September Health Tip

Prescription Medications for Smoking Cessation

Prepared by:
John Meyer, Pharm. D. Candidate
Meredith Eames, Pharm. D. Candidate
Preceptor: Nancy Borja, Pharm. D.

Every time you inhale a puff of tobacco from a cigarette, your heart rate and blood pressure temporarily increases, and the blood flowing throughout your body carries less oxygen to your body’s cells.  Consider how many drags of a cigarette are taken each day by a smoker that averages one pack per day containing 20 cigarettes per pack.  The amount of strain put on your body due to the decreased oxygen, increased heart rate, and increased blood pressure can be detrimental?  In addition, smoking also causes your blood to thicken leading to improper circulation of the blood throughout the body as well as narrowing of the blood vessels that carry the blood to your vital organs.  These side effects can lead to peripheral vascular and cerebrovascular disease, and can put a person at a much greater risk of having a heart attack.  Smoking can also increase the risk of lung diseases such as emphysema, pneumonia, chronic bronchitis, COPD, and lung cancer.  Unfortunately, you don’t have to be a smoker to be affected by some of these lung diseases.  Both first and second hand smoke can be harmful to the body and affect the overall health status and well-being of an individual. According to the American Heart Association, 25.1 million men and 20.9 million women are smokers; these individuals are at an increased risk for heart attack, stroke, cancer, and several lung diseases.  In this article we will discuss how to quit, the benefits gained, and what prescription medications are available to help quit the addiction.   

How to Quit:
The initial step on the path to smoking cessation is to realize the harm that tobacco can do to your body and those individuals around you.  Next, you need to be able to recognize your need to quit.  Start by setting an official quit date in order to motivate you to achieve this goal.  Do not be afraid to ask for help, there are many support programs available as well as medication to help break the addiction.   

Benefits of Quitting:
According to the American Cancer Society’s Guide to Quitting Smoking, there are visible and immediate rewards to smoking cessation such as a decrease in wrinkles around the face, stained teeth, gum disease, and an increase in sense of taste and smell.  The significant benefits gained over time, include the following:

• Heart rate and blood pressure drop 20 minutes after quitting
• Carbon monoxide levels in your blood drop to normal 12 hours after quitting; increasing the amount of oxygenated blood to your cells, tissues, and organs.
• Circulation improves and lung function increases 2 weeks to 3 months after quitting
• Coughing and shortness of breath decrease 1 to 9 months after quitting and your lungs ability to clear mucus is also improved, thereby reducing the risk of infection.
• The risk associated with coronary heart disease is reduced to half that of a smoker’s 1 year after quitting.
• The risk associated with stroke is reduced to that of a nonsmoker 5 to 15 years after quitting
• Lung cancer death rate is half that of a smoker 10 years after quitting as well as a decrease risk of developing cancer of the mouth, throat, esophagus, etc…

Prescription Medications to Quit:
Chantix® (varencycline): a new nicotinic receptor agonist currently approved by the FDA for smoking cessation:

• Starter pack (28-day supply) consists of 0.5 and 1 mg tablets used to titrate up to a target dose of 1mg twice daily. 
• Treatment is initiated one week before target quit date.
• A continuation pack (28-day supply) is available for patients who have finished the starter pack.  It contains 1 mg tablets to be taken twice daily for a total dose of 2 mg per day.
• Duration of therapy is 12 weeks, if no relapse occurs it is recommended that patient continues on another 12 weeks of therapy to further long term abstinence.
• Most common side effects include nausea, vomiting, constipation, flatulence, and sleep disturbances.
• Costcomparison: a patient who smokes one pack per day at an average cost of $4per pack spends $840 a month on cigarettes.  Although Chantix is not currently coveredon most prescription plans, the cost on average is $120 a month, and oncesmoking cessation is achieved, you get all the health benefits previously discussed.

Zyban®, Wellbutrin® (bupropion): FDA approved for smoking cessation, as well as other medical conditions:

• Can be used alone or in combination with over-the-counter nicotine transdermal system (nicotine patch) or nicotine lozenge for smoking cessation.
• Begin 1-2 weeks before target quit date, and titrate up to target dose of 150mg twice daily.
• Treatment should last 7-12 weeks to ensure effectiveness and avoidance of relapse.
• If using a nicotine transdermal system, start on the quit day and use with the Wellbutrin as dosed above. This can be used for 8-20 weeks to avoid relapse
• Most Common side effects are:
  • Nausea/vomiting, dry mouth, headache, constipation, increased sweating, joint aches, sore throat, blurred vision, altered taste, or dizziness
• Cost comparison: this medication is available generically and may be covered by insurance.
  • If there is no insurance, than the average monthly cost is 60 dollars

For many smokers, help is needed in order to assist them in the quitting process.  Your health care provider and pharmacist are always there to help you set your goals and to keep you motivated to achieve a healthy lifestyle.

References:

1. American Cancer Society: Guide to Quitting Smoking.  Prevention and early detection.Available at http://www.cancer.org.  Accessed August 1, 2007.
2. American Heart Association website.  Available at http://www.americanheart.org.  Accessed August 1, 2007.
3. Micromedex website.  Available at http://www.micromedex.com.  Accessed August 1, 2007.