Q: Is there a prescription medication to help me stop smoking? My doctor says no.
A:I hope you misunderstood your doctor, because there are prescription medications that can help you stop smoking. But none is guaranteed to work, and the medications are most effective when taken as part of a broader program, such as a support group.
The first medicine is nicotine. It’s the nicotine in tobacco smoke that hooks a smoker; other components of tobacco smoke increase the risk of cancer, heart disease and other illnesses. Giving nicotine as a medicine helps with the withdrawal symptoms that make quitting so hard — anxiety, irritability, insomnia, difficulty concentrating, weight gain and depression. It comes in many forms: gums, lozenges, skin patches, nasal sprays, inhalers. Some don’t require a prescription. Often people start on a high dose that is gradually decreased to help wean the body slowly off its nicotine addiction.
Bupropion could also help you quit. It’s an antidepressant medication that may also affect the brain chemistry that causes addiction. Side effects include difficulty concentrating and sleeping, tremor and abdominal symptoms.
The new kid on the block is a medicine called varenicline (Chantix). Early studies suggest that it may be a little more effective than bupropion. People are supposed to take varenicline for a week before they stop smoking and then for an additional 23 weeks, if they have managed to quit. Side effects can be a problem. Doctors are supposed to closely monitor people taking varenicline for agitation, depression and suicidal thinking and behavior.
None of these medications is effective for everyone, but you could be one of the many people whom they help. Quitting is possible. In the United States, ex-smokers now outnumber smokers.
Dr. Anthony L. Komaroff, Editor in Chief, Harvard Health Letter
