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Which Medicine Will Help You Quit Smoking?

Everyone agrees that if you smoke, you should quit. There is controversy about the best way to accomplish that difficult task, however.

Experts agree that the best thing a smoker can do for his or her health is to quit. That, however, is easier said than done. Nicotine can create powerful dependence, and many people have a lot of trouble giving it up. No wonder they may look for assistance in the form of a stop-smoking prescription. Which drug is best?

Zyban vs. Chantix to Quit Smoking:

Q. I took Zyban to quit smoking in 1997. Other than it slowing me down, I had no side effects. After about two weeks on it, I had no desire for any more cigarettes.

I’ve been tobacco free since then. Prior to that, I had smoked for over 30 years. Why are people still taking Chantix, which is known to cause side effects, when older drugs that work are still available? My guess is that Zyban would also cost less than Chantix.

A. The active ingredient in Zyban is bupropion, the same compound found in the antidepressant Wellbutrin. Bupropion was tested against placebo or non-drug treatment in 44 randomized trials for smoking cessation (Cochrane Database of Systematic Reviews, Jan. 8, 2014). People taking Zyban were 60 percent more likely to have quit after at least six months.

Despite the success of these study subjects, a more recent review of real-world smokers found that neither Zyban nor Chantix made a significant difference in long-term smoking cessation (Journal of the National Cancer Institute, June, 2018).  The authors of this analysis suggest that the support and counseling provided in clinical trials may account for the discrepancy.

Which Is Better–Gradual Decrease or Cold Turkey?

A study in the Annals of Internal Medicine (March 14, 2016) suggests that giving up cigarettes suddenly may be more effective than the slow approach. The research included almost 700 British adults who wanted to quit smoking. They were randomly assigned to gradually decrease their smoking 75 percent over two weeks or to quit smoking abruptly on the first day of the study intervention.

Nicotine Patches for All Who Quit Smoking:

Both groups got nicotine patches and counseling. Those cutting down gradually also got nicotine gum or lozenges to help them.

Following up at both one month and six months after quit day, the researchers found that at one month half of those who’d stopped cold turkey were no longer smoking, compared to 39 percent of the gradual quitters. At six months, 16 percent of the gradual quitters and 22 percent of the abrupt quitters were not smoking.

Smokers who want to quit may need to try several times. This study suggests that quitting all at once might work best. Our late friend Tom Ferguson, MD, author of the No-Nag, No-Guilt, Do-It-Your-Own-Way Guide to Quitting Smoking, would say that you should do what you think is best for you, on your own timeline. You might also consider whether you feel a medication would be helpful. This is a good topic to discuss with your primary care provider, who will surely want to support your efforts to quit.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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