Stop Smoking
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Smoking cessation refers to the process of discontinuing tobacco smoking. Tobacco smoking is one of the leading causes of preventable death worldwide, associated with numerous health risks including cancer, heart disease, stroke, and respiratory conditions. Quitting smoking significantly reduces these health risks and improves overall wellbeing. However, smoking cessation can be challenging due to the highly addictive nature of nicotine, which creates both physical dependence and psychological habituation. The addiction cycle is reinforced through biological, psychological, and social factors that can make quitting difficult without appropriate support and treatment strategies.
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When attempting to quit smoking, most people experience withdrawal symptoms due to nicotine dependence. Common symptoms include intense cravings for tobacco, irritability, anxiety, difficulty concentrating, restlessness, increased appetite, and sleep disturbances. These symptoms typically begin within a few hours of the last cigarette, peak within the first week, and gradually subside over 2-4 weeks, though some psychological cravings may persist longer. The severity of withdrawal varies considerably between individuals and can be influenced by factors such as the duration and intensity of smoking, genetic predisposition, and concurrent stress levels. Many people report mood changes including depression, frustration, and anger during the withdrawal period.
Stop Smoking FAQs (4)
Varenicline offers a unique dual mechanism of action that differs from other smoking cessation medications. As a partial agonist of nicotinic acetylcholine receptors, it partially stimulates these receptors, providing some dopamine release (about 30-60% of what nicotine would provide) which helps reduce withdrawal symptoms and cravings. Simultaneously, it blocks nicotine from fully activating these receptors if smoking occurs, reducing satisfaction from cigarettes. This contrasts with nicotine replacement therapy, which simply provides nicotine without tobacco toxins, and bupropion, which works primarily on dopamine and noradrenaline neurotransmitter systems. Clinical trials consistently show varenicline has superior effectiveness, with abstinence rates approximately 2-3 times higher than placebo and significantly better than both nicotine replacement therapy and bupropion.
While varenicline is highly effective, it's not appropriate for everyone. It's contraindicated during pregnancy and breastfeeding, and alternative approaches are preferred for young people under 18. Dosage adjustments are necessary for people with severe kidney impairment. Those with a history of cardiovascular disease can use varenicline, but should be monitored as some studies suggest a small increased risk of cardiovascular events. People with serious psychiatric conditions can use varenicline, but should be monitored for mood or behaviour changes, particularly during the first few weeks of treatment. Varenicline is not suitable for those with rare hereditary galactose intolerance disorders. The medication has minimal interactions with other drugs, making it appropriate for people on multiple medications. For most adult smokers without these specific contraindications, varenicline is considered a first-line option due to its superior effectiveness. Your GP or smoking cessation specialist can help determine if varenicline is appropriate based on your specific health history and needs.
Varenicline and e-cigarettes represent different approaches to smoking cessation. Varenicline has robust evidence from numerous clinical trials demonstrating its effectiveness and safety, with 12-week quit rates around 44% (compared to 18% for placebo). It treats the neurochemical addiction directly but requires prescription and has a defined treatment duration. E-cigarettes, while increasingly popular, have more varied and evolving evidence. They can be effective for some smokers, particularly when used exclusively rather than alongside traditional cigarettes. E-cigarettes provide nicotine along with the behavioural rituals of smoking, which some find helpful. Unlike varenicline, they're readily available without prescription and may be used long-term. While generally considered less harmful than smoking, the long-term safety profile of e-cigarettes is still developing. Some smokers successfully use both approaches—varenicline to address physical dependence while occasionally using e-cigarettes in high-risk situations.
If varenicline doesn't work for you or causes intolerable side effects, several alternative approaches are available. First, consult your healthcare provider about dosage adjustment—sometimes reducing to 0.5mg twice daily improves tolerability while maintaining effectiveness. If nausea is problematic, taking the medication with food and plenty of water may help.