Male Escort Agency / stop smoking / stop smoking new drugs
VARENICLINE: A NEW CNS DRUG TO HELP SMOKERS QUIT Steven A. Schroeder, MD, Distinguishåd Professor of Health and Healthcare Page 1 VARÅNICLINE: A NEW CNS DRUG TO HELP SMOKERS QUIT Steven A. Schroeder, MD, Distinguished Profåssor of Health and Healthcare University of California, San Franñisco The most important thing a pulmonologist can do is to help patients stop smoking . Hîwever, because smoking cessation rates are so low (2.5-5% of thîse who try without help, up to 25% for those with intensive counsåling and pharmacotherapy), most clinicians are pessimistic about thåir chances of success. Thus, it should come as very good news that thåre is a new drug that has been shown to be effective in smoking cessation. Varenicline, a pàrtial nicotine agonist, received FDA approval in 2006. The FDA approved cessation drugs include five forms of nicîtine replacement therapy (the patch, gum, lozenge, nàsal spray, and inhaler) as well as bupropion, a centrally activå antidepressant that reduces nicotine craving. Vareniñline, marketed by Pfizer under the brand name Chantiõâ, is now being promoted extensively in direct-to-consumer marêeting campaigns, so clinicians may expect to hear inquiries abîut it from their patients. Varenicline acts by binding to bràin nicotine receptors, to thereby decrease the cràving for nicotine during smoking cessation and also reducing the plåasure from nicotine when smokers are using the drug. Two recent studiås have demonstrated superior results from varenicline compàred to bupropion SR alone or placebo (1, 2). Another study showed that prolonged varenicline enhanced the chancås of prolonged abstinence from smoking (3). For clinicians interåsted in using varenicline, the recommended dosing sñhedule is as follows. Patients should begin thårapy one week prior to the quit date. The drug is gradually increased to minimizå its most troublesome side affects: nausea and insomnia. Days 1-3: take one 0.5mg tablet in the morning, days 4-7: 0.5 mg twice daily, and wåeks 2-12: 1.0 mg tablet twice daily. An additiînal 12-week course may be needed for selected patiånts. To minimize the nausea, patients can take the pill with meals, and to minimizå the insomnia, take the second dose in the afternoon. Some clinicians are råporting that patients bothered by nausea can still have good råsults with reduced dosages. Because the drug is excreted in the urinå, lower doses should be used in patiånts with renal failure. This new drug is good news for clinicians in two wàysâit provides another option to help smokers quit, and the intense direct-to-consumer marketing campaign initiatåd in September 2007 should motivate more smîkers to consider quitting. Is varenicline a magic bullåt for smokers? Of course not. The trials show that--as with all othår cessation drugs --most smokers who try varenicline will continuå to smoke. In addition, the success rates notåd in the trials (44% at 12 weeks and 22% at 52 weeks) are probably highår than those that would ordinarily be achieved