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Quitting smoking

Medication to help you quit smoking

Some people quit smoking with the help of medicine. Quit smoking medicines can reduce your nicotine withdrawal symptoms, reduce your urge to smoke, and boost your chances of quitting. Many studies have shown that quit smoking medicines can double or triple a person's chances of quitting. 1

Quit smoking medicines can help you quit, but they arenít magic. They are meant to be used in combination with behavioural quit smoking methods, like group and counselling.

If youíre thinking about quitting, or youíve tried quitting and would like some help, you may want to talk to your doctor about quit smoking medicines.

Talk with your doctor to find out which quit smoking method(s) and medicine(s) are right for you

Each smoker is different. Itís important to choose quit smoking methods that are right for you. Your doctor can help you do make this choice. Your doctor can:

  • Ask how much you smoke, how long youíve been smoking, and what triggers your smoking.
  • Ask if youíve tried to quit before, and how you found it: How hard was it? What was the hardest part? What triggered you to start smoking again?
  • Look at your overall health, your medical history, the health conditions and diseases you may have, and what other medicines you may be taking.

Once your doctor has all this information, s/he can figure out which combination of quit smoking methods and medicine are most likely to help you. Your doctor can review some options with you. Then you can choose the options that best meet your needs. Youíre more likely to stick with quit methods that you think will work.

Quit smoking medicines approved by Health Canada

Nicotine replacement therapy (NRT)

Some brand names of nicotine replacement therapy (NRT) : Nicoderm and Habitrol patches; Nicorette gum, lozenge and inhaler; Thrive gum and lozenge, and store brands (generics)

How does it come?
Nicotine replacement therapy (NRT) comes in four forms: the patch, gum, an inhaler, and lozenges. It comes in different strengths (dosages), and several brand names.

Do I need a prescription?
No. You can buy nicotine replacement therapy (NRT) over the counter at drugstores.

How does it work?
NRT helps you quit by easing your nicotine withdrawal symptoms. It can reduce symptoms like anger, anxiety, cravings, difficulty concentrating, hunger, impatience and restlessness.2

NRT works by giving you some of the nicotine you used to get from cigarettes. It helps you control how much nicotine you are taking. With NRT, you can slowly lower your dose of nicotine as your body adjusts to being smoke-free.

NRT patches slowly send nicotine into your bloodstream. Instead of getting hits of nicotine from smoking, your body gets a steady supply of nicotine from the patch.

NRT gum, inhalers and lozenges give you a more immediate hit of nicotine. People take these kinds of NRT as needed through the day, when they have a very strong craving for a cigarette.

How do I use it?
Before using NRT, you talk to a doctor or pharmacist. Tell them about your health conditions, all the other medicines you are taking, and how much you usually smoke. They will ask if you are pregnant or breastfeeding. Based on this information, the doctor or pharmacist can say if NRT is right for you. If it is, they can help you chose the right dose and explain how to take it.

Ask the pharmacist how to use NRT Ė there are different directions for the patch, gum, the inhaler and lozenges. Follow the directions carefully.

It's important to choose your dose of nicotine replacement therapy based on the number of cigarettes you usually smoke. For exmaple, a person who usually smokes two packs a day should take a higher dose of NRT than a person who smokes just half a pack a day.

There are two ways to use nicotine replacement therapy:

1) The abrupt quit method: You completely quit smoking, then start using NRT to cope with nicotine withdrawal symptoms.

2) The ďcut down to quit" (gradual reduction) method: Doctors recommend this method for people who canít or donít want to quit abruptly (all of a sudden). If your doctor recommends this method, you will set a schedule to slowly cut down the number of cigarettes you smoke over the next few weeks or months. To help with cravings, you replace some of your usual cigarettes with NRT gum. As time goes on, you cut out more and more cigarettes, until youíve stopped smoking completely. You continue to take NRT gum as needed for up to three months after youíve quit, to control withdrawal symptoms.

What do I need to know if I take this medicine?
Nicotine replacement therapy is safe and can be used by most smokers. But some people should not use the nicotine replacement therapy. For complete information on who should not use NRT, talk to your doctor or pharmacist.

If youíre using the patch and you notice irregular heartbeat, chest pain, palpitations, leg pain, or severe stomach upset (indigestion, heartburn), remove the patch and see your doctor. If you notice other unwanted side effects, see your doctor or pharmacist.

NRT patches, gum, inhaler cartridges and lozenges contain enough medicine to hurt or kill children and pets. Keep NRT away from kids and pets. When you throw used patches in the garbage, be sure that kids and pets canít reach them.

If youíve taken NRT for the maximum time written on the pack, but you still having cravings and you think youíre at risk of smoking again, talk to your doctor or pharmacist.

Bupropion SR Ė brand names Zyban and Wellbutrin SR

How does it come?
It comes as pills.

Do I need a prescription?
Yes. You need to talk to a doctor about using this medicine.

How does it work?
Bupropion (Zyban) is an anti-depressant medicine. It works on the chemicals in your brain. It can help control nicotine cravings. It does not contain nicotine.

How do I use it?
You start taking bupropion about a week before you stop smoking. Most people take the pills for several weeks.

Some people who take bupropion also take nicotine replacement therapy. Ask your doctor about this option, if you are interested.

What do I need to know if I take this medicine?

  • Take this medicine exactly as directed.
  • Go to all follow-up appointments with your doctor. Tell your doctor about any side effects. The doctor may need to adjust your dose.
  • Watch for rare side effects- changes in your mood and seizures:

Mood changes: In 2004, Health Canada issued an advisory about bupropion (Zyban) and similar anti-depressant medications.

Health Canada said ďa small number of patients taking drugs of this type may feel worse instead of better, particularly within the first few weeks of treatment or when doses are adjusted. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others." If you are taking this medicine and you feel worse or have unusual thoughts, see your doctor right away.

Seizures: Taking Zyban may trigger seizures, especially in people who are at a higher risk for seizures (because of their medical conditions or other medicines they're taking). Your doctor will consider your seizure risk before prescribing Zyban.

If you have a seizure while taking this medicine:

  • Call your doctor or go to the emergency department right away,
  • Stop taking Zyban, and
  • Do not take Zyban (or other medicines that contain bupropion, inlcuding Wellbutrin) again.

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Varenicline tartrate Ė brand name Champix

How does it come?
It comes as pills.

Do I need a prescription?
Yes. You need to talk to a doctor about using this medicine.

How does it work?
Varenicline tartrate works in the part of your brain thatís addicted to nicotine. It makes smoking feel less enjoyable. This makes it easier to quit. It does not contain nicotine.

You take the pill as your doctor directed, increasing the dose during the first 2 weeks. You quit smoking between the 8 and 14 th day of treatment.

People usually take the pills for 12 weeks. If after 12 weeks youíve quit smoking and want help to stay quit, your doctor may prescribe varenicline for another 12 weeks.

What do I need to know if I take this medicine?

  • Take this medicine exactly as directed.
  • Go to all follow-up appointments with your doctor. Tell your doctor about any side effects. The doctor may need to adjust your dose.
  • Some people who were taking varencicline (Champix) report rare hypersensitive (allergic) reactions including swelling and serious skin reactions. If you notice any allergic reactions stop taking the medication and see your health care provider.
  • Watch out for unusual, serious changes in your mood:

Some people who were taking varencicline (Champix) reported serious symptoms: unusual feelings of agitation, depressed mood, feeling hostile, changes in their behaviour, impulsive or disturbing thoughts, or thinking about hurting themselves or others.

Health Canada issued an advisory about varenicline tartrate (Champix) in January 2009 and safety information about varenicline tartrate (Champix) in June 2008. Health Canada recommends that:

  • Before taking Champix, tell your doctor if youíve ever had depression or other mental health problems. Your symptoms could get worse while taking this medicine.

When youíre taking Champix:

  • If you or your friends notice you have unusual thoughts, feelings or behaviours, especially if youíre feeling depressed, aggressive, or like you want to hurt yourself, stop taking the medicine right away. See your doctor.
  • Donít drive a car or operate hazardous machinery until you know that Champix won't affect your ability to drive properly.

Information update: ďHealth Canada reviewing stop-smoking drug Champix (varenicline tartrate) and potential risk of heart problems in patients with heart diseaseĒ

How to get the most from your quit smoking medication
  • Follow the directions carefully. When you follow the directions, youíre more likely to quit successfully.
  • Go to follow-up appointments with your doctor. Itís important for your doctor to see how youíre doing, monitor side effects, and adjust your dose if necessary.
  • If you have any questions or concerns, talk to your doctor.
Where to get complete information on quit smoking medications

This page gives general information on the quit smoking medicines. It does not tell you everything you need to know about each medicine. For complete information about medicines, their risks and benefits, and whether they are right for you, see your doctor.

Your doctor may recommend a different dose or a different way of taking quit smoking medicines. Follow your doctorís advice.

How to pay for quit smoking medications

Many people get quit smoking medicines free as part of their health insurance plans or through their provincial health plan. If you have extra health insurance (through work, for example) call your insurance company to see what your plan covers. To find out if your provincial or territorial health plan will pay for quit smoking medicines, call a quit line in your area or ask your pharmacist.

If you are pregnant, if your become pregnant, or if youíre breastfeeding

If you are pregnant, breastfeeding, or if you become pregnant, itís very important to quit smoking. You also have to think of you babyís safety. Talk with your doctor before you take any quit smoking medication. Ask your doctor about ways to quit. Your doctor will think about your health and the safety of your baby, and recommend the safest ways for you to quit. Generally, doctors recommend that pregnant smokers try to quit using counselling and group support. If pregnant smokers are still not able to quit, doctors suggest that they take nicotine replacement therapy to quit.3.

If you donít smoke much, if youíre a teen, or if you use smokeless tobacco

Medical evidence shows that quit smoking medicines can increase peopleís chance of quitting smoking successfully. This is true for most kinds of tobacco users, but there are some exceptions. There is not enough evidence to say quit smoking medicines work for:

  • people who smoke fewer than 10 cigarettes a day
  • teens (people 18 and under)
  • people who use smokeless tobacco (chew tobacco, snuff, etc.).4

If you smoke less than 10 cigarettes a day, or youíre a teen, or you use smokeless tobacco, ask your doctor to recommend good ways to quit.

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1. Fiore M et al. Treating Tobacco Use and Dependence: 2008 Update. Chapter 6: Evidence and recommendations.U.S. Department of Health and Human Services. See Table 6.26. Meta-analysis (2008): Effectiveness and abstinence rates for various medications and medication combinations compared to placebo at 6-months postquit (n = 83 studies).

2.ibid. (as above)

3. Greaves, L., Cormier, R., Devries, K., Bottorff, J., Johnson, J., Kirkland, S. & Aboussafy, D. (2003) A Best Practices Review of Smoking Cessation Interventions for Pregnant and Postpartum Girls and Women. Vancouver: British Columbia Centre of Excellence for Womenís Health.

4.Fiore M et al. Treating Tobacco Use and Dependence: 2008 Update. Chapter 7: Specific Populations and Other Topics. U.S. Department of Health and Human Services.