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How to Quit Smoking With Varenicline (Chantix).

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A friend recently told me that her mom was about to try to quit smoking by using Chantix. She had heard some scary things about the drug and wanted some simple advice on how to use it effectively and safely, and also on what she could do to help.

Of course the most important thing to do in that situation is to tell your mom you love her and that you are really pleased she is trying to quit smoking. Support and encouragement from a family member can be a great help, particularly when there has been a history of unsuccessful quit attempts and the person may be discouraged by fear of failing again.

The next obvious thing to say is that it is important to follow the advice of the doctor who prescribed the medicine, and to thoroughly read the labeling and instructions for use that come with the medicine. I say this because the fact is that most of us forget the detailed instructions given by our doctor, within five minutes of leaving the appointment. Similarly, many of us don’t read the labeling properly at all (me included). But stopping smoking is a life-saving intervention and these medicines are not without their risks and side effects so it is worth taking the time.
One problem with Chantix is that it causes some side effects, with nausea being the most common (around 30% of users experience some nausea). The medicine should be taken for 7 days prior to the “Quit Date” (day 8 of the medicine), on an increasing dose (0.5mg once per day on days 1-3, the 0.5mg twice per day days 4-7) until starting the full dose (1mg twice per day) on day 8. One important tip is to take the tablet with a large glass of water, after eating. This will tend to reduce the severity of nausea. If the nausea is too much (happens in less than 5% of patients) then it is worth going back to the doctor, who can prescribe a reduced dose of 0.5mg tablets that can be supplied in bottled form at the pharmacy. This dose has much less severe side effects and is almost as effective at reducing cigarette cravings and withdrawal symptoms.
Chantix works via two separate mechanisms. Firstly it stimulates nicotine receptors in the brain in a way that reduces nicotine withdrawal symptoms and cravings. Secondly it blocks those receptors so that the nicotine from a cigarette cannot have its usual satisfying effect. Many patients find that though they continue smoking during the first 7 days of therapy, those cigarettes become less satisfying. Similarly a “lapse” cigarette after day 7 will likely also be less satisfying and less likely to lead to a full blown relapse. Although it is important to aim for complete abstinence from smoking (i.e. not a single puff) from the target quit day, slips needn’t be viewed as a complete disaster or a reason to give up. With Chantix these slips may actually serve to teach the brain that it will no longer get satisfaction from smoking (at least while taking Chantix).

There have been some other widely publicized side effects of Chantix, including some that may not be directly caused by the drug. It is clear, for example that Chantix (like the 24-hour nicotine patch) stimulates vivid dreams, or at least causes more of these to be remembered on wakening. This can be troubling if the dreams are nightmares, although they are frequently not nightmares. There have also been reports of other “neuropsychiatric side effects” in people taking Chantix. These have included agitation, depression and suicidal thoughts. It is not clear that Chantix causes any of these symptoms, but it is recommended that patients be monitored for this kind of adverse reaction while taking Chantix. So family members should keep an eye on the person trying to quit, and check how they are feeling. If there are any signs of very troubling thoughts or behavior, then the doctor should be called without hesitation. Of course some moodiness is absolutely normal on quitting smoking, even while taking Chantix. It is wise to check back with the prescribing doctor within a week of the target quit date to let him/her know about progress and any side-effects.

Although Chantix comes with its own online/telephone support plan (“Get Quit), I think it is wise to obtain as much additional support as possible. Ideally this would involve attending a local specialist smoking cessation service and being assessed by a trained counselor. If such a service is not available locally, it is certainly worth phoning the national telephone “Quitline” at:
1-800 QUITNOW (1-800 -784-8669)

The service provided may vary by state, but usually includes an option for telephone counseling.
In addition, I would recommend getting additional support from some of the excellent quit smoking websites that are available. Two of the best are:
www.quitnet.com and www.becomeanex.org

Sometimes when taking a medicine to quit smoking it is easy to build up expectations that it will be a wondercure, and then be disappointed when the cravings still occur and it gets hard. So the most important thing is to continue to be supportive when the going gets tough. Helping the would-be quitter to keep trying even when it is tough, and even after some failed attempts , is key. Many people have a few slips along the way and may even go back to full-blown smoking for a while, but if they set a new quit date, and keep taking the medicine, they will still stand a good chance of successfully quitting.

Sometimes people stop taking Chantix after a month or so because they feel it has worked and they no longer need it. However, the evidence suggests that taking the full course will likely produce better outcomes, and after 12 weeks on the medicine the doctor can prescribe for another 12 weeks to help prevent relapse. In addition to taking the medicine, making sure no tobacco is left around the house, making sure every success is celebrated and continuing to support the quit attempt beyond the initial few weeks, will all help prevent relapse to smoking.
Sometimes people taking Chantix are pleased that they can cut down their smoking without too much effort. But I think its critical to keep going until you get to zero cigarettes per day, and stay with it. To do that you need to get rid of all the cigarettes and be clear that the aim of the game is quitting, not cutting down. Unfortunately most people find that when they have cut down for a while they increase again when a period of stress comes along.

So the main advice is to keep trying, focusing on not taking a single puff of tobacco, and taking it a day at a time.
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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