New study compares Chantix to the nicotine patch

We have already talked about the studies showing that Chantix (varenicline or Champix outside the US) is more effective than both placebo pills and Zyban (bupropion) for smoking cessation. There has also been one study comparing smoking cessation outcomes before and after Chantix was available (by John Stapleton and colleagues in the UK).

Today a new study has been published comparing the effects of a standard course of Chantix (12 weeks) with a normal course of the nicotine patch (10 weeks) for stopping smoking. This was a randomized “open-label” study, meaning that neither the participants nor the researchers were able to choose which participants got which treatment, (they were allocated to treatment on the basis of random numbers), but that everyone new which treatment they got (i.e. there were no placebo or dummy patches or pills).

The study by Aubin and colleagues was carried out across 5 countries (Europe and USA), with 376 smokers being assigned to Chantix and 370 to the patch. All the participants smoked at least 15 cigarettes per day (average = 23 per day). The participants were required to be relatively healthy with no unstable illnesses within the previous 6 months (including psychological problems or substance dependence). None had used nicotine replacement therapy in the previous 6 months. About half (48%) had previously tried the nicotine patch, and almost 90% had previously tried to quit. The average age of participants was 43, and they had smoked for around 26 years. 93% of the participants were white.

Participants attended weekly appointments for the first 12 weeks, then had 7 further appointments up to the one year follow-up, as well as 5 telephone contacts.

3 months after the target quit date, 56% of those treated with Chantix had not used any tobacco during the prior month, as had 42% of those treated with the nicotine patch. This advantage for Chantix treatment was statistically significant. At the one year follow-up (i.e. after about 9 months without treatment medications) 26% of those allocated Chantix treatment remained remained quit, as did 20% of those treated with the patch (also a statistically significant difference). During the first 7 weeks of treatment, those treated with Chantix reported significantly lower craving, negative affect (bad mood) and restlessness.

About twice as many patients treated with Chantix (8%) as the patch (4.3%) had to discontinue the medicine due to an adverse event. The most frequent adverse events were nausea (37% on Chantix versus 10% on the patch), insomnia (around 20% in both groups) and headache (19% Chantix, 10% patch).

There has been some recent concern (discussed on this forum) about Chantix potentially causing depression and suicidal thoughts. In this trial, one person became depressed and it was believed to be caused by Chantix, and another person had suicidal thoughts (causing hospitalization) 11 days after completing Chantix treatment. These low rates of serious depression (<1%) in association with Chantix treatment are consistent with prior reports. It is interesting that ratings of “negative affect” were significantly lower among those taking Chantix than the patch during the first 7 weeks (meaning that Chantix users experienced, on average less bad moods/depressive thoughts than those wearing the patch). So the etiology of depression while taking Chantix remains a mystery. One possibility is that Chantix, because it is slightly more effective than prior medications, enables some people to successfully quit who would not otherwise have succeeded, and some of those people may be more prone to depression in association with quitting smoking.

Overall, the results from this study are consistent with previous studies in showing that Chantix is probably the most effective single medicine for smoking cessation, that it frequently causes mild side effects (e.g. transient nausea) and that serious adverse events are uncommon.

Ref:
Aubin HJ et al. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomized, open-label trial. Thorax published online Feb 8, 2008.

Labels: cessation, Chantix, cigarette smoking, jonathan foulds, Nicotine Replacement, patch, varenicline

Permalink | 4 Comments| Email Post

Post your comment

Getting through the first few weeks

When people quit smoking it is very common for them to experience a temporary increase in certain unpleasant symptoms. The most common nicotine withdrawal symptoms are:
1. Irritability
2. Restlessness
3. Poor concentration
4. Depression
5. Increased appetite
6. Anxiety
7. Insomnia

I discussed these symptoms in previous posts:
What is nicotine withdrawal syndrome? 3/6/07
http://www.healthline.com/blogs/smoking_cessation/2007/03/what-is-nicotine-withdrawal-syndrome.html

Ten tips for coping with nicotine withdrawal. 3/7/07
http://www.healthline.com/blogs/smoking_cessation/2007/03/ten-tips-on-coping-with-tobacco.html

However, I’m bringing this topic up again because I’m noticing a number of people trying to quit smoking by using Chantix who are still experiencing some of the symptoms mentioned above but are concluding that these symptoms are caused by the medicine. Of course with any individual person the best way to figure out the cause of a new or worsening symptom is to discuss the problem in detail with your health professional. But in general, if someone has just quit smoking and they experience one of the symptoms mentioned above, the first explanation to consider is that it is a temporary nicotine withdrawal symptom caused by stopping smoking, rather than a symptom caused by a smoking cessation medicine.

Sometimes similar symptoms can be caused by smoking cessation medicines. For example, insomnia and vivid dreams can also be caused by the 24 hour nicotine patch and by bupropion (Zyban or Welbutrin). Chantix has also been known to cause vivid dreams. Generally, the heavier a smoker the person is, the more likely they will be to experience strong withdrawal symptoms, and the less likely their symptoms are caused by their medication. The opposite is also true. So if a 40-a day smoker experiences insomnia 2 days after quitting smoking while taking the standard dose of a smoking cessation medicine it is more likely to be due to nicotine withdrawal. If a 10 cigarettes per day smoker who never wakes at night to smoke and doesn’t smoke within half an hour of waking in the morning experienced the same insomnia it is might be caused by the medicine. In the case of the patch, they might want to try taking it off a few hours before going to bed, and in the case of Zyban or Chantix they might want to make sure they don’t take the second pill just before going to bed.

My main point here, however, is to caution against blaming the medicine for symptoms that it may actually be helping with, and then stopping using the medicine too soon. Any change in timing or dosage of a medicine should be discussed with your doctor first.

Similarly, it is tempting when a medicine is not giving complete relief of unpleasant symptoms like insomnia, anxiety or cravings to want to try another medicine as well. As always, a decision on what medicines are most likely to help you in any specific situation is best made after a full discussion between you and your doctor. However, when one of the symptoms mentioned above is the problem, and particularly if you were a heavy smoker and have recently quit, then the symptom is likely caused by nicotine withdrawal and will resolve by itself gradually over a couple of weeks. Medicines that have not been approved by the FDA or a similar medicines regulatory authority for smoking cessation will be unlikely to help much.

To tell if you are a “heavy smoker” check out my previous posts on that topic:
How addicted are you to cigarettes? (1) 5/19/07
http://www.healthline.com/blogs/smoking_cessation/2007/05/how-addicted-are-you-to-cigarettes-1.html

How addicted are you? (2) 5/19/07
http://www.healthline.com/blogs/smoking_cessation/2007/05/how-addicted-are-you-2.html

If you are a heavy smoker and are having a rough time quitting I’d strongly encourage you to get as much support as you possibly can. As well as speaking to your own personal health professional, I’d recommend a specialist face-to-face tobacco treatment service if there is one near you (they will have experts in smoking cessation counseling and medicines), as well as use of smoking cessation telephone helplines and internet sites, that were also discussed in previous posts:

Telephone quitlines: do they help smokers to quit? 4/19/07
http://www.healthline.com/blogs/smoking_cessation/2007/04/telephone-quitlines-do-they-help.html

Can smoking cessation internet sites help you to quit? 4/21/07
http://www.healthline.com/blogs/smoking_cessation/2007/04/can-smoking-cessation-internet-sites.html

Key things to remember during the rough times are:
A. Nicotine withdrawal symptoms are worst during the first couple of weeks after you completely quit tobacco and gradually calm down to be almost gone by the 4th week.
B. Each individual episode of craving for a cigarette typically lasts a few seconds, and rarely longer than a couple of minutes. Keeping yourself busy and actively switching your mind onto other things will help get rid of cravings more quickly.
C. Cravings are stimulated by being around tobacco and other people smoking. If you have any in the house, get rid of it. If you are hanging out in a place where people are smoking, hang out somewhere else!

You have probably put in quite alot of effort by the time you found this web-site. Don't throw it away by having a smoke. Keep going. It is tough but you can succeed.

Labels: Chantix, cigarette smoking, nicotine, patch, quitting, side-effects, symptoms, withdrawal, Zyban

Permalink | 3 Comments| Email Post

Post your comment