Tobacco

[BBC3]

Been trying to start it lately to kick the chew. Really strong mojo me thinks. First dose and I was projectile vomiting. Few days late back on the horse. Lasted 2-3 starter days and had some wild off to the races with the heart brief (Tachycardia I think), and early one morning in the "heart attach hour". So I got paranoid and took a beta blocker that I am prescribed for BP occasional. Did not have any more issues, but did not take another that day. I See that Chantix is both an Alpha & beta actor. Is it any wonder peoples hearts are doing tricks on it, and really unaddressed by the manu at this time. I have read the prescribing information liberally and I have found they really set up a crappy little study considering the amount of people this was going to apply to!! Really, they tested it on about 4500 people prior to pulling a total Bill Gates and rendering the general public the next unofficial Beta group.. LOL They probably sold that much in the first 5 mins it was available... Further, they have really been playing down post marketing reports it seems, and bringing more study groups on line in very controlled / pre-planned segments. There is conspiracy smell here to say the least... But I cant resist as It clearly is a important find if it cessates, at least for a while to forget the habit....

So anyone got any horror stories for me. Or facts will sometimes do as well.

 

[Michael Scally MD]

Re: Chantix - What we know on this around here.?

See: https://thinksteroids.com/community/posts/742571 AND https://thinksteroids.com/community/posts/712056

 

[CubbieBlue]

Re: Chantix - What we know on this around here.?

Been trying to start it lately to kick the chew. Really strong mojo me thinks. First dose and I was projectile vomiting. Few days late back on the horse. Lasted 2-3 starter days and had some wild off to the races with the heart brief (Tachycardia I think), and early one morning in the "heart attach hour". So I got paranoid and took a beta blocker that I am prescribed for BP occasional. Did not have any more issues, but did not take another that day. I See that Chantix is both an Alpha & beta actor. Is it any wonder peoples hearts are doing tricks on it, and really unaddressed by the manu at this time. I have read the prescribing information liberally and I have found they really set up a crappy little study considering the amount of people this was going to apply to!! Really, they tested it on about 4500 people prior to pulling a total Bill Gates and rendering the general public the next unofficial Beta group.. LOL They probably sold that much in the first 5 mins it was available... Further, they have really been playing down post marketing reports it seems, and bringing more study groups on line in very controlled / pre-planned segments. There is conspiracy smell here to say the least... But I cant resist as It clearly is a important find if it cessates, at least for a while to forget the habit....

So anyone got any horror stories for me. Or facts will sometimes do as well.

I had a friend of a friend have some semi-permanent horrible mental side effects from it. I would stay the fuck away.

 

[chemman]

Re: Chantix - What we know on this around here.?

First dose and I was projectile vomiting.

Hard to smoke while blowing chunks. These psych drug makers really got it figured out!

 

[Crazy Crew]

Re: Chantix - What we know on this around here.?

Hard to smoke while blowing chunks. These psych drug makers really got it figured out!

LOL

Worked for me, though I did have some wild dreams. I kept smoking for a while, but got to the point I just didn't want to any longer. It's not a 30 day cure take months to do it properly.

It is known to have side effects (some severe) and that is why they start you on half doses to see how you will react to them.

 

[BBC3]

Re: Chantix - What we know on this around here.?

First and my preliminary thoughts are that any phychological issues are related to nicotine, and not chantix. People smoke for a reason. Its very theraputic. So you take this away, tweek the receptor only a little, and you have a pissed off camper. I GUARANTEE that if they took 5000 smokers cigarettes away, you would have an even higher rate of psychosis given that they dont even get the partial receptor stimulation.. LOL Further, notice it says mental issues after stopping the drug. Well, go figure, you take a fellow and stimulate his nicotine receptors and he is really SMOKING... Now take away the drug and presto, you have THE TRUE DAY ONE OF STOPPING SMOKING. So really. I have my doubts on this described psycholsis.

However, I will say that my CPAP was on the floor this morning and I was disconnected never even waking. I just really pray it does not lend to, or open the door for active night terrors.!!! You are now talking folks in danger for real...

I am forging onward still attempting with no issues today. My concern is the cardio aspect. I suspect there are some real issues here that are unaddressed. I think it may in part be due to the fact that people using it have already f'd up their circulatory systems with cigs. But that 180 BPM pulse flutter shot I got the other day was real, and a first for me. Apparently I am not the only one either.... I am not all that unhealthy...

 

[BBC3]

Re: Chantix - What we know on this around here.?

Did you see. I asked for a referral and I was the last one preaching on that thread... LOL. At least I did not condradict myself.....:drooling:

See: https://thinksteroids.com/community/posts/742571 AND https://thinksteroids.com/community/posts/712056

 

[IanMac]

Re: Chantix - What we know on this around here.?

I found this Saturday while researching this for a family member:

The potential for a Chantix lawsuit is being reviewed and evaluated on behalf of individuals who:

•Committed or attempted suicide on Chantix
•Suffered severe physical Injury as a result of sudden abnormal behavior
•Diagnosed with new on-set diabetes from Chantix
•Developed Stevens Johnson Syndrome or Toxic Epidermal Necrolysis due to Chantix
•Suffered severe physical injury or death from an Accident or Fall caused by seizures, black-outs, vision disturbances or other sudden problems
The anti-smoking drug has been linked to a number of psychological side effects and other problems which could be caused by the effect the drug has on the brain.

However, Chantix problems have also begun to surface at an alarming rate, making it one of the drugs most associated with severe adverse events according to the FDA's Adverse Event reporting system.
The active ingredient in Chatix acts on the brain, which has led to a number of problems and side effects, which the manufacturer failed to adequately research or warn about. Since it was first approved through an expedited priority review, the FDA has required Pfizer to add information to the Chantix warning label about a possible increased risk of suicide, suicidal thoughts and abnormal behavior seen among users of the drug. However, lawsuits are also being reviewed for a number of other Chantix problems which have caused severe injury or death for a number of users.

This was at Chantix Lawsuits - Chantix Lawyers - Chantix Class Action Lawsuit. There will probably be a class action against Pfizer because of Chantix.

Peace,
Ian

 

[BBC3]

Re: Chantix - What we know on this around here.?

Thanks,
Thats amazing still not reflection on the heart and circulatory probs. Throbosis, blood clotting, cardia CNS episodes..... Incredible. Apparently the market is providing an alibi here by inhere condition/risk. I do keep reading fair attempts to discount these issues to damage already done, and probably so to some degree. But I dont want a freaking deep vein blockage, or a stroke because some tiny piece of plaque broke off is a heart race off... Further, I dont need any long term permannent damage. I am clearly experiencing Tennitis, and deafness can apparently result. Reading the info one would asssume temporarty, but I dont think so. I have never seen many CNS damage issues repair well in my studies. So the rish may be far to high for this experiement on me...

I found this Saturday while researching this for a family member:

The potential for a Chantix lawsuit is being reviewed and evaluated on behalf of individuals who:

•Committed or attempted suicide on Chantix
•Suffered severe physical Injury as a result of sudden abnormal behavior
•Diagnosed with new on-set diabetes from Chantix
•Developed Stevens Johnson Syndrome or Toxic Epidermal Necrolysis due to Chantix
•Suffered severe physical injury or death from an Accident or Fall caused by seizures, black-outs, vision disturbances or other sudden problems
The anti-smoking drug has been linked to a number of psychological side effects and other problems which could be caused by the effect the drug has on the brain.

However, Chantix problems have also begun to surface at an alarming rate, making it one of the drugs most associated with severe adverse events according to the FDA's Adverse Event reporting system.
The active ingredient in Chatix acts on the brain, which has led to a number of problems and side effects, which the manufacturer failed to adequately research or warn about. Since it was first approved through an expedited priority review, the FDA has required Pfizer to add information to the Chantix warning label about a possible increased risk of suicide, suicidal thoughts and abnormal behavior seen among users of the drug. However, lawsuits are also being reviewed for a number of other Chantix problems which have caused severe injury or death for a number of users.

This was at Chantix Lawsuits - Chantix Lawyers - Chantix Class Action Lawsuit. There will probably be a class action against Pfizer because of Chantix.

Peace,
Ian

 

[CubbieBlue]

Re: Chantix - What we know on this around here.?

Thanks,
Thats amazing still not reflection on the heart and circulatory probs. Throbosis, blood clotting, cardia CNS episodes..... Incredible. Apparently the market is providing an alibi here by inhere condition/risk. I do keep reading fair attempts to discount these issues to damage already done, and probably so to some degree. But I dont want a freaking deep vein blockage, or a stroke because some tiny piece of plaque broke off is a heart race off... Further, I dont need any long term permannent damage. I am clearly experiencing Tennitis, and deafness can apparently result. Reading the info one would asssume temporarty, but I dont think so. I have never seen many CNS damage issues repair well in my studies. So the rish may be far to high for this experiement on me...

If you really want to quit you can do so without taking a possibly life altering pill bro.

 

[GirlyMan]

Re: Chantix - What we know on this around here.?

Worked for me, though I did have some wild dreams. I kept smoking for a while, but got to the point I just didn't want to any longer. It's not a 30 day cure take months to do it properly.

I used it get off Nicorette which I've been using for the last 15-20 years to get off Copenhagen snuff which will kill you with esophageal cancer. It does what it claims, it blocks your brain from feeling the nicotine. Only side effect I noticed was like CubbieBlue, crazy vivid dreams, some of them even lucid. But I can imagine that someone not as used to rewiring their brain in various and sundry ways might have other, possibly even adverse, side effects.

 

[BBC3]

Re: Chantix - What we know on this around here.?

To be clear. Wellbutrin will occupy but not activate receptors, at least some of them. I still note some nicotine effect while taking wellbutrin, but not much CHANTIX is revolutionary in that it actually not only occupies the receptors, but triggers them too. It appears that the Chantix even more accurately targets the nicotine D receptors, HOWEVER, it only partially stimulates while strongly blocking outside nicotine sources. So in Chantix, you get Wellbutrin PLUS a kick effect, so to speak. OR both antagonist and agonist effects.

Wellbutrin I have found is like chokin the chicken SENSLESS at the age of 18. He already got 4 nuts, but cant get enough. And justa spanking, and spankin, and spankin with no relief. I get a mild response at the brain while on WB, and dip my brains out regardless. The difference is you can pile your mouth full of copenhagen and never break a sweat. An amount that would have even expert level users puking. So the point is you never realize you are not getting the hit I think and further re-inforce the Habit as a function of taste and application.

GirlyMan, I hear ya, and yes synthetic nicotine will keep one from going insane. But I KNOW it is lacking something. There is just something not identified in the natural leaf that patches and gum dont provide. It actually kinda like the chicken chokin example come to think of it. Cant explain. I actually suspect that: either it is the pesticide/herbicide interaction the synthetic form lacks that we crave, or even a secret chemical applied by tobacco industry, if not just as simple as dousing with a light acid or something like that. But something is missing....

I used it get off Nicorette which I've been using for the last 15-20 years to get off Copenhagen snuff which will kill you with esophageal cancer. It does what it claims, it blocks your brain from feeling the nicotine. Only side effect I noticed was like CubbieBlue, crazy vivid dreams, some of them even lucid. But I can imagine that someone not as used to rewiring their brain in various and sundry ways might have other, possibly even adverse, side effects.

 

[GirlyMan]

Re: Chantix - What we know on this around here.?

I get a mild response at the brain while on WB, and dip my brains out regardless. The difference is you can pile your mouth full of copenhagen and never break a sweat. An amount that would have even expert level users puking.

Don't think I ever puked from it, but when it got to the point where I was stuffing both my lower and upper lips continually, and coughing up black shit (not from my lungs, from my esophagus), it was time to do anything to get off of it. Nicorette worked and probably saved my life.

 

[BBC3]

Re: Chantix - What we know on this around here.?

AHHH!!! European... Yes I resorted to only upper lip years ago. The funny thing is that you can get away with the local damage for increasing time exponential if you understand how to diversify exposure. They should have classes on it. I would have began working the upper and lower mix up all at once, I would probably have more time here.... FUCKING CRACK FOR THE BRAIN!!!

So now if you can tell me that you know the Secret of the Swallow. That magical transition to the end of the filthy display, we can acknowledge equal Power in the kindom of lip scorchers... LOL But gravely concerned... REALLY, I have to now find it somewhere within me to get this monkey off me again.. Its crazy. 2 weeks on clear insanity followed by two more deeply disturbed - BUT a milestone. Then the end of the second month and it no longer consumes your mind 24/7. At the end of 90 days you can almost tolerate using peers with a laught. And in 120 days its a figment of your imagination even whilst in a drunken tavern... Crazy.. But the craziest part is that at that time you are going, "ya know, that wasn't so bad. Hell I can quit any time". And it is truely do to the lack of the benefit and POSITIVE effects we gain from it. IT IS THE FURTHEST THING FROM ADDICTION. Unfortunately the drug is quickly tolerated. And not only, you can be off a year and its like you never stopped. This I am afraid is CLEAR INDICATION OF THE RECEPTORS WE DEVELOP OVER TIME ON. Where it takes YEARS to tolerate a dosage, we just pop a couple and next thing its ALL DAY LONG... Proof of permanent changes in biological structure I am afraid indeed. I will close this paragraph by pointing out that the one weird thing I noticed in the past at week 12 (and believe me that has only occurred once or thrice!!), is this strange sensation of insecurity. I recall driving around just feeling weak. Like someone was going to just walk over to my car, pull me out the window, ass rape me and take my money whilst video broadcasting live.[)] I recall trying to rationalize it. Seems like now that I was not bold or careless enough to risk my life on a daily basis, it seemed to weaken my perception of my self worth. REALISTICALLY people can sense the disturbance in you vibe as you are clearly out of your own for how long a dare not speculate as 16 weeks was my tops ever..

So really then. HOW TO QUIT? More accurately, how to replace all the incredibly gratifying sensations we get there. And no disrespect to smokers as I used to be a notorious "switch Hitter", they aint even close. That feeling from cigarettes is actually the feeling of poisoning onces self in one of the worst ways possible. To truely understand nicotine, one must place thy sacred chaw inst thow lip. If only for a moment, you would impart enough nicotine to equall 3 cigarettes and then you will know the true power of the chaw side.... Clean, refreshing, DELICIOUS, TASTY, EMPOWERING, JUst damn good........I am distracted now. SO HOW TO SATISFY THIS FRICKIN PACK OF WILD BANCHIE DAMN NICOTINE RECEPTORS THAT NOW RULE MY SIMPLE LITTLE BRAIN?? And let me tell you, unchecked and unappeased those little bastards will reak all kinds of insanity on your ass ranging from extreme paranoia, confusion, somnolence, can't crap any more - EVER..., fat as hell cause your body has been trying to slow down for years and now you have taken away the reason. It aint gonna stop trying to slow down over night. Now it just continues with no counter.... The old eatin cause ya need somethin to do is freaking B..... S....... from hell. You get fat cause your damn body does not work right any more..... Sweet Jesus I will see 350lbs in a year if I loose it... And God forgive as I do not use in vain.... Just merited here. I have tried using the young children as a vehicle, but I think I am so scared of life responsibility and pressure that I would that I actually use them as a reason to DO IT. Kinda ingrateful abyss attitude with no respect for nothin. So I am a coward??!! And this probably translates throughout my entire spectrum of life. I think many are scared too. Just running as fast as we can, and not even moving from the couch! If I could just get me some a dat stuff big Tony is smoking I think I could rock and roll too. RIGHT.... So the truth is then that "successful" people in our society get there by praying on the FEARS OF OTHERS. They have successfuly identified these fears, labeled them so as not to forget, and now captialize thereof.... I could go on. But you already know this...:drooling:

Don't think I ever puked from it, but when it got to the point where I was stuffing both my lower and upper lips continually, and coughing up black shit (not from my lungs, from my esophagus), it was time to do anything to get off of it. Nicorette worked and probably saved my life.

 

[BBC3]

Re: Chantix - What we know on this around here.?

One of my points on the last rant is that I can debunk Chantix in about 5 sentences. But you know I will use more... What the hell is someone gonna do when the nicotine agonist has been removed at the end of 12 weeks. Fuck, how much $money$ you gonna give PHIZER NOW.. And for a product that CLEARLY would have killed my ass long ago if someone had handed me a Chantix Pill to as a hook at 15 yrs old.. LOL. REALLY folks dip their entire lives in many instances mabe just loosing some teeth by 80+ years old age. And hell, teeth are really immaterial in todays society anyway. I'm married. She might even like it. I think I would. Digressing.... err... POINT - Chantix I speculate would have killed my ass after 10 years of continued use.... That was a long time ago.... KNOCK ON FREAKING TEAK>>> NOW!!

1. So now we have hungry receptors.

2. Whether we are quitting cigs or chantix we are now without the food they love and demand

3..What to do?

4. Replace it with another dopamine source over next years? Food, sex (right better learn the cock cause the wife aint fillin that bill), gambling, other illegal drugs/blow, ------ WHAT WHAT WHAT WHAAAAAT>. I am not a fucking robot. I will never understand those with no compulsion. This is what life is all about... So the reality is that mine is nearing the end or I would not be considering quitting. There it is. I dont even have the sack that Thelma and louise stroked. Fucking Roman times indeed. I am 4 decades of age, I am getting THE FEAR, I am KING PUSSY ...

Enough...

 

[BBC3]

Re: Chantix - What we know on this around here.?

Whhoooooo _s aaaahhhhhhhhhhhhh

 

[Michael Scally MD]

Re: Chantix - What we know on this around here.?

Use of Chantix (Varenicline) for 4 Weeks Before Quitting Smoking

"The smoking-cessation drug Chantix (varenicline) may work better if people take it several weeks before trying to quit," according to a study published Monday in the Archives of Internal Medicine. Investigators gave Chantix to "53 people beginning four weeks before their quit date and throughout the remainder of the three-month cessation period. That group was compared with people who were given three weeks of a placebo pill followed by one week of Chantix before their quit day and for the remainder of the study." Investigators found that those who started Chantix "for a month before the quit date were more likely to be abstinent at the three-month mark: 47.2% were abstinent compared with 20.8% of the people in the placebo group."


The ?4?2 nicotinic receptor partial agonist varenicline tartrate is an effective smoking cessation medication. It is used in dosages increasing from 0.5 to 1 mg/d for 1 week before the target quit date (TQD) to generate sufficient systemic levels and to habituate users to the possible occurrence of nausea and thereafter in dosages of 2 mg/d for up to 6 months.

Varenicline seems to affect smokers in 2 different ways. It alleviates withdrawal discomfort and urges to smoke after smokers stop smoking. This effect is ascribed to the action of varenicline on dopaminergic pathways. Treatment is intended to ensure that ex-smokers continue to receive at least a part of the boost to their dopamine levels in the nucleus accumbens that they previously obtained from smoking. The second effect consistsof a reduction in the enjoyment of smoking and in smoke intake. This is presumed to be caused by the drug's blocking of the receptors that would otherwise facilitate the "reward" experienced when smoking. Up to now, this second effect has only been demonstrated over 1-week uptitration before the TQD and in unsuccessful quitters who rated the enjoyment of their "lapse" cigarettes.

The therapeutic effects of varenicline when administered as per current labeling rely primarily on the first mechanism (ie, alleviation of withdrawal discomfort once smokers stop smoking). Researchers hypothesized that, if the drug lowers the subjective reward that accompanies smoking, its use over an extended period before the TQD (varenicline preloading) could help to weaken the association of smoking with reward and to enhance cessation and the efficacy of varenicline therapy.

The present trial was designed to test whether varenicline preloading for 4 weeks reduces urges to smoke and facilitates smoking cessation compared with using the drug for just 1 week before the TQD as per current labeling. They also tested whether any smoking cessation effect is mediated by the influence of varenicline preloading on ad lib smoke intake before quitting or its effect on postcessation withdrawal discomfort. Last, they attempted to determine whether any effects of varenicline preloading plateau within 4 weeks of exposure.


Hajek P, McRobbie HJ, Myers KE, Stapleton J, Dhanji A-R. Use of Varenicline for 4 Weeks Before Quitting Smoking: Decrease in Ad Lib Smoking and Increase in Smoking Cessation Rates. Arch Intern Med 2011;171(8):770-7. Arch Intern Med -- Abstract: Use of Varenicline for 4 Weeks Before Quitting Smoking: Decrease in Ad Lib Smoking and Increase in Smoking Cessation Rates, April 25, 2011, Hajek et al. 171 (8): 770

Background The use of varenicline tartrate alleviates postquit withdrawal discomfort, but it also seems to reduce the "reward" associated with smoking. The current treatment schedule, which commences 1 week before quitting, relies primarily on the first mechanism. We set out to determine whether increasing the prequit medication period renders cigarettes less satisfying and facilitates quitting.

Methods One hundred one smokers attending a stop-smoking clinic in London, United Kingdom, were randomly allocated to receive varenicline for 4 weeks before the target quit date (TQD) or to receive placebo for 3 weeks before the TQD, followed by varenicline for 1 week before the TQD. In both groups, standard varenicline treatment was given for 3 months after the TQD. Measures included smoking satisfaction and smoke intake before quitting, urges to smoke and withdrawal discomfort after quitting, and sustained abstinence from the TQD to 3 months.

Results Varenicline preloading reduced prequit enjoyment of smoking (P = .004) and smoke intake (P < .001), with 36.7% of participants reducing their cotinine concentrations by more than 50% (reducers). Varenicline preloading did not affect postquit withdrawal symptoms, but it increased 12-week abstinence rates (47.2% in the varenicline arm vs 20.8% in the placebo arm, P = .005). The effect was particularly strong among the reducers in the varenicline arm (66.7% in reducers vs 22.6% in nonreducers, P = .002). Varenicline preloading was well tolerated.

Conclusions Although several issues remain to be clarified, varenicline preloading can generate a substantial reduction in ad lib smoking and enhance 12-week quit rates. Current treatment schedules may lead to suboptimal treatment results. Trials with longer follow-up periods are needed to corroborate these findings.

 

[hardasnails1973]

Re: Chantix - What we know on this around here.?

How about just the thought off blowin 5 bucks a pack. Move to a state where you can smoke the good stuff and let your insurance pay for it. Makes you feel proud to be an American...

 

[BBC3]

Re: Chantix - What we know on this around here.?

I should move to Florida. The average price of a can of copenhagen is 6.99... Besides, one can not place a value on the finer things.. They are priceless... But then again so is intentionally rotting one's face.

 

[BBC3]

Re: Chantix - What we know on this around here.?

Yes, well there is no doubt this would help. I am seeing very little reduction in craving at about a week in, and still on only 1mg/day total. BLood levels are definitely rising as I feel like I am on another planet.

Oh yea. Taste perversion is already occurring. I cant imagine how anyone would smoke 4 weeks in on this dose.

Use of Chantix (Varenicline) for 4 Weeks Before Quitting Smoking

"The smoking-cessation drug Chantix (varenicline) may work better if people take it several weeks before trying to quit," according to a study published Monday in the Archives of Internal Medicine. Investigators gave Chantix to "53 people beginning four weeks before their quit date and throughout the remainder of the three-month cessation period. That group was compared with people who were given three weeks of a placebo pill followed by one week of Chantix before their quit day and for the remainder of the study." Investigators found that those who started Chantix "for a month before the quit date were more likely to be abstinent at the three-month mark: 47.2% were abstinent compared with 20.8% of the people in the placebo group."


The ?4?2 nicotinic receptor partial agonist varenicline tartrate is an effective smoking cessation medication. It is used in dosages increasing from 0.5 to 1 mg/d for 1 week before the target quit date (TQD) to generate sufficient systemic levels and to habituate users to the possible occurrence of nausea and thereafter in dosages of 2 mg/d for up to 6 months.

Varenicline seems to affect smokers in 2 different ways. It alleviates withdrawal discomfort and urges to smoke after smokers stop smoking. This effect is ascribed to the action of varenicline on dopaminergic pathways. Treatment is intended to ensure that ex-smokers continue to receive at least a part of the boost to their dopamine levels in the nucleus accumbens that they previously obtained from smoking. The second effect consistsof a reduction in the enjoyment of smoking and in smoke intake. This is presumed to be caused by the drug's blocking of the receptors that would otherwise facilitate the "reward" experienced when smoking. Up to now, this second effect has only been demonstrated over 1-week uptitration before the TQD and in unsuccessful quitters who rated the enjoyment of their "lapse" cigarettes.

The therapeutic effects of varenicline when administered as per current labeling rely primarily on the first mechanism (ie, alleviation of withdrawal discomfort once smokers stop smoking). Researchers hypothesized that, if the drug lowers the subjective reward that accompanies smoking, its use over an extended period before the TQD (varenicline preloading) could help to weaken the association of smoking with reward and to enhance cessation and the efficacy of varenicline therapy.

The present trial was designed to test whether varenicline preloading for 4 weeks reduces urges to smoke and facilitates smoking cessation compared with using the drug for just 1 week before the TQD as per current labeling. They also tested whether any smoking cessation effect is mediated by the influence of varenicline preloading on ad lib smoke intake before quitting or its effect on postcessation withdrawal discomfort. Last, they attempted to determine whether any effects of varenicline preloading plateau within 4 weeks of exposure.


Hajek P, McRobbie HJ, Myers KE, Stapleton J, Dhanji A-R. Use of Varenicline for 4 Weeks Before Quitting Smoking: Decrease in Ad Lib Smoking and Increase in Smoking Cessation Rates. Arch Intern Med 2011;171(8):770-7. Arch Intern Med -- Abstract: Use of Varenicline for 4 Weeks Before Quitting Smoking: Decrease in Ad Lib Smoking and Increase in Smoking Cessation Rates, April 25, 2011, Hajek et al. 171 (8): 770

Background The use of varenicline tartrate alleviates postquit withdrawal discomfort, but it also seems to reduce the "reward" associated with smoking. The current treatment schedule, which commences 1 week before quitting, relies primarily on the first mechanism. We set out to determine whether increasing the prequit medication period renders cigarettes less satisfying and facilitates quitting.

Methods One hundred one smokers attending a stop-smoking clinic in London, United Kingdom, were randomly allocated to receive varenicline for 4 weeks before the target quit date (TQD) or to receive placebo for 3 weeks before the TQD, followed by varenicline for 1 week before the TQD. In both groups, standard varenicline treatment was given for 3 months after the TQD. Measures included smoking satisfaction and smoke intake before quitting, urges to smoke and withdrawal discomfort after quitting, and sustained abstinence from the TQD to 3 months.

Results Varenicline preloading reduced prequit enjoyment of smoking (P = .004) and smoke intake (P < .001), with 36.7% of participants reducing their cotinine concentrations by more than 50% (reducers). Varenicline preloading did not affect postquit withdrawal symptoms, but it increased 12-week abstinence rates (47.2% in the varenicline arm vs 20.8% in the placebo arm, P = .005). The effect was particularly strong among the reducers in the varenicline arm (66.7% in reducers vs 22.6% in nonreducers, P = .002). Varenicline preloading was well tolerated.

Conclusions Although several issues remain to be clarified, varenicline preloading can generate a substantial reduction in ad lib smoking and enhance 12-week quit rates. Current treatment schedules may lead to suboptimal treatment results. Trials with longer follow-up periods are needed to corroborate these findings.