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10 Things You Should Know About Smoking Cessation Drugs

While they may have some side effects, prescription drugs can help you knock out that cigarette habit. See more drug pictures.
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When you learn to start smoking, it's not an easy process. It burns you. It chokes you. It makes you nauseous and dizzy, and while your head is spinning, you have a really bad taste in your mouth.

But learning to stop smoking is a whole lot worse. You cough. You fidget. You crave. You want cigarettes. You want to go back to the day that you started this process and live that day over.

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These days, your doctor can offer you a lot more help, in the form of smoking cessation drugs, while you're going through the withdrawal. There's Zyban, which gives you a mental boost. There's Chantix, which keeps your brain from sucking up the chemical benefits of nicotine. And then there are your old friends, the nicotine patch, nicotine gum and nicotine lozenges. If you've been smoking for any length of time, you've probably encountered them before.

While these methods may substantially increase your chances of quitting, they're not for everyone. The side effects can be overwhelming, and on rare occasions, even deadly. But experts say it's worth a try. Dr. Steven A. Schroeder, distinguished professor of health and health care at the University of California at San Francisco, says that even with the warnings, using the drugs is much safer than continuing to smoke.

Read on to find out 10 things you need to know before turning to cessation drugs to help you kick the habit.

Getting over that sweet, sweet nicotine is as much a physiological process as it is a discipline. If you step away from the destructive effects of smoking, you can see nicotine as something of a wonder drug. It revs up your brain. It helps you concentrate. It makes you think faster and better. And -- ahhh -- it just makes you feel so calm and so happy.

And while it's doing all that, it cuts your appetite and speeds up your heart rate. Aside from all these great benefits, nicotine increases dopamine, which may qualify as our happiest brain chemical. Heroin, cocaine and alcohol all bring dopamine into play, and the stimulation of dopamine has long been regarded as a critical component in addiction.

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So to get rid of the cigarettes, you'll need to manage that tough dip in dopamine. That's what the drugs are there to do, and as we'll see, different drugs tackle the job in different ways. If you use them correctly, they can double your chances of giving up smoking for good.

Different smoking cessation drugs act in different ways to help you stop smoking for good.
Different smoking cessation drugs act in different ways to help you stop smoking for good.
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Doctors prescribe Chantix for people who are likely to have trouble breaking the habit of lighting up. Chantix blocks the brain's ability to enjoy the surge of chemicals, so that if you light up while you're trying to quit, your brain will not reward you. This drug doesn't contain nicotine, and it doesn't act as a replacement for nicotine in the brain.

According to Pfizer, the manufacturer of Chantix, 44 percent of the drug's users in a study had quit within three months of starting treatment, compared to 18 percent who had quit using a placebo.

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Zyban, an antidepressant, minimizes the effects of dopamine in the brain and mimics some of the effects of nicotine. GlaxoSmithKline, the manufacturer of the drug, reported that 36 percent of patients who received a dose of 300 milligrams per day had reported quitting within seven weeks, compared to 17 percent of patients in the trial who used a placebo.

Unlike with Chantix, some studies have found that Zyban mimics some of the effects of nicotine in the brain.

These non-prescription products help people break the habit of lighting up throughout the day without having to deal with nicotine withdrawal. At least a decade before antidepressant options were available, smokers were using nicotine replacement to get through the trial of withdrawal from smoking.

Transdermal patches don't give you the kick that smoking does: Instead of the 10-second delivery system that cigarettes provide, the patches will deliver the drug steadily and evenly. If you wear them at night, you might have strange dreams, but you're less likely to wake up wanting that morning smoke.

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Nicotine gum, on the other hand, does give you that occasional kick. You use nicotine gum by biting it a couple of times, then holding it in your mouth and biting again whenever a craving kicks up. You start with one piece every hour or two, then scale down to one piece every four to eight hours.

Even though quitters are only supposed to use the replacement therapies for 12 to 24 weeks, Dr. Steven A. Schroeder says that it's better to use them longer if you need to than to start smoking again.

Go all out for the best results -- studies show that combining drugs with nicotine patches or gum can help you kick the habit quicker.
Go all out for the best results -- studies show that combining drugs with nicotine patches or gum can help you kick the habit quicker.
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Those great success rates for smokers who quit by the seventh week using Zyban get a power boost when combined with nicotine replacement therapy. A clinical trial showed that 58 percent of patients who used combination therapy had quit by week 7, as opposed to 36 percent in a separate trial who took Zyban alone [source: GlaxoSmithKline]. The manufacturer of the drug reports, however, that the study has not been replicated and should not be interpreted as demonstrating the superiority of one method of treatment over another.

However, a separate study by a researcher at the University of Wisconsin showed that patients who used Zyban, along with the long-acting patches and the occasional boost from nicotine gum, were most likely to quit.

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Chantix has not been tested in combination with nicotine replacement therapy.

Also, it's important to remember that if you experience some side effects with one drug, you may multiply those side effects with three.

Although every drug produces specific, well-documented side effects, headache and nausea are commonly listed as side effects of many smoking cessation drugs.

Of course, it's often hard to tease out whether the drug is causing side effects or whether the profound shock of quitting smoking is causing them.

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Often, people who use nicotine patches at night, or who use Chantix, report having weird dreams. But this isn't reported as a side effect of Zyban. However, users of both Chantix and Zyban report having trouble sleeping.

For most methods, patients report that the nausea, headaches and dizziness subside within a few days of starting. Like quitting itself, managing the side effects can be a matter of buckling down for those few first miserable days and then getting on with the hard work of quitting in the long term [sources: Pfizer, GlaxoSmithKline].

If you're pregnant and trying to quit smoking, talk to your doctor -- medication might be a better choice than cigarettes.
If you're pregnant and trying to quit smoking, talk to your doctor -- medication might be a better choice than cigarettes.
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Prescription drugs and nicotine replacement are not recommended for several groups of people across the board. Most pregnant women and nursing mothers are advised to steer clear of prescription drugs and nicotine replacement. But Dr. Schroeder says that in some cases, with a doctor's supervision, it might be better for these women to use a drug than to keep smoking. "None of these medicines is going to be as damaging as the pregnant women who keep smoking," he says.

For other groups, the guidelines are more clear-cut. The antidepressants, like Zyban, are absolutely off-limits to people with seizure disorders or a history of manic episodes, bipolar disorder, bulimia or anorexia [source: GlaxoSmithKline].

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People with heart disease should be cautious about starting nicotine replacement therapy at high doses.

In general, clinical trials on drugs that help people quit smoking have been conducted on heavy smokers. That makes sense, because this is the group that needs the most help.

However, because of the emphasis on the group with the toughest habit to break, there are few guidelines on how light smokers should use the drugs or whether the drugs are effective in helping light smokers quit. The research does show, however, that even light smoking has adverse effects on health.

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A recent study examined the habits of smokers from racial and ethnic minorities, and found that while they were more likely to be light smokers, they had just as little success quitting as other smokers and were less likely to receive medical intervention in quitting [source: Claremont Graduate University].

Be careful when combining cessation drugs or nicotine replacement with cigarettes -- it's possible to overdose on nicotine.
Be careful when combining cessation drugs or nicotine replacement with cigarettes -- it's possible to overdose on nicotine.
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If you read the packages that come with nicotine patches and gum, they'll tell you unequivocally not to smoke while you're using these products.

However, in recent years, researchers have studied people who were given the patch while still smoking, and in general, the studies found that smokers who started the patch before quitting were more likely to quit than those who didn't replace the nicotine before quitting. It's certainly worth mentioning that these smokers were kept under routine supervision of doctors and medical teams during the trials [source: American Cancer Society].

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If you quit while using the patch, and you just can't avoid a real cigarette now and then, you'll probably be OK, but you need to watch for signs of nicotine overdose. Those symptoms include anything from nausea and rapid heartbeat to seizures, cold sweats, tremors and confusion. The American Cancer Society recommends that you call the Poison Control Center if you suspect an overdose.

Medical researchers usually toss out 10 pounds as the magic number for weight gain when you quit smoking. If you use Zyban or nicotine replacement, you probably won't gain weight while you're quitting -- but you'll gain it later.

One study showed that after a year, women who quit smoking by using Zyban gained as much as 13 pounds less than women who quit while using a placebo. After two years, the group had gained 8 pounds less. The men who took Zyban showed substantially smaller differences than women, with an average weight gain of 3 pounds less [source: Doctor's Guide].

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Further research has shown that in the long run, that weight gain will most likely occur. That's because nicotine affects metabolism, and when you lose the boost, your body moves toward its natural weight. But it's a whole lot less demoralizing to put off the worry about the pounds you might gain while you're focused on losing your friend the cigarette.

While rare, smoking cessation drugs can cause potentially dangerous side effects. Talk to your doctor if you feel depressed or hostile.
While rare, smoking cessation drugs can cause potentially dangerous side effects. Talk to your doctor if you feel depressed or hostile.
David Malan/Photographer's Choice/Getty Images

A rare but significant side effect of Chantix and Zyban involves an increase of bizarre behavior, including depression, hostility and suicidal thoughts [sources: Pfizer, GlaxoSmithKline]. In the drug world, this is called a black-box warning.

With Chantix, regulators have seen fewer than 100 episodes of suicide in 9 million users, but it's still enough to issue the warning.

With this side effect, as with others, it's hard to tell whether it's the drug that actually leads to this behavior. "It's unclear whether it's the drug causing it, if the quitting smoking causes it, or if these people are prone to committing suicide in the first place," Dr. Schroeder says.

Some depression and bizarre behavior are not uncommon with people who are trying to quit, regardless of the method they choose. "When the nicotine patch first came on the market, there were similar rumors," Dr. Schroeder says.

To learn more about smoking and how to quit, check out the links on the next page.

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The FDA recently announced plans to explore nicotine reduction in cigarettes to non-addictive levels. HowStuffWorks takes a look at the possibility.


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Sources

  • American Cancer Society. "Guide to Quitting Smoking." (May 9, 2011)http://www.cancer.org/Healthy/StayAwayfromTobacco/GuidetoQuittingSmoking/index
  • Claremont Graduate University. "Community and Global Health study reveals challenges for light smokers who want to quit." March 7, 2011. (May 10, 2011)http://www.cgu.edu/pages/4546.asp?item=4902
  • Doctor's Guide. "Smoking Cessation Aid, Zyban (Bupropion), May Help Avoid Weight Gain." Aug. 8, 2000. (May 10, 2011)http://www.pslgroup.com/dg/1dc5f2.htm
  • GlaxoSmithKline. "NicoDerm CQ." (May 9, 2011)http://www.nicodermcq.com
  • GlaxoSmithKline. "Nicorette." (May 9, 2011)http://www.nicorette.com
  • GlaxoSmithKline. "Zyban Prescribing Information." September 2010. (May 7, 2011)http://us.gsk.com/products/assets/us_zyban.pdf
  • Pfizer Inc. "Chantix." (May 7, 2011)http://www.chantix.com/index.aspx
  • Schroeder, Steven A. Distinguished Professor of Health and Health Care, University of California at San Francisco. Personal interview. May 6, 2011.

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