Menu

Dr. Len's Cancer Blog

Expert perspective, insight and discussion

Dr. Len's Cancer Blog

The American Cancer Society

For Smokers: A New Ray of Hope

by Dr. Len May 11, 2006

For years I have had at least one consistent answer to the question, “What is the single most important thing I can do about my health?”

 

And the answer is, “If you are a smoker, stop.  And if you are not a smoker, don’t start.”

 

But the  major barrier for smokers who want to quit, despite all of the news and information about the incredible dangers of cigarette and cigar smoking, is the fact that cigarette and cigar smoke is so incredibly addicting.

 

Once hooked, many people simply can’t do anything about it.  That’s not their fault, given the fact that the nicotine in cigarettes and cigars is one of the most addicting substances we know of.

 

Today, a new form of targeted therapy has been approved by the Food and Drug Administration that may just be the answer for many chronic smokers who have failed quit attempts in the past.

 

The name of the drug is varenicline (trade name: Chantix) that has been developed and will be marketed by Pfizer.

 

The reason so many of us are hopeful about this new medication is because it has a different mechanism of action than other smoking cessation aids such as nicotine patches and gum (which provide the body with nicotine without the dangerous cancer-causing substances found in cigarette smoke), and the medication bupropion (trade name: Zyban) which is an antidepressant that has a particular anti-smoking effect not found in other antidepressants.

 

Although the mechanism of nicotine addiction is a complex process in our bodies, understanding how it works is relatively simple.

 

People who smoke become addicted to the nicotine.  No cigarette, no nicotine, and about 4-6 hours after your last puff you need another fix.

 

That is a classic addictive behavior process.

 

What happens is that we have something called a nicotine receptor that is located in several parts of our brain.  According to a recent article in the International Journal of Clinical Practice, there are an increased number of these receptors in the part of our brain that deals with what we can call “pleasurable responses.” 

 

When you inhale nicotine, it travels through your body into your brain and latches on to these receptors.  That then stimulates the brain cell to which the receptor is attached to secrete a substance called dopamine.  When the amount of dopamine in the spaces around the cells in this part of the brain increases, the smoker feels good.

 

Voila! Another chronic smoker is introduced to the habit.

 

As people smoke, according to the author of the article, the number of nicotine receptors in the brain increases, as does the pleasurable response.  This is all associated with a “learned behavior” of connecting the functions associated with smoking a cigarette with the sense of pleasure.  We learn to relate the opening of the pack of cigarettes and lighting the cigarette with the pleasurable response that is going to follow.  And we learn that there are certain things we do, such as smoke while drinking an alcoholic beverage or eating a meal, will also result in the same effect.

 

This is all very complicated, but the net result is that a number of changes occur in our bodies and our brains that create habits that can be very difficult to change without a very concerted effort.

 

Varenicline is a new approach to dealing with this problem. 

 

As I mentioned before, we can provide nicotine substitutes and antidepressants.  But varenicline is actually a targeted therapy, based on principles similar to the targeted therapies I have discussed in other blogs (for example, Herceptin) except in this case it is targeting a receptor on a nicotine-vulnerable cell as opposed to a cancer cell.

 

The net effect is the same: block the receptor with varenicline, and the nicotine can’t get to the receptor and can’t cause its triggering effect on the dopamine levels in our brains.

 

However, varenicline itself does stimulate the production of dopamine, so there is still some of the same positive feelings that nicotine would produce.

 

So, in effect, you can get the boost you need similar to what you would get from a cigarette without having to smoke a cigarette, or taking a nicotine substitute for that matter.

 

In essence, the chains of dependence are broken.

 

But that is not all you would have to do to be successful with this new medication.  You also need to learn to break the other bad habits that reinforce your dependence.  You need to avoid places you associate with smoking (such as bars and restaurants), or at least have to learn how to deal with those stimuli and challenges.

 

Programs such as the American Cancer Society’s Quitline ™ are designed to help you with your efforts, and Pfizer has announced they too will provide a support program.

 

How successful will varenicline be?

 

We really don’t know the answer to that as I write this.

 

According to information I have been provided, this drug was tested in relatively healthy smokers (if there is such a thing) who had no cardiac disease or problems with depression.  The smokers in the clinical trial spanned a reasonable age range similar to typical smokers.

 

According to a Pfizer news release, 20% of smokers who used the medicine remained smoke free for over a year.  The drug was four times as effective as a placebo, or dummy pill, and it was twice as effective as bupropion.

 

That may not sound like much, but it is fair to say that many of these folks had made multiple attempts to quit (we need to remember that, like any difficult habits, stopping smoking can take many, many attempts until you are successful.  Pfizer says it takes on average 10 quit attempts before a smoker is successful in stopping).

 

We also need to remember that smoking is an addiction, and a chronic disease.  So it is one that will be with a smoker for a lifetime, and the cravings don’t quit even many years after stopping.

 

So if we have a population of folks in this country who are hard core smokers (22% of our population, or 45 million Americans smoke) and we are able to keep 20% of them off of cigarettes for a year, then that is probably a considerable success under those conditions.

 

And, if the first effort isn’t effective, and they keep trying, eventually the odds are they are going to be successful.  Over half the people in the United States who ever smoked and are alive today are former smokers.

 

What about side effects? 

 

The official Food and Drug Administration announcement says the most common side effects are nausea, headache, vomiting, flatulence (gas), insomnia, abnormal dreams and a change in taste.

 

The frequency of nausea is not insignificant, and affected a majority of the participants in the clinical trial for a number of days after they started the medicine.  That said, if the participants continued the medication, the nausea did resolve.

 

The bottom line is that the news of varenicline’s approval today is exciting.  How quickly this medication is going to work its way into clinical practice is uncertain at this time.

 

We need to make a much better effort as doctors and clinicians to remind our patients about the dangers of smoking, and encourage them to quit.  We need to provide and take advantage of the resources and medications available to smokers to help them stop smoking.  We need to create environments (such as through clean air laws) where smoking is prohibited.

 

This new approach to smoking cessation is probably going to fairly quickly become part of our treatment programs if we are able to get folks into their doctors’ offices and have the doctors work with them by prescribing the medication and getting their patients into support programs.

 

But there are some cautions in my opinion that we also need to be aware of.

 

Recall that I mentioned above that the smokers in the clinical trials were relatively healthy.   That makes them a select population of folks who smoke.

 

When we get into the real world with any new medication we have large numbers of people taking it who are not subject to the careful monitoring that occurs in a clinical trial.

 

That means that people with lung disease, heart disease, diabetes, hypertension and depression to name but a few conditions are going to be taking this medicine.  That also means they will be taking a number of other medications at the same time.

 

Although it is obvious that the experts who developed the drug are knowledgeable about these considerations and have taken this into consideration, I always am a bit cautious about any new medicine and its potential other unanticipated side effects that may be found as the medicine becomes part of standard clinical practice. 

 

If you are a “healthy” smoker similar to those studied in the clinical trial, you have a reasonably good idea of what to expect from varenicline.  If you have many other serious medical conditions and take a number of other medications you need to be aware of any additional symptoms you develop if you start the medicine.

 

This advice is no different than I provided my patients when I was in practice, and is not unique to this medicine.

 

Many medicines have come to market and been extremely effective.  But I have learned from experience that we do not learn everything we need to know about a drug like this from a clinical trial.  The consequence is that “post marketing surveillance” is very important.

 

(By the way, as a piece of general information, if you have any unusual side effect from any prescription medication, you or your health care clinician can report it directly to the FDA on their website at MedWatch.

 

My sincere hope is that this medication is effective in helping those who are chronically addicted and possessed by their smoking habit.  We need new advances like this to help these folks achieve the goal that many of them desire.

 

Time will tell if it is as effective as the studies suggest.

 

In the meantime, call us at 1-800-ACS-2345 24/7 and talk to us if you are ready to make the attempt, even if you have not been successful 10 times before.

Filed Under:

Medications | Tobacco | Treatment

Comments

6/8/2006 3:41:40 PM #

Jennifer

I took Zyban (Wellbutrin) to quick smoking twice.  I am currently smoking now, but since the Wellbutrin made me feel better(depression symptoms, my doctor told me I could stay on it.  I take one a day.  

My question to you is "Can I continue to take the Wellbutrin once a day along with the new drug Chantix? If so, do you think my chances will be even greater if I am taking both?

Jennifer

6/25/2006 7:02:24 PM #

Suzanne

I HAVE BEEN TAKING WELLBUTRIN FOR ABOUT 15 YEARS.  I WANT TO STOP TAKING THIS AND WOULD LIKE TO KNOW HOW TO GET OFF THIS MEDICATION!
COLD TURKEY OR ?

THANKS FOR YOUR HELP IN THIS MATTER

Suzanne

8/21/2006 10:15:48 AM #

Kelley

I have finally quit smoking and have tried everything.  I believe that my success is owed to CHANTIX.  This stuff is great!  I take Zoloft and HRT and it has not interfered with them.  I am so happy and I hope that it can help other smokers!  BTW I was a hard core smoker.  I have been tobacco free for 3 weeks and have been around many smokers and adult beveridges and not been tempted.  GOOD LUCK!!

Kelley

9/29/2006 12:50:58 PM #

jim cook

Ions are electrically charged particles formed by the gain of one or more electrons (called positive ions), or the loss of one or more electrons (called negative ions). Negative Ions can be generated by lightning, ocean surf and waterfalls, or even by rubbing two different materials against each other due to the fact that some materials tend to gain electrons from things they come in contact with. Negative ions are abundant in mountains and forests, since all plants give off some ions. Many scientific studies have been conducted over the years showing that negative ions are beneficial to human body, can improve human body health.
Our award-winning Negative Ion Health Clothings  are innovative products that have the unique ability of  gaining electrons and negatively charged. The products supply negative ions to your body CLOSELY and CONTINUOUSLY, and can activate metabolism of cells, increase the energy flow in the body,  adjust the nervous system, accelerate blood circulation, and improve your health. We have broad negative ion products, our negative ion knee supporters, elbow supporter, ankle supporter and waist supporters are great to ease joint pains, and our negative ion bed sheet, blanket are excellent in reducing sleep disorders, our scarfs or shawls are very effective in fighting asthma, allergy, we have many other products to improve your health. Besides negative ions benefit, our negative ion clothings also have superior heat insulation that can keep your body warm in cold weather without dress to many layers, great permeability to keep your body dry and stay out of moisture, and excellent fire resistance. All these features combined together make our teviron negative ion clothings the most wonderful products in the world. Many clients have testified that the products are really magic.  If you want  to see more info about  our gorgeours negative ion products, please visit us at:

http://www.DressToCure.com

jim cook

12/29/2006 4:22:42 PM #

Kathleen

Chantix does work.  Following according to instructions.  Good luck.

Kathleen

1/15/2007 12:24:30 AM #

Tamara

I am on bupropin, the generic of wellbutrin, I take it once a day and I want to take the Chantix to quit smoking. Is it safe to take both medications at the same time. I am taking bupropin for depression and anxiety.

Tamara

2/28/2007 2:38:36 PM #

Diane

Same as above - can I continue my Wellbutrin.  Also, my pharmacy just gave me the 1mg tablets.  Can I cut these in half for the days that require 1/2 mg.?

Diane

3/15/2007 11:10:54 PM #

Rosa Mojica

Can I take chantix and wellbutrim at the same time?

Rosa Mojica

3/17/2007 1:42:25 PM #

Betty

I stared taking chantix 12 days ago. I had tryed to quit so many times before that quitting became my hobby but I could never stay quit. This time I will.  The first week on chantix I was allowed to smoke but I cut way back below 50% of what I normally smoked. I just did not have the desire to smoke the way I did before. The Chantix was working but I still did have the desire to smoke and did not think it would help at first . On the 7th day I quit smoking. I have not thought much about cigrettes since except about how happy I am to have quit. I feel like a burdden has been lifted. I think the Chantix is really helping. The cravings I normally had after eating a meal are non existant. The side effects are mild compared to smoking. Smoking will surely kill you in the end.

Betty

3/20/2007 6:12:52 PM #

Colleen Rue

Iam really scared to take Chantix, because of my medication Iam taking. I take Heart , Depression , and I have Diabetes.  Could you help me out????????

Colleen Rue

3/22/2007 2:17:02 PM #

Cynthia

I am a clinical psychologist and I was taking Chantix. Being a psychologist I am aware of the symptoms of depression and after being on Chantix for 6 weeks (1mg twice daily), I have become severly depressed. It directly corresponds to how long I have been on the medication. It is not from nicotine withdrawl because I am still using nicotine gum.

I looked through the information that Pizer gives you and in little tiny letters they say that a common side effect is depression. They need to put this is large letters because I was so depressed that I was having the ocassional suicidal thought. I worry about the people who are taking this and are not aware of depression and what it feels like. If you are prone at all to depression, I would not take this medication. Be careful! It is unfortunate because I really have not felt like smoking but it is not worth feeling this depressed.

Cynthia

3/23/2007 12:05:11 PM #

Mike

I have been nicotine free for one week now.  I have smoked a pack a day for 25 years.  I started with chantix, while it might have helped me cut back in that first week but counting my cigarettes also played a part.  After being smoke free for three days and having endured the worst withdrawal ever I quit taking chantix.  It was no real help but did give me a head ache.  I am still going through withdrawal.  This is my last chance, just say no, one more smoke and I die smoking.  Sayings that help.  What I question is does my Dr. get a kick back on my prescription.  He suggested that I take Chantix for a year.  $120.00 a month adds up.  Especially for a medication that only has benefits while I am actually smoking.

Mike

4/23/2007 7:52:49 AM #

Tommy

Can I take Chantix and Zyban at the same time?

Tommy

4/27/2007 3:47:25 AM #

Peter Borelli

I just sent a note but there was some kind of error. I am sending this to see if it gets through

Peter Borelli

4/29/2007 9:25:16 AM #

Moti

I am also looking for info about taking chantix and zyban/wellbutrin/bupropion (all names for same drug) at the same time.  Haven't found it, but I did get a number to call with my chantix prescription, so I'm going to call them to find out.  It is Sunday, otherwise I'd post the answer.  Here is the Chantix phone #:877 chantix

Moti

5/1/2007 5:32:23 PM #

Megan

I have been taking chantix for a 3 weeks and have been doing great. As I understand there is no drug interactions with chantix but since you have to go to the doctor to get it...ask all those questions. I really like this med. I have never had such and easy time quitting and being able to deal with life at the same time. I plan to keep on this drug for the next 3 to 6 months..the expense so far is worth and will be cheaper in the end if I stay quit!

Megan

5/23/2007 5:33:02 PM #

kim brown

I was wondering is I can take my Wellbutrin along with Chantix??..
with out any side effects .

kim brown

6/26/2007 12:53:03 PM #

Angel Marie

I too am taking the generic for wellbutrin twice a day and started the 1/2 pill chantix today as well.  Can I take them both together?  Walgreens and King Soopers Pharmarcies both said that they do not interact together so I could.  I know this is a new drug so I was curious if this is true?

Angel Marie

6/27/2007 1:25:03 PM #

Mike

Can I take 300mg of Wellbutrin and Chantix at the same time?

Mike

9/4/2007 9:26:26 AM #

Lisa

Can I take wellbutrin and chantix at the same time?

Lisa

9/4/2007 9:26:29 AM #

Lisa

Can I take wellbutrin and chantix at the same time?

Lisa

9/22/2007 1:58:31 PM #

OSVALDO

365847  68 YEARS OLD AND SMOKED FOR 45
TAKING CHANTIX BY TREE MONTHS NOW
NOT SMOKING AT ALL BUT SAME TIME EVENTUALLY TAKING ZOLOFT
BECAUSE HAVING DAILY DEPPRESION AND MY DR. SAID I NEED
TO TAKE 100 MG SERTRALINE DAILY...
I AM VERY SATISFIED BUT DEPRESSION CONTINUES
ALSO I AM TAKING LOTREL 5-10 AND COREG AND METFORMIN...
CAN YOU HELP ME ?
THANKYOU

OSVALDO

10/5/2007 11:59:26 PM #

amy

I have had cancer, (surgery cured it) havent had any treatments, Is it ok to take chantix, if you have had cancer, ovarian cancer, papillary serious carcinoma?

amy

10/16/2007 6:24:27 PM #

Linda

Can you take both wellbutrin and chantix at the same time?

Linda

10/17/2007 6:05:59 PM #

missy

325487 I am taking 150mg of bupropion sr twice a day, can i start taking chantix along with the bupropion? would one effect the other? If so, how?

missy

11/13/2007 12:19:00 PM #

Gail Peterson

I am currently taking wellbutrin and chantix. The wellbutrin is for depression though.  Is it safe to take both of them at the same time.

Gail Peterson

11/13/2007 6:55:58 PM #

lynettee meadows

i was given 1 mg chantix tablets i would like to know if i can break them in half is this a safe way to take this tablet by the way the dr wrote the rx wrong instead of starter pack he gave me the 1 mg box

lynettee meadows

12/13/2007 6:10:58 PM #

peggy strevel

Is it advisable to take Chantix and Wellbutrin at the same time?

peggy strevel

1/1/2008 10:17:20 PM #

wyates

Question: My pharmacy only gave me 1 mg chantix tablets. Can i cut these in half for the days that require 1/2 mg?

wyates

2/29/2008 7:28:46 AM #

jill

I have been on Chantix for two months. I have been doing great. I havent smoked and I feel great. During the first two weeks I became really depressed and crying alot and my doctor put me on Wellbutrin. I started feeling alot better. However within the next month everytime I eat I began to feel nausea, hotflashes, headache to the point of vomiting. I would take the medication with Wellbutrin in the morning have lunch and would feel sick the rest of the day. I got off the chantix today because I lost 8 pounds due to feeling like this. I have been smoke free for two months and dont plan to continue. Wondering why these symptoms occurred in the second month.

jill

10/15/2008 12:27:23 PM #

Amy

Can I take Chantix and wellbutrin at the same time? I have been smoke free since 7-25 with the help of Chantix twice a day. I recently weaned down to once a day but a blues, depressed feeling has set in that scares me. I have Well-butrin and would like to start it but will wait to hear from you to make sure I can take both together. Thanks so much!!

Amy

2/20/2009 9:07:35 PM #

mary

yes is it safe to take chantix,with phentermine?

mary

2/22/2009 7:35:32 PM #

Amanda

I was wondering can I take the generic Wellbutrin and Chantix, and also can you have a drink of alcohol while on these meds? I have a cruise coming up and was wanting to know, thanks!

Amanda

2/24/2009 9:19:04 AM #

Len Lichtenfeld

I cannot provide medical advice on this blog.  You need to address these questions to your health care professional.

There are no published clinical trials that evaluate the effectiveness or harm of using Wellbutrin and Chantix together. Given the fact that these are both drugs that act on the central nervous system, one would be wise to use extreme caution in mixing the two (especially with the recent warnings regarding Chantix) unless part of a very well controlled clinical trial (if such a trial exists).

Len Lichtenfeld

6/1/2009 12:43:24 PM #

Shirley Demmer

Is it possibe to take Wellbutrin and Chantix at same time?

Shirley Demmer

6/1/2009 2:44:31 PM #

Len Lichtenfeld

There is no recommendation to use those two drugs together, and there may be risk.  Don't do anything without talking to your health care clinician.

Len Lichtenfeld

6/24/2009 9:24:21 PM #

Tom Zeppelin

Can I take Wellbutrin once a day along with the new drug Chantix? If so, do you think my chances will be even greater if I am taking both?
Please respond

Tom Zeppelin

12/11/2009 9:53:50 AM #

Mike

I am also taking Chantix and Wellbutrin.  The Chantix has helped with smoking, but so far (about 7 weeks) I haven't noticed the Wellbutrin having any effect on my anxiety.  Could taking the two drugs together minimize the effects of either one of them?

Mike

12/11/2009 6:41:41 PM #

renee

I just filled my scrip for Chantix, I too wonder about the interaction with Prozac. My Dr. seemed fine with it so I guess only time will tell. I have been on Prozac for postpartum depression and also went back to smoking after I had the baby. I really feel it's time to JUST QUIT... So I am praying it works without all of these crazy side effects I am hearing about.

renee

12/16/2009 9:56:23 PM #

Keith ODonnell

I have been smoking since I was 13 years old, I will be 38 in March, I have been smoking for 25 years, a pack a day. I have seen what smoking has done to my Mother who is currently 61 and suffering from her years of smoking, breathing is a chore for her, she is on 24/7 oxygen. I tried to quit 7 years ago with Wellbutrin and it worked until I had a big stress induced relapse and did not look back til now, I am day 6 into my Chantix script, had two episodes of brief dull headache, but I get cluster headaches so these were nothing. Tobacco taste is different, I noticed it a few hours after first dose, food tastes the same, I bet this is a factor in the lessening of cravings, even though smoke can smell nasty, the taste "don't know how" is good to me, now since Chantix, not so much. I am quitting on day 7 at 11:59 pm and on the 8th day I begin the journey of a "former smoker".

Keith ODonnell

2/16/2010 12:07:34 PM #

Dan

I take 300 mg of welbutrin daily to help me cope w/the symptoms of PTSD.  Do I need to stop taking Welbutrin before I begin using Chantix?

Dan

2/21/2010 4:42:40 PM #

Debbie

i am like most above, i am currently taking wellbutrin for anxiety, i have had another relapse with smoking, can i take chantix while taking wellbutrin?

Debbie

1/23/2011 12:27:00 AM #

Celeste

I have not smoked now for 5 days and I have been taking chantix I found that chantix helped me cut back on my smoking I finally stoped smoking after taking chantix for two weeks but thats only because I said enough chantix has not helped me quit at all I have had the worst withdrawls for the last four days today is day 5 and it was not as bad but I cant help but wonder how long I will feel like this. What keeps me from smoking is I say to myself I have already gone this long without a cig why smoke and start all over, this is the hardest thing I have ever had to do in my life. I have been a smoker for 24 years.

Celeste

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

MORE »

 

Recent Comments

Comment RSS