A few words of caution about paying between $1,200 and $1,700 for a 90 day supply of varenicline or Chantix (sold outside the U.S. as Champix). Never in the history of smoking cessation products have we seen such a wide array of serious potential side effects, including death.
The Medication Guide for Chantix is available at Chantix.com.
Anyone considering taking Chantix should carefully read the Guide prior to doing so. Not only does it share the risks associated with taking Chantix, it also lists the things that smokers should tell their doctor prior to receiving a prescription.[1]
The following are quotes from parts of the February 2019 version of the Medication Guide:
- Some people have had serious side effects while taking CHANTIX to help them quit smoking, including: New or worse mental health problems, such as changes in behavior or thinking, aggression, hostility, agitation, depressed mood, or suicidal thoughts or actions.
- Seizures. Some people have had seizures during treatment with CHANTIX. In most cases, the seizures have happened during the first month of treatment with CHANTIX.
- New or worse heart or blood vessel (cardiovascular) problems, mostly in people, who already have cardiovascular problems. Get emergency medical help right away if you have any of the following symptoms of a heart attack, including: chest discomfort (uncomfortable pressure, squeezing, fullness or pain) that lasts more than a few minutes, or that goes away and comes back, pain or discomfort in one or both arms, back, neck, jaw or stomach shortness of breath, sweating, nausea, vomiting, or feeling lightheaded associated with chest discomfort.
- Sleepwalking can happen with CHANTIX, and can sometimes lead to behavior that is harmful to you or other people, or to property.
- Allergic reactions can happen with CHANTIX. Some of these allergic reactions can be life-threatening.
- Serious skin reactions, including rash, swelling, redness, and peeling of the skin. Some of these skin reactions can become life-threatening.
- Stop taking CHANTIX and get medical help right away if you have any of the following symptoms: swelling of the face, mouth (tongue, lips, and gums), throat or neck, trouble breathing, rash with peeling skin, blisters in your mouth.
- The most common side effects of CHANTIX include: nausea, sleep problems (trouble sleeping or vivid, unusual, or strange dreams), constipation, gas, vomiting.[1]
And here's the problem. We can't accurately predict who will and won't sustain harm. What can be asserted with confidence is that varenicline is not the magic cure, or nearly as effective in real-world use, as Pfizer marketing suggests.
Three randomized clinical trials pitted varenicline against NRT: Aubin 2008, Tsukahara 2010, and Dhelaria 2012. In each, varenicline failed to show statistical significance over NRT when looking at the percentage of quitters within each group who were still not smoking at 24 weeks.[2]
The Aubin study notes that two varenicline users experienced severe depression, with suicidal ideation causing one to be hospitalized 11 days after ending use. It found that among 376 Chantix users and 370 patch users that the likelihood of a Chantix user experiencing vomiting was 5.5 times greater, that decreased sense of taste was 5.3 times greater, abdominal pain x5, disturbances in attention x4.5, nausea x4, flatulence x4, constipation x3, headaches x2, dizziness x2, diarrhea x2, with 2.3 times as many Chantix users complaining of fatigue.
Does it make sense to assume all these risks without a significant increase in your odds of success?
England's "Stop Smoking Services" (NHS SSS) may offer the most comprehensive government-sponsored cessation services of any nation. Services include free individual or group counseling and support.
A 2008 study analyzed NHS SSS program performance. It found that at four weeks after starting varenicline use (Champix in the UK) that 63% of users were still not smoking as compared to 48% using nicotine replacement products (NRT) such as the nicotine patch, gum or lozenge, and 51% who stopped smoking without the use of any product.[3]
While at first blush it appears that varenicline has the lead, keep in mind that these are four-week results and that both varenicline and NRT users still face another 4-8 weeks of "treatment" before trying to adjust to living and functioning with natural brain dopamine stimulation.
A 2005 English study examined one-year NHS SSS success rates but didn't include varenicline (Champix in the UK) as it wasn't yet on the market.[4] It found that while 25.5% of those who attempted to stop without using any pharma product were still smoke-free at one year, only 15.2% of NRT users and 14.4% of bupropion (Zyban) users were still not smoking.
Can you see why I've been concerned since 2008, when Chantix first failed to prevail over NRT, that it could be undercutting cessation and costing lives?
What about more recent real-world Chantix success rates? Two key factors in valuing quitting methods are its productivity and effectiveness.
The July 2018 PLoS One Weaver study was the most comprehensive population-level quitting method study yet. There, according to Table 7 data, cold turkey generated 5 times more ex-smokers than all approved quitting products combined, while being twice as effective as Chantix and Zyban combined, 3 times as effective as NRT, and 2.6 times as effective as e-cigarettes.[5]
Joel has written extensively on pharma industry cessation products. He was warning about nicotine gum's ability to foster relapse or become a crutch as early as 1984.[6]
Joel encourages those contemplating using industry products to take their own poll of all successful long-term ex-users who have remained nicotine-free for at least a year.[7] He encourages us to believe our own survey findings.
But don't ask Ray Liotta how he quit. Remember his 2018 Chantix commercials? "Hi, I'm Ray and I quit smoking with Chantix."
Well, there's just one problem with that. Ray's 2016 social media posts indicate that he quit smoking in 2002, but Chantix wasn't approved for sale until 4 years later in 2006.[8]
References:
2. Aubin HJ, et al, Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomized open-label trial, Thorax, August 2008, Volume 63(8), Pages 717-724; Tsukahara H, et al, A randomized controlled open comparative trial of varenicline vs nicotine patch in adult smokers: efficacy, safety and withdrawal symptoms (the VN-SEESAW study), Circulation Journal, April 2010, Volume 74(4), Pages 771-778; and Dhelaria RK, Effectiveness of varenicline for smoking cessation at 2 urban academic health centers, European Journal of Internal Medicine, July 2012, Volume 23(5), Pages 461-464.
3. UK NHS, Statistics on NHS Stop Smoking Services in England, April to December 2007 [see Table 6], April 16, 2008.
4. Ferguson J, et al, The English smoking treatment services: one-year outcomes, Addiction, April 2005, Volume 100 Suppl 2, Pages 59-69 [see Table 6].
5. Weaver SR et al, Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015–2016. PLoS ONE 2018, 13(7): e0198047. https://doi.org/10.1371/journal.pone.0198047
6. Spitzer, J, Pharmacological Crutches, Joel's Library, 1984.
7. Spitzer, J, Quitting Methods - Who to Believe? Joel's Library, 2003.
8. Polito JR, Did Ray Liotta really quit smoking with Chantix? December 11, 2018, https://whyquit.com/pr/121118-did-ray-liotta-really-quit-smoking-with-chantix.html
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