This Rx Helped Smokers Ease into Quitting

Varenicline may help smokers quit smoking over time

(RxWiki News) Quitting cold turkey works for some smokers, but others struggle with stopping all at once. It's not easy for most smokers, but there's a medication that might help some ease into quitting.

A new study found that a medication called varenicline (brand name Chantix) could help smokers who want to quit by reducing how much they smoke first. The authors of this study found that smokers who used varenicline were able to reduce their smoking, and more of them quit compared to those using a placebo.

Those who used varenicline were also more likely to still be tobacco-free a year later.

“The U.S. Public Health Service and other guidelines recommend smokers set a quit date in the near future and quit abruptly," the authors of this study wrote.

These researchers noted, however, that the patient might not have a specific goal in mind. If the doctor gives the patient a prescription and recommends cutting back, the patient can then commit to a specific future date.

Dr. Philip McAndrew, a family medicine physician and smoking cessation specialist at Loyola Medicine in Chicago, told dailyRx News that patients can use other methods while taking medication to help them quit smoking.

"I recommend nicotine replacement such as nicotine gum, nicotine patches or nicotine nasal spray on the QuitDate and then after," Dr. McAndrew said.

Jon O. Ebbert, MD, of the Mayo Clinic in Rochester, MN, led a team who assigned more than 1,500 smokers to either 24 weeks of varenicline or a placebo — a sugar pill that had no effect.

Dr. Ebbert and team said they felt that more smokers would quit gradually, especially if offered medication that could assist them.

These researchers asked patients to meet specific targets: reduce smoking by 50 percent at the end of four weeks and by 75 percent at eight weeks. The final goal was to quit smoking entirely by 12 weeks.

By week four, 47.1 percent of the varenicline group had reduced their smoking by half. Only 31.1 percent of the placebo group had been able to do the same.

People who used varenicline were more likely to be able to abstain from smoking than the placebo group after quitting at 12 weeks.

Dr. Ebbert and team noted that patients in the varenicline group were more likely to report nausea, abnormal dreams, insomnia, constipation, vomiting and weight gain than those in the placebo group. Some of these effects, such as constipation and weight gain, can also occur when people quit smoking.

Dr. Ebbert and colleagues noted that their patients received counseling and support during the study, which could also have affected patients’ success in quitting.

“We were not attempting to fit smokers into a specific stage of readiness for behavior change," Dr. Ebbert and team wrote. "Instead, our approach aimed to reduce barriers to engaging in the quitting process by allowing and facilitating smoking reduction in a [pre-quitting] phase. Our sample most closely resembles the 33% of smokers who want to quit sometime between 1 and 6 months in the future. The approach used in this study would be expected to be of interest to 14 million of the 42 million current smokers.”

The US Food and Drug Administration has a black box warning on Chantix. Called "black box" because the warning has a black border, it means there is the potential for serious risk or harm from the medication — even though it might be small.

The Chantix black box warning notes that some people who take Chantix may become seriously depressed or even suicidal. Other possible behavior changes include hostility and agitation. Patients should speak to a doctor about the safety of any new medication.

"Varenicline I consider a second or third line medication for smoking cessation," Dr. McAndrew said. "I have reviewed several articles that reveal that varenicline is a risk both psychologically and from a cardiac risk standpoint for patients.  I would use Varenicline when the patient has tried all other methods."

Dr. McAndrew said that every smoker is different, and each will need different support and treatments.

This study was published Feb. 17 in JAMA.

Pfizer, which manufactures Chantix, funded this research. All of the study authors either received funding from or worked for Pfizer.

Review Date: 
February 16, 2015