One of our most popular columns is our 'Fact Or Fiction' column, where we investigate certain rumors or misconceptions out there regarding anything pharmacy. In our latest edition, we discuss the whether or not the smoking cessation prescription Chantix is effective.

Fact Or Fiction

FACT OR FICTION: Chantix Is An Ineffective Smoking Cessation Aid

Overview

Chantix (varencline) is a prescription medication used as treatment for smoking cessation. It is often reported that Chantix is no more effective than simply stopping smoking cold turkey or no more effective than nicotine replacement therapies.

Due to the sometimes high cost of Chantix, this information would certainly be of some concern. additionally, Chantix is sometimes associated with severe side effects that could dissuade a patient from taking the medication. This article will hopefully clarify up any unclear information.

How Does Chantix Work?

To start, a common questions asked is how does Chantix differ from regular nicotine replacement therapies such as nicotine gum, patches or lozenges. It's important to know that Chantix is not nicotine and therefore is fundamentally different than nicotine replacement therapies.

It is known as a partial agonist and actually binds to the nicotinic (nicotine) receptors in the body, just as actual nicotine does. When Chantix (or nicotine for that matter) binds to these receptors, a familiar chemical is released, known as dopamine. Dopamine is commonly known as the brain-reward system, or "feel-good" chemical.

This brain reward system is a common pathway for pleasurable activities in most drugs of addiction. This includes nicotine. It is thought that Chantix is effective in reducing smoking cravings for two reasons:

  • Due to the stimulation of nicotinic receptors, Chantix diminishes nicotine cravings and withdrawal symptoms.
  • Since Chantix occupies and therefore blocks the nicotine receptors in the body, it reduces the reward of nicotine in cases where someone relapses and uses tobacco. In other words, the sense of satisfaction associated with smoking is potentially decreased.

If Chantix produces the same effects as nicotine, how is it any different than the nicotine we take in from smoking? After smoking a cigarette, nicotine levels in the blood peak extremely rapidly and in turn decrease very rapidly as well, until the next cigarette.

This quick peak that nicotine produces causes a significant release of dopamine and an intense craving for more once nicotine levels in the body drop. This is what makes you want another cigarette. Nicotine replacement products and Chantix do not typically produce these steep peaks and dips as nicotine does.

Dopamine release with these products tends to be much more steady. For this reason, it is thought that products that deliver nicotine or nicotine stimulation more slowly than smoking have minimal potential for addiction and strong cravings.

Is Chantix Effective?

This brings us to the question of just how effective Chantix is for smoking cessation. The efficacy of Chantix has been demonstrated in numerous and well conducted clinical trails. Not only have studies demonstrated that patients had less cravings for cigarettes, the symptoms of withdrawal were significantly decreased as well.

In addition, Chantix was compared against other common medicinal treatments for smoking cessation. Chantix was shown to be more effective than both buproprion AND nicotine replacement therapy. 

One number that people want to know if bottom line effectiveness. What are the chances that you will stop smoking if you take Chantix? The efficacy of the drug appears to hover around 50%. This number may be where patients get the idea that Chantix isn't very effective.

It certainly is not effective in everyone that tries it, but a 50% success is significantly better than stopping smoking cold turkey or therapy with other products. Not only is Chantix more effective, but multiple studies have shown that Chantix is a decidedly cost-effective treatment compared with alternative smoking cessation products and can provide significant cost savings to patients.

In terms of taking the medication,  the recommended treatment begins one to two weeks before a scheduled quit date. For the first 3 days, you take one 0.5 mg tablet daily and on the 4th day the dose is increased to one 0.5 mg tablet twice daily up to and including the 7th day.

The dose is then again increased on 8th day to one 1 mg tablet twice a day up to the end of 12 weeks. After 12 weeks, the medication can either be discontinued or further treatment for another 12 weeks with 1 mg twice a day can be given to prevent relapse.

For major side effects, Chantix has 2 real concerns. First off, there are new warnings about Chantix and an increased risk of cardiac events in patients with heart disease. Pharmacists can be confident telling patients that the risk of cardiac events is extremely small, especially in patients with no risk factors, and is much less dangerous than continuing to smoke. The FDA reviewed a randomized clinical trial and investigated the possibility of cardiac side effects.

They looked at a study of 700 smokers with cardiovascular disease who were treated with either Chantix or placebo. They found that cardiovascular adverse events were not common overall. However, they did note that certain events such as heart attacks did occur more frequently in patients treated with Chantix than in patients treated with placebo.

In light of this, the FDA recommends that patients taking Chantix contact their doctor if they experience any of these symptoms:

  • New or worsening chest pain
  • New or worsening pain in the legs while moving

In addition to cardiovascular effects, there are reports of vivid dreams and more seriously, psychiatric events. It's tough to tell if these events are due to Chantix or if they're really due to nicotine withdrawal. In any case, any changes in mood or mental functioning could be a side effect of the medication and you should therefore contact your doctor.

Final Words

All in all, based on all the data available, Chantix is a fairly safe medication with a good history of effectiveness.