 |
Click here to return to the home page |
How to Quit Smoking (or die trying) Everyone knows that smoking cigarettes is bad for them. Most who are still smoking are either trying to quit, or trying to get up the nerve to try to quit. Even kids who smoke know it’s bad for them, most seem to figure they’ll smoke for a while, then quit. Unfortunately, almost 1/3 of those people who try even a single cigarette will eventually become addicted to smoking. There are many methods and medications (both prescription and over the counter) on the market to help people quit smoking. I will review many of them, and also focus on the new medication Chantrix. Most important is for the smoker to want to quit. It is almost impossible to get your wife/son/mother/cousin to quit if they don’t want to. It has also been my experience that it is extremely difficult for someone to quit for their future health. If the smoker wants to quit because it’s a filthy, smelly, dirty habit – that seems to be most effective. (BTW – if you keep reminding yourself that you hate something, eventually you probably will.) Studies show that motivated people do best if they receive some counseling on methods and tricks to quitting, and then use some form of medication. Acupuncture does not seem to be effective. Most medications are some form of nicotine replacement. Because nicotine is physically addictive, the thought is that by replacing the nicotine the smoker will not have the physically agitating withdrawal symptoms while getting out of the habit of smoking. Nicotine is available as a patch, gum, inhaler, lozenge and nasal spray. All are about equally effective. In trials where they are compared to placebo (same vehicle, no medicine) placebo quit rates run 10-20% in a year, compared to 20-30% for the nicotine replacement therapy. The gum and patch have not shown any additional benefit when used more than 8 weeks, and the nasal spray appears to be the most addictive. Adding the gum, spray or inhaler to the patch seems to work better than each alone. Zyban (Bupropion SR) is also used as an antidepressant, and works by decreasing the cravings for tobacco. By itself, the success rate is slightly better than nicotine replacement, but combined it appears to be significantly better. Zyban can be difficult to tolerate; the most common side effect will be insomnia. Chantrix was recently approved by the FDA. Like Zyban, it is taken twice daily. There are receptors in the brain that reinforce the effects of nicotine, thereby maintaining smoking. Chantrix inactivates those receptors. It reduces cravings, withdrawal symptoms and smoking satisfaction for those who smoke when on the drug. Initial studies show, that when taken for 12 weeks, the smoke free rate at one year was 23%, vs. 15% for Zyban and 9% for placebo. The main side effect will be nausea, although in the studies it was so mild that it didn’t cause people to stop the drug. Some comments about these numbers. As you see, they vary widely, depending on who does the studies and interprets the results. Therefore, you can’t compare one quit rate to another, unless they were done in the same study. Look at the placebo rate (those received no medications) and compare to the treated rate to get an idea of how effective the treatment was. In any case, none of the treatments are great. There are many different treatments available to help people quit smoking. Most important is motivation though. It is important to review these options with your physician to find a treatment that works best for you. Try these links for more information: http://www.cancer.org/docroot/ped/ped_10.asp
|
|
copyright 2006, Jasmine Moghissi, MD