Ask the Pharmacist

Q. I have tried to quit smoking several times but I think I need extra help for me to be successful. Can you tell me about some of the drug therapies available?

A. Last week we focused on some of the non-pharmacological measures that may help some people finally be able to quit smoking. Many of these lack much in the way of evidence that they actually work.

The reality is that pharmacological therapy (drug therapy) is usually needed to help you quit the nicotine habit, especially if you were a moderate or heavy tobacco user. Note that it doesn’t have to be an either/ or situation. You may combine the non-drug methods mentioned last week with any of the following medications to further enhance your success.

When it comes to medications, there are two categories; Nicotine therapy (NRT) and non-nicotine therapy. Nicotine therapy helps you control the cravings while attempting to quit by replacing the nicotine you smoke with a product that contains nicotine such as chewing pieces, patches, lozenges and inhalers. Because these do contain nicotine, it is advised that you have already quit smoking, otherwise you will be increasing your nicotine levels and may cause potential harm to your body. The gum, inhaler and lozenges are meant to be used on an as needed basis to help curb the instant craving.

The patches, however, give you a continued supply of nicotine through the skin and after several weeks you gradually reduce the strength of the patch until you ideally no longer need to use them. Don’t be surprised if you still have cravings while the patch is on. In those cases, you may use one of the “as needed” remedies such as the gum, inhaler or lozenge to help you through it. Combining the products as such may help you to be more successful in your quitting endeavour.

Regarding the gum, just be aware that it is not to be chewed like a regular piece of gum. Rather you should chew the gum only once every minute or two and then “park” it on the side of your mouth in between. Chewing on the nicotine gum as you would regular gum would deliver too much nicotine at once.

Many people like the inhalers as it gives them something to put in their hands and they are extremely flexible when it comes to their use. Each cartridge (which is loaded into the inhaler) carries enough nicotine to last 20 minutes but it does not have to be consumed consecutively. Hence if you’re in a situation where the cravings are overwhelming, you can take a couple of short sips (you do not need to inhale it in like a cigarette, it’s closer to what you do when drinking from a straw) of the inhaler to regain control and then place it back in your pocket for the next time you need help.

As for non-nicotine therapy, there are a few products on the market to consider. Bupropion (Zyban) has been used for many decades in smoking cessation. Some of you may be familiar with the name as it is also used as an antidepressant under the brand name Wellbutrin. It is not recommended to use if you are susceptible to seizures, on MAOI therapy or have either anorexia or bulimia nervosa. Some people have side effects such as insomnia, agitation or mood dysfunction while taking bupropion so it is advised to be closely monitored if taking this medication.

Another medication to consider is varenicline (Champix). This has been a good option for people that find it difficult to stop smoking instantly but rather wish to slowly reduce the number of cigarettes used daily. Vivid dreams, sleeplessness, headache, nausea and vomiting are possible side effects seen with varenicline. There are potential cardiovascular and psychiatric concerns seen with this medication which has prompted Health Canada to encourage extra monitoring when it is prescribed.

Nortriptyline has been prescribed with some success for some people. It is officially classified as an antidepressant (which might be of benefit given how difficult quitting can be for some people) and does tend to help people sleep better as well. Clonidine is yet another prescription medication that can be used but it is not indicated for smoking cessation on the label. Clonidine was originally used to lower blood pressure and has also been found to be beneficial in combatting hot flashes and helping some people deal ADHD.

Heavy smokers may find that NRT does not provide enough of a nicotine replacement to help them reduce and quit smoking. Speak to your pharmacist to see if you can increase the dose of your NRT. You may also consider combining NRT and non-nicotine therapy, although this may give you further unwanted side effects such as nausea, headache or dyspepsia. Though further studies are needed, you may need to consider combining both varenicline and bupropion if you were unable to reduce your smoking habit by half after using NRT for 1 week.

If you are serious about kicking the habit and getting on the road for a healthier new you, we congratulate you for making that decision. For more information on this or any other health topic, contact your pharmacist.