Tuesday, June 18, 2013

Chantix as Tobacco-Free Assistant: Magic Cure or Curse?

I am a 53 year old woman who started smoking when I was 9, by 13 I was up to 2 packs a day, I smoked 2 packs a day for 40 yrs. Every woman in my family died from emphysema. My mother was 59, my Aunt 69, my Grandmother ? I have been wanting to quit for over 20 yrs. I've tried hypnosis, smoking camps, Smoker's Anonymous, pills, patches, anything. Nothing worked. A friend told me she had gotten Chantix and it gave her weird dreams so she stopped taking it. I said I like weird dreams, can I have what's left over. (I know this is not the right the way to get it) she gave it to me, with instructions. On the 6th day I woke up (you can smoke for the 1st 7 days) and didn't even think about a cigarette, NO CRAVING WHATSOEVER! (From Message Board, 05-22-13)

There are many smokers who would be happy to quit, but they are unable to do so using exclusively willpower. That is why, having an efficient assistance is critical for them. Today, we are going to review Chantix, Varenicline tartrate, a smoking cessation medication that was developed by Pfizer, Inc. In May of 2006, Chantix was approved for use by the Food and Drug Administration (FDA), so it is perfectly legitimate product, covered by many medical insurance plans.

How it Works?

It is a common knowledge that Nicotine is highly addictive. It provides consumers with an almost immediate "kick" of euphoria that is the result rapidly changing brain chemistry beginning within 7 seconds of the first puff on a cigarette. Nicotine attaches to nicotinic receptors which affect functions such as breathing and heart rate. That process in turn triggers the release of dopamine, the neurotransmitter thought to be responsible for reinforcing the pleasure/reward associations people have with smoking.

Chantix works by partially activating a specific type of nicotinic receptor called alpha4beta2 nicotinic receptors. The effect of this on the user is similar to a low to medium dose of nicotine. In this way, Chantix helps to relieve symptoms of nicotine withdrawal that people experience when they quit smoking.

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Nicotine activates the same reward system as do other drugs of abuse such as cocaine or amphetamine, although to a lesser degree. Research has shown that nicotine increases the level of the neurotransmitter dopamine, a chemical in the brain responsible for feelings of pleasure and well-being. The acute effects of nicotine wear off within minutes, so people continue dosing themselves frequently throughout the day to maintain the pleasurable effects of nicotine and to prevent withdrawal symptoms. Once in place, Chantix blocks nicotine from activating alpha4beta2 nicotinic receptors, which in turn prevents dopamine stimulation in the brain. This gives the person quitting a critical advantage. Should he/she decide to smoke while using this drug, there is no nicotine "feel good" rush, and the smoking experience is flat; dull. Smoking then becomes unfulfilling, and quitting hopefully, easier to accomplish.

I found out I have emphasema during a pre-op exam this summer which required I see a pulmonary specialist (no cancer, thank God!). She recommended Chantix. My husband and I both smoked over 40 years (him 3 pks a day, me 1). After only 1 month of treatment, we are both cigarette free and have been for 4 months. There are occasional cravings, but easy to overcome. I have had no side effects. Considering the stress of having a spinal fusion, having to buy a new house, and finding out my 11 year old Doberman named Sugar has diabetes all during the same time frame, I consider this remarkable. I am 60 years old and cigarette free for the first time since I was 15. I don't know what I would have done without this drug. My husband and I tried everything from cold turkey to hypnosis, and nothing else worked (From Message Board, 10-17-12).

Is Chantix Effective?

Six clinical trials involving 3659 chronic cigarette smokers were used as a basis for the effectiveness of Chantix as a therapy for smoking cessation.

Five of the trials were randomized, placebo-controlled studies, and showed that Chantix was more effective than a placebo to help people quit smoking. In two of the five trials, people using Chantix therapy (22 percent) were more successful at quitting smoking than those using Zyban (bupropion hydrochloride) (16 percent) as a quit smoking aid. For those taking a placebo, abstinence at the one year mark was approximately 8 percent.

Me and my husband both have been smokers for over 30 years and smoked 1 to 2 packs a day. We decided to do this together and it works. After just a few days we were down to just half a pack a day. Now we have quit totally and so glad. Yes there are side effects like feeling like we have the stomach flu and some moodiness but that we can deal with. I would rather have some side effects than keep smoking. This is the ONLY THING THAT WORKS!!!!!!!! I recommend it highly to anyone and everyone. My grandson told us now you get to see me grow up. It brought tears to our eyes. Our doctor gave us medication for the nausea which helps but there is no way I would give up on this medication. I am also bipolar and have anxiety and major depression and doing fine even with all my other medications. I hope others will give it a chance. Just work with your doctor. Adjustments can be made to your meds. Its better to quit smoking than to stop this medication if at all possible (From Message Board, 12-31-12).

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Considering Chantix

Chantix is not OTC (over-the-counter) medication, and should be prescribed by medical professional. Tell your doctor about all your medical conditions, including if you:
  • Have ever had depression or other mental health problems, as these symptoms may worsen while taking Chantix.
  • Experienced nicotine withdrawal symptoms with prior quit attempts, with or without CHANTIX. Quitting smoking, with or without Chantix, can result in nicotine withdrawal symptoms (such as depressed mood, agitation) or a worsening of existing mental health problems, such as depression.
  • Have kidney problems or get kidney dialysis. Your doctor may prescribe a lower dose of Chantix for you.
  • Have a history of heart or blood vessel problems before starting Chantix. If you have new or worse heart or blood vessel symptoms during treatment, tell your doctor. Get emergency medical help right away if you have any symptoms of a heart attack or stroke.
  • Are pregnant or plan to become pregnant. Chantix has not been studied in pregnant women. It is not known if Chantix will harm your unborn baby. It is best to stop smoking before you get pregnant.
  • Are breastfeeding. Although it was not studied, Chantix may pass into breast milk. You and your doctor should discuss alternative ways to feed your baby if you take CHANTIX.

Tell your doctor about all your other medicines, including prescription and nonprescription medicines, vitamins, and herbal supplements. Especially, tell your doctor if you take:
  • Insulin
  • Asthma medicines
  • Blood thinners

Week one on the starter pack. Was still smoking, no urge to quit, no side effects. Start week 2 (2 mg a day). I go to bed at 11-12 every night. Started waking up at 3 am on the dot every morning. Extremely vicious nightmares. I am all for vivid dreams but I have never in my life experienced anything like these. I love my wife deeply and in one dream she cheated on me, I woke up and found myself actually angry at her like it really happened...these are nightmares that haunt you the next day. By day 12, I started hallucinating, seeing patterns on the wall, in text, etc. It DOES eliminate the pleasure of smoking..thus the ease of quitting, and depression set in. Use with caution (From Message Board, 02-13-13).

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Taking Chantix

You'll start Chantix therapy a week before you quit smoking. Following your doctor's specific instructions, you'll begin with a small dose of Chantix once a day, gradually increasing dosage until you're taking 1 mg tablets twice daily.

So, in order to minimize the chance of side effects, it is recommended to start with a baby dose and increase to full strength therapy gradually. For the first three days, you take a 0.5mg pill of Chantix daily (one white pill once per day). On day four through day seven, you take a 0.5mg Chantix tablet twice per day (one white pill in the morning and one white pill 12 hours later). On day eight until you complete your treatment with Chantx you take 1 mg twice per day (one blue pill in the morning and one blue pill 12 hours later).

Always take Chantix with a full glass of water on a full stomach. The standard recommended length of treatment is 12 weeks. Some people take Chantix for twenty four weeks.

Adverse Effects

As you may understand, the list of the disclaimers in the considering Chantix section leads to conclusion that its consumption should be considered seriously and discussed with your doctor due to the noted side effects.

The most common side effect for people taking Chantix is nausea. Other less common side effects include headache, difficulty sleeping, and abnormal dreams. Rare side effects reported by people taking Chantix compared to placebo include change in taste, vomiting, abdominal pain, flatulence, and constipation.

One of the worst experiences of my life. After 2 weeks on Chantix I was sleeping 18 hrs a day, slurred speech, chest pain, confusion, irrational thinking, unsteady gait, disorientation, extremely emotional, major depression, I became suicidal to the point of being hospitalized for 3 days in the phyc. ward. Horrifying experience to be admitted, strip searched, not completely understanding what has happened. How do I live with the memory of my children seeing me there and in that condition? Completely out of control.  Embarrassed and ashamed and scared. Difficult symptoms continued for 2 weeks after stopping the medication, anxiety, slurred speech, dizzy, afraid to leave the house for fear of becoming like that away from home where I could not get help. I know this works very well for some people w/ little or no side effects, but please, if you decide to use this product, ask your family/friends to watch you carefully, and help you to contact your dr. if they feel your behavior has changed enough to worry them. You may not always be thinking clearly enough to seek help youself. I paid dearly, much much more than my $30 copay, to quit smoking for 10 days.... Be careful (From Message Board, 11-28-12).

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Depression and Suicide

In November 2007, the FDA announced it had received post-marketing reports that patients using Chantix for smoking cessation had experienced several serious side-effects, including suicidal ideation and occasional suicidal behavior, erratic behavior, and drowsiness. On February 1, 2008 the FDA issued an alert to further clarify its findings, noting that "it appears increasingly likely that there is an association between Chantix and serious neuropsychiatric symptoms." It is unknown whether the psychiatric symptoms are related to the drug or to nicotine withdrawal symptoms, although not all patients had stopped smoking. The FDA also recommended that health care professionals and patients watch for behavioral and mood changes. In May 2008, Pfizer updated the safety information associated with Chantix, noting that "some patients have reported changes in behavior, agitation, depressed mood, suicidal thoughts or actions."

Starting from July 1, 2009, the US Food and Drug Administration requires Chantix to carry a black box warning, the agency's strongest safety warning, due to public reports of side effects including depression, suicidal thoughts, and suicidal actions.

In 2011, it became to the general public that numerous reports of suicides and violent reactions tied to Chantix were left out of a crucial government safety review. The reports were missing because the drug’s manufacturer Pfizer Inc. submitted years of data through 'improper channels', according to the Food and Drug Administration. Cases of 150 suicides, more than doubling those previously known, were among 589 delayed reports of severe issues uncovered in new analysis by the Institute for Safe Medication Practices (ISMP).

Thomas Moore, who has served as an expert witness in court cases related to Chantix, said it is the riskiest drug among those analyzed from the FDA's adverse event reports. In the third quarter of 2010, it ranked first in reported deaths, with twice as many fatalities logged as any other drug, he said.

Here are just few cases of unexplained violent behavior, which may (or may not) be attributed to Chantex, presented by Moore:
  •  A 24-year-old woman who started beating her boyfriend in bed because 'he looked so peaceful' and later attempted suicide.
  • A 42-year-old man who punched a stranger at a bowling alley.
  • A 47-year-old woman who died after she came out of a room, yelled at her daughters and then shot herself.

"We found that Chantix is associated with more suicidal behavior reports than any other smoking-cessation drug on the U.S. market. The risks simply outweigh the benefits," – the echoing opinion of Dr. Curt Furberg, professor of Public Health Sciences at Wake Forest Baptist Medical Center. His study relies on adverse events from the FDA's Adverse Event Reporting System from 1998 through September 2010. He analyzed 3,249 reports of serious self-injury or depression linked to Chantix and Zyban. He found that 2,925 cases, or 90 percent, of suicidal behavior or depression reported to the FDA were related to Chantix, even though the drug was only approved for four of the nearly 13 years of data included in the study. By comparison, there were 229 cases of suicidal behavior or depression related to bupropion and 95 cases related to nicotine replacement products.

Prior studies by Furberg and colleagues have shown Chantix increases the risk of heart problems, unprovoked aggression, and sudden blackouts.

"There were reports of people driving cars and blacking out," said Furberg. He and fellow researchers were so concerned about this side effect that they took their findings to the Federal Aviation Administration, which banned pilots from using Chantix in 2008.

In spite on the new data, FDA officials said the new reports did not change the agency’s position on the risks and benefits of the controversial drug, which received a black box warning that included suicide — the strongest caution possible — in 2009.

Please use extreme caution while taking this medication! After a pack a day for 10 years, I figured I’d try this drug since patches/gum didn't help. The side effects severely outweigh the benefits. I had a total mental breakdown with this drug with attempted suicide. Gastrointestinal problems were rather severe and disrupted my daily function. And the agitation and lack of sleep due to extreme lucid dreams/nightmares have caused severe strain on my relationships with friends and family (aiding in the breakdown). I have completely stopped this nightmare of a drug and have had to start taking hearty doses of Valium to get my anxiety, panic, and depression under check. If I knew then what I know now about this drug I would have never ever started it in the first place. Keep in mind that all of these side effects happened all within 3 weeks of taking this drug! Please please try alternative ways of quitting smoking instead of taking this drug. It is not worth the side effects what so ever (From Message Board, 10-19-12).

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There is no doubt, Chantix is extremely effective assistant to stop smoking, helping even in the most severe cases of nicotine addiction. I do have several friends, for whom this drug helped to become nicotine-free forever. However, you should exercise extreme caution, while considering, discussing with your doctor, and actually taking the drug.

Tell your doctor all the medical conditions you are experiencing now, and have experienced in the past and all medications you are taking. As prescribed, please follow the doctor’s recommendations precisely to minimize the risk. And, finally, monitor yourself and ask your family members to watch you closely, while you on Chantix treatment. If you notice any described side effects out of reasonable proportions, stop taking the drug immediately and discuss your treatment plan with your doctor.

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