Harvard Heart Letter

Caution advised on Chantix use

If you are one of the millions of Americans trying to quit smoking, keep up the good work. It isn't easy, but the payoffs are huge. If you are using the quit-smoking drug Chantix (varenicline), there's a new bump in the road: for people with heart disease, the FDA says the drug slightly increases the chances of having a heart attack or other cardiovascular problem. A Canadian study concludes that use of the drug increases the risk of heart attack, stroke, and heart failure in all users (CMAJ, July 4, 2011).

The FDA approved Chantix in 2006 based on clinical trial results that it doubled the quit rate (10% for placebo, 23% for Chantix). The drug works by latching onto nicotine receptors in the brain and activating them, much as nicotine does. This reduces a smoker's craving for nicotine and eases withdrawal symptoms.

Other effective options besides Chantix are available to help smokers quit. Using a nicotine patch plus nicotine gum or a nicotine lozenge is one of the best methods for quitting. A medication called bupropion (sold as Wellbutrin or Zyban) is another option. The most effective strategy involves using nicotine replacement or a medication along with some sort of counseling or support, either in person, by telephone, or even by text message. Information and advice about quitting are available at www.smokefree.gov, a Web site developed by the National Cancer Institute.

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