The Role of Prescription Medication in Quitting Smoking
Quitting smoking is one of the most important things a person can do for their health, yet it is notoriously difficult due to the addictive nature of nicotine. While some people attempt to quit cold turkey, the success rates are low, with only 3-5% succeeding for more than six months. This is why medical professionals often recommend a combination of counseling and prescription medication to manage cravings and withdrawal symptoms. The two main types of pills doctors prescribe are varenicline and bupropion, which work differently from over-the-counter nicotine replacement therapies (NRTs). These non-nicotine medications affect the brain's chemistry to reduce the urge to smoke and make the experience less rewarding.
Varenicline (Chantix)
Varenicline (brand name Chantix) is an FDA-approved prescription medication specifically designed to help people quit smoking. It works in two ways to combat nicotine dependence:
- Partial Nicotine Receptor Agonist: It partially stimulates the same nicotine receptors in the brain that nicotine from cigarettes would. This stimulation releases a small amount of dopamine, reducing cravings and withdrawal symptoms without the full rewarding effect of smoking.
- Receptor Blocker: It also blocks nicotine from binding to these same receptors. If you smoke while on varenicline, the nicotine cannot fully activate the brain's reward system, making the act of smoking less enjoyable and gratifying.
How to Use Varenicline
Treatment with varenicline typically begins one week before a patient's target quit date. The dosage is gradually increased over the first eight days to help the body adjust. A standard course of treatment is 12 weeks, but for those who successfully quit, an additional 12 weeks may be prescribed to prevent relapse.
Potential Side Effects of Varenicline
- Nausea
- Trouble sleeping or unusual dreams
- Headache
- Constipation or gas
- Changes in taste
- Dizziness or fatigue
It is important to note that a black-box warning regarding serious neuropsychiatric side effects was removed in 2016 after further studies did not find a significant link. However, any unusual mood or behavior changes should be reported to a doctor immediately.
Bupropion SR (Zyban)
Bupropion sustained-release (SR), sold for smoking cessation as Zyban, is another FDA-approved, non-nicotine prescription medication. It was originally developed as an antidepressant (Wellbutrin) but was found to be effective in helping people quit smoking by reducing cravings and withdrawal symptoms. The exact mechanism for smoking cessation is not fully understood, but it is believed to act on neurotransmitters like dopamine and norepinephrine in the brain.
How to Use Bupropion SR
Bupropion SR is usually started one to two weeks before the planned quit date. The typical dosage is one or two 150 mg tablets per day. The tablets should not be crushed, chewed, or split to maintain the sustained-release effect. Like varenicline, a full course of treatment is generally 12 weeks, but may be extended.
Potential Side Effects and Contraindications for Bupropion
- Side Effects:
- Insomnia (taking the last dose early can help)
- Dry mouth
- Headache
- Anxiety or agitation
- Contraindications:
- History of seizures
- Eating disorders (anorexia or bulimia)
- Use of MAO inhibitors in the last 14 days
- Abruptly stopping alcohol or sedatives
Comparing Varenicline and Bupropion
Choosing between varenicline and bupropion depends on individual health factors, medical history, and personal preference. A doctor can help determine the best fit for your situation. Here's a comparative overview:
| Feature | Varenicline (Chantix) | Bupropion SR (Zyban) |
|---|---|---|
| Mechanism | Partial agonist and antagonist at nicotine receptors, reducing withdrawal symptoms and blocking nicotine's rewarding effect. | Antidepressant affecting neurotransmitters (dopamine, norepinephrine) to reduce cravings and withdrawal symptoms. |
| Efficacy | Studies suggest varenicline is generally more effective than bupropion for achieving short-term abstinence, though rates may become similar over time. | Proven efficacy, particularly when combined with counseling. |
| Starting Time | Start one week before quit date. | Start one to two weeks before quit date. |
| Treatment Duration | Standard 12 weeks, may be extended to 24. | Standard 7-12 weeks, may be extended up to 6 months. |
| Common Side Effects | Nausea, vivid dreams, insomnia, headache. | Insomnia, dry mouth, headache, anxiety. |
| Key Contraindications | No absolute contraindications, but caution with certain heart conditions or kidney problems. | History of seizures, eating disorders, or MAO inhibitor use. |
Maximizing Your Success with Prescription Pills
Merely taking a pill is not a guaranteed path to quitting. The most effective strategy combines medication with behavioral support and a strong commitment to your quit plan. Here are some important tips:
- Start Before You Quit: As directed by your doctor, begin taking the medication 1-2 weeks before your designated quit date. This allows the medicine to build up in your system and manage initial cravings.
- Follow the Full Course: Don’t stop taking the medication early, even if you feel you have successfully quit. Using the medication for the recommended duration significantly increases the chances of long-term success.
- Consider Combination Therapy: Some evidence suggests that combining a prescription pill with a nicotine replacement therapy, like a patch, can be more effective than a single method. Consult your doctor to see if this is right for you.
- Seek Behavioral Counseling: Take advantage of support programs, counseling, or quitlines. The combination of medication and counseling is highly effective.
- Address Triggers: Identify the people, places, and situations that trigger your urge to smoke and develop strategies to avoid or manage them.
Conclusion
For those wondering what pills do doctors give you to stop smoking, varenicline and bupropion are the primary FDA-approved options. They both offer powerful support in overcoming nicotine addiction by targeting the brain's reward and withdrawal pathways. While varenicline has shown slightly higher short-term efficacy in some studies, both are effective, particularly when used in conjunction with a comprehensive support program. Ultimately, the decision should be made in close consultation with a healthcare provider to determine the best medication and approach for your individual needs and health history.
- Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a healthcare professional before beginning any smoking cessation treatment.
