Find out how to quit smoking with the most effective drug

Tobacco smoking is considered the major changeable factor causing death internationally. Tobacco smoking is the major cause of non-infectious diseases along with arterial hypertension, high cholesterol, alcoholism, insufficient physical activity, and unhealthy eating habits.

It is estimated that smoking contributes to 17% of deaths and 13% of disability all over the world. Although the harm of tobacco smoking is known to everyone, in the developing countries, around 60% of men and 20% of women which makes around 30% of the total population.

Fortunately, we can see a positive tendency in tobacco smoking cessation in the example of the developed countries. For instance, in the 1960s, 44% of adult population of the USA was tobacco smokers but now this number has dropped to 20%. Then the number of smokers was thrice as much as people who quitted smoking but now the number of those who quitted is higher than of actual smokers.
The majority of smokers wants to quit smoking and tried doing it several times.

Why is tobacco smoking harmful and dangerous?

Addiction to nicotine is a chronic addiction/dependence that is quite alike to other addictions, i.e. drug addiction, alcoholism, which require medicinal help for the achievement and maintenance of persistent smoking cessation.

Nicotine contained in tobacco causes potent addiction to smoking. In just several weeks of daily smoking, smoking cessation is accompanied by strong withdrawal syndrome. Worth noting that addiction-development potential of nicotine is equated with heroin and cocaine, smoking cessation is associated with withdrawal symptoms, including mood changes, anger, irritability, depression, impaired concentration.

Nicotine activates nicotinic acetylcholine receptors in the central nervous system, dopaminergic pathways in the mesolimbic system of the brain and thus contributes to the development of craving and dependence. Chronic smokers when quitting smoking show the lower production of dopamine, a “pleasure hormone”, which release when smoking results in pleasure from smoking.

Tobacco smoke contains more than 4000 chemical substances 40 of which are especially dangerous as they are proven carcinogens, i.e. cause cancer. It also contains poisons that influence the cardiovascular and nervous systems such as nicotine, benzopyrene, cyanide, arsenic, formaldehyde, carbon dioxide, carbon monoxide, etc.

Nicotine causes blood vessels spasm and as a result oxygen deficiency in the tissues. Over time, it leads to hypertension, coronary heart disease, stroke, heart attack, and other severe and life-threatening diseases.

Three major diseases associated with tobacco smoking are lung cancer, chronic bronchitis, and coronary heart disease. Worth noting that chemicals that accumulate in the smokers’ bodies can promote the development not only of the lung cancer but also breast, prostate, stomach, and other types of cancers. Around 25% of smokers die 10, 20, or 30 years earlier than they would if they quitted smoking or never smoked.

Tobacco smokers are 13 times more likely to develop angina, 12 times more likely to develop myocardial infarction (heart attack), 10 times more likely to develop stomach ulcer, and 30 times more likely to have lung cancer.

For women, tobacco smoking has the effect also on the reproductive function. German study implying the follow up of 6,000 patients concluded that infertility happens on average in 4% of women while in smokers this number grows to 42%. Although it is a reversible fertility that can be treated with the use of hormones, and, of course, tobacco smoking cessation.

How to quit smoking and maintain the result?

It is proven by multiple research that quitting tobacco smoking is better done with the use of medications with proven efficacy. Not only they help to make the first step for smoking cessation but also help to keep the dangerous addiction away if used correctly. There is a number of tobacco smoking cessation aids with proven efficacy. It is optimal to choose the most effective drug based on the scientific data. However, if a patient has any contraindications for the drug use or develops unbearable or dangerous side effects, then the second-effective drug can be used, and so on.

If you plan to quit smoking with a help of a doctor, be ready that he or she may offer you a combined therapy monotherapy is not effective enough and at the same time, it has been proven that the combination proposed for administration is more effective than monotherapy.

A summary assessment of the effect of pharmacotherapy on smoking cessation:

Tobacco smoking cessation effect rate was considered according to the strictest criteria – efficacy, help in maintaining the result in fight with an addiction. CI - confidence interval.

The data of the meta-analysis comparing the effectiveness of two non-nicotinic smoking cessation aids Varenicline (Chantix) and Bupropion show a substantial and significantly greater efficiency of Varenicline (Chantix). Varenicline users were more than 2 times more likely to quit smoking than Bupropion users.

Varenicline is a nicotinic acetylcholine receptor agonist with high affinity and selectivity for nicotinic receptors. The degree of receptor activation by Varenicline is lower than by nicotine - 40-60%. Which means that less dopamine is released than in response to nicotine. This provides the smoker with a feeling of comfort without withdrawal symptoms in the absence of nicotine, while not leading to the development of dependence on the drug. Having a greater affinity for receptors in comparison with nicotine, Varenicline blocks its ability to bind to receptors, thus exhibiting antagonist properties. When smoking while taking Varenicline, the level of dopamine does not additionally increase, which does not lead to pleasure, and the need to smoke decreases.

Varenicline is administered orally in tablets of 0.5-2.0 mg/day. The duration of the course of treatment is usually 12 weeks. Taking the drug is started 1 week before the expected date of quitting smoking - the patient takes the drug and continues to smoke, and after a week tries to stop smoking. If they fail, a second attempt occurs after 1 week, etc. Most patients manage to stop smoking in the first 2 weeks of treatment. If this fails by week 12, an additional 12 weeks of treatment increases the likelihood of a successful outcome, including the long-term effectiveness of smoking cessation.

Drugs not recommended for the treatment of nicotine addiction due to the lack of evidence of their effectiveness for these purposes are serotonin reuptake inhibitors (sertalin, fluoxetine), anxiolytics (buspirone, diazepam), anaprilin, opioid receptor antagonists (naltrexone), silver acetate, mecamylamine.

Post by: Rachel Lewis, Senior Medical Advisor at Medibank, Sydney, New South Wales, Australia