Stop Smoking Generic Drugs F.A.Q.
What are smoking cessation medications?
Smoking cessation medications or aid are the medicinal substances used to cope with tobacco smoking addiction.
All around the world medical specialists agree that tobacco smoking is a serious medical and social problem. Besides, it is one of the prevailing preventable causes of noncommunicable diseases. The harmful effects of smoking on the body are known to mankind for many centuries. However, despite the many centuries of knowledge about the dangers of smoking and decades of struggle with this habit, the number of smokers all over the world is steadily increasing. The situation with the spread of tobacco smoking in all countries has become a global epidemic. Currently around 1.26 billion people smoke around the world with 700 million of them being children and adolescents. If the situation does not change, then by 2030 the total number of smokers will be 1.6 billion.
According to the data based on the WHO surveys, around 60% of smokers wish to quit smoking and 69% need assistance in quitting smoking, which confirms the insufficiently effective work of medicine and pharmacy specialists in this area.
Why is tobacco smoking harmful?
In the process of burning cigarettes or other smoking tobacco products, smoke is generated. At the time of tightening the temperature at the tip of the cigarette reaches 900° C. During smoking, the dry distillation of tobacco resulting in the formation of toxic substances (about 4000 components) occurs; more than 200 of them are dangerous to the body. The entire composition of tobacco smoke has not been studied, but the substances identified in it are highly toxic, irritating, poisonous and carcinogenic.
Many scientific studies have studied the pathological mechanisms of exposure to carbon monoxide, metals, polycyclic aromatic hydrocarbons that are in the direct (smoke, which smokers inhale) or side (smoke coming from the lit end of a cigarette, which people breathe around) cigarette flow. These substances enter the human body both with active and passive smoking (it is more correct to call it compulsory for others).
A special place among the substances of tobacco smoke takes carbon monoxide (CO), which is a by-product of the combustion process and is present in tobacco smoke in high concentrations. Its content in the smoke of one cigarette is 10–20 times higher than the nicotine content. The main toxic effect of CO is that it has a high affinity for hemoglobin which is 20 times stronger than that of oxygen. This leads to blockage of hemoglobin, the formation of carboxyhemoglobin and the development of tissue hypoxia. This is especially dangerous during pregnancy. Fetal hemoglobin has a stronger association with CO than adult hemoglobin, so the fetus has higher carboxyhemoglobin content than its mother. Chronic cellular hypoxia gradually develops in the fetus, which persists even during periods when the mother does not smoke, including at night. As a result, both hematocrit and blood viscosity increase both in the fetus and in the mother, which leads to impaired functioning of the placenta and slowing the growth of the fetus, and also increases the risk of stroke.
The presence of metals in the tobacco smoke depends on the tobacco used for cigarettes production. In the main stream of all types of cigarettes, metals such as cadmium, lead, mercury, nickel and chromium are detected, sometimes zinc and beryllium, and cadmium, nickel and zinc in the side stream are also found. One of the most toxic substances in tobacco smoke is polycyclic aromatic hydrocarbons. Their toxic effect is in interaction with cellular components, such as DNA, which leads to the development of mutations that can cause cancer and damage to the fetus.
In addition to these, toluene, carbon disulfide, dichlorodiphenyltrichloroethane, benzene, vinyl chloride, and others, which are identified as toxic substances, are also found in tobacco smoke. For instance, benzene vapors even in small quantities with repeated exposure disrupt the function of the blood-forming organs, and in large quantities act on the central nervous system; formaldehyde is a toxic substance, it irritates the mucous membranes of the respiratory tract and eyes; hydrocyanic acid is a strong poison that binds hemoglobin, paralyzes the respiratory centers and causes choking; Aniline is a poisonous substance. The carcinogenic substances of tobacco smoke more than 10 times increase the risk of developing cancer in both active and passive smokers. Of particular danger is the radioactive isotope polonium-210, most of which accumulates in the body and causes the development of cancer cells.
What kinds of smoking cessation medications exist?
There are a lot of smoking cessation medications brands and trade names but all of them can be divided in three groups:
– Nicotine replacement therapy, i.e. nicotine or cytisine, an alkaloid that has a similar effect on the body, is part of the tablets. Such tablets act as a mini-cigarette, which, moreover, does not have to be smoked — that is, nicotinic receptors are irritated, causing a chain of reactions similar to those of smoking.
The major positive factor of medicines from this group is the elimination of the most dangerous component of smoking, i.e. inhalation of smoke, and respectively the dangerous substances contained in it. Besides, these medications relieve the symptom of withdrawal syndrome as they provide the receptors with the needed dose of nicotine.
The drawback of such medicines is the maintenance of the nicotine dependence.
– The second group includes medicines that affect certain parts of the brain in which the addiction to smoking develops. One of the most known formulations from this group is Zyban (or Bupropion by Sun Pharma). It is an inhibitor of reuptake of norepinephrine and dopamine, reduces the production of positive reinforcement from smoking, and reduces the severity of symptoms of withdrawal. Zyban's active ingredient is antidepressant Bupropion. It is an atypical antidepressant, an inhibitor of the reuptake of norepinephrine and dopamine, thereby reducing the severity of symptoms of tobacco cessation, reducing the painful manifestations of nicotine withdrawal. Zyban does not cause aversion to smoking, but effectively reduces the severity of symptoms in the withdrawal syndrome. The drug does not act immediately, so during the first two weeks you can combine smoking and taking Zyban. This, as a positive feature, is noted by those who are unable to stop smoking once and for all but are quit by gradual decrease of cigarettes per day.
– The third group includes a single medication called Chantix (or Champix in some countries) by Pfizer. It binds to nicotinic acetylcholine receptors, the same to with which nicotine binds. It blocks the ability of nicotine to stimulate the neuronal mechanism, which makes it possible to feel the pleasure of smoking with the subsequent formation of dependence.
At the same time, Varenicline, the active substance of the medication, stimulates nicotinic receptors so that withdrawal syndrome is less pronounced (Varenicline is still less active than nicotine), craving for cigarettes is reduced, and withdrawal syndrome is easier or even unnoticed. This medication is considered the most effective for people who themselves decided to quit smoking, i.e. they are ineffective if given to people who do not know that they use anti-smoking aid medicine as they do not form direct reflex connection smoked - disgusted – quit. There is a special scheme of use which must be followed. Besides, a person who decides to quit smoking must set the complete cessation date within a certain period of the use of the pills.
For how long should I use smoking cessation drugs?
It depends on the formulation used:
– Nicotine-replacement means are used for 12 or more weeks depending on their form and your personal experience with them;
– Antidepressants such as Zyban can be used from to six weeks or as appointed by a doctor;
– Chantix is advised to be used for 12 weeks and additional 12 weeks in case of continued craving for cigarettes. This medication doesn’t require you to go “cold turkey” as when use start taking Chantix, you can still smoke but need to set a cessation date in 1-2 weeks. It is reported that many people quit and never return to smoking taking the pills only for two weeks. But it is advised to continue using the tablets to avoid any temptations especially if you have smokers in your family or among your friends or co-workers.