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Medications for Smoking Cessation

It has been scientifically established that smoking tobacco increases the smokerís risk for developing potentially fatal diseases such as lung cancer, emphysema, and heart disease. Danger also exists for those who live and work around the smoker Ė in some cases, frequent inhalation of secondhand smoke is an even higher risk than smoking itself!

Many smokers do want to quit and may have made several attempts in the past. In a previous article, Help Yourself Quit Smoking, I gave tips to help you if you would like to quit. These included removing tobacco from the home, joining a support group, and avoiding alcohol. In addition, medications are available to help you during the difficult nicotine withdrawal process. These include nicotine replacement (gum, lozenges, or inhalers), buproprion (Zyban), and varenicline (Chantix in U.S.; Champix in other countries). But medication isnít appropriate for everyone. Here are some considerations to discuss with your doctor.

First, are you pregnant or planning to get pregnant? Smoking has been associated with increase in low birth weight, cleft lip and palate, congenital heart defects, SIDS, impaired speech processing, and other negative events for the fetus, as well as ectopic pregnancy and complications such as separation of the placenta. Nicotine replacement therapy is even more dangerous than smoking with regard to certain congenital malformations, and it is labeled class D (positive fetal risk) by the FDA. However, the overall benefit of quitting smoking may outweigh the risk of the medication. An alternative is the drug Zyban (also known as Wellbutrin). It cannot be considered completely safe in pregnancy, but a decade of clinical use and scientific studies has shown no association of Zyban use with fetal abnormalities. The newest medication, Chantix, is labeled class C, indicating that risks to the fetus have been shown in animals but no studies have been done in humans.

Second, do you have a history of psychiatric problems, particularly major depression? Both Chantix and Zyban can increase feelings of depression, aggression, and suicidal thoughts. Withdrawal from nicotine is unpleasant in itself; a person with a history of depression may be at risk. If you and your doctor choose one of these medications to help you quit, make sure you have adequate social support. Report increases in depression or aggression, and any suicidal thoughts, to your doctor immediately.

Third, are you over 65 (more likely to have decreased kidney function) or do you have moderate to severe kidney disease? These conditions make any medication problematic since the drug can accumulate in your body instead of being cleared by the kidneys. If this happens toxicity will result. If you and your doctor determine that you require medication to help you stop smoking, the dosage may be reduced to prevent toxicity. Make sure you are aware of the drugís possible side effects, and report them to your doctor if they appear.

Smoking cessation is a significant benefit to your health and the health of those around you. Medications can make the process less difficult by reducing withdrawal symptoms. If you are considering one of these medications, discuss it with your doctor (even for an over-the-counter gum or lozenge) and make sure you give your doctor a complete medical history so that he or she can help you make the best decision. Good luck!

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