutrin.” Patients taking bupropion for depression reported a decreased urge to smoke, leading to its use today as an anti-smoking aid. Side effects may include dry mouth and trouble sleeping. Patients who are pregnant, have seizures, have an eating disorder, or drink alcohol heavily should not use bupropion.

Another prescription medication, varenicline (Chantix), also helps smokers quit by reducing the urge to light up. This drug limits the pleasurable effects of smoking by interfering with the nicotine receptors in the body. Side effects may include nausea and vivid dreams. Patients who are pregnant or have kidney problems should not take varenicline. Also, because mood swings, depression, and suicidal thoughts have been reported rarely in patients taking varenicline, your doctor should carefully monitor its use.

Final thoughts

Talk to your doctor before trying to quit smoking and especially before using any of the medicines described here. Since not all medicines are right for all people, your doctor can assess any risks you might have and will recommend your best option.

With any quitting aid, it is important to follow the directions fully. Also, remember that these drugs are not a “magic pill”—quitting still requires that you commit to changing the habits that trigger your tobacco use. Support from loved ones or former smokers who understand the challenges of quitting can also help you break the addiction.

Sources: www.smokefree.gov, www.surgeongeneral.gov/tobacco

— J. LeBas

For more information, on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

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