The High Cost of Quitting You've probably seen the new advertising campaign for Chantix, the drug that reduces a smoker's desire for cigarettes. The ads are based on the tortoise and the hare fable, and the metaphor is clear: Chantix will help smokers knock out the craving - all they need to do is be like the tortoise and stay the course. The Chantix print advertisement is so cute (with an adorable smile photoshopped onto the tortoise's mug) that kids will probably ask their parents if they can take Chantix. My advice to those kids: Just say no. Adults might want to consider that option as well. I first told you about Chantix in the spring of 2006, just as Pfizer was preparing to launch the new drug. At that time, all systems were go based on long-term studies that found Chantix to be effective for about 20 percent of subjects, compared to only 16 percent of subjects who used Zyban, another smoking cessation drug. Unlike nicotine-replacement drugs, Chantix takes the opposite strategy, blocking nicotine from binding to certain brain receptors. This action keeps nicotine from prompting the release of dopamine in the brain's pleasure centers - derailing the craving for another cigarette, and another, and another… As you might suspect, Chantix users pay the piper with the risk of side effects. Common side effects listed on the Chantix web site include nausea, constipation, gas, vomiting and changes in dreaming. (No specifics about what those "changes" might be.) But that list just gets things started. Side effects listed as "frequent," include diarrhea, gingivitis, chest pain, back pain, dizziness, anxiety, depression, emotional disorder, polyuria (excessive urination), menstrual disorder, and hypertension. That's a pretty daunting list, considering the drug is only effective in the long term for about one in five users. But on the upside, a few Chantix users may feel like they've hit the jackpot with an infrequent side effect described this way: "Fewer than 1 out of 1,000 patients reported euphoria." For some smokers it might end up being easier to kick the cigarette habit than give up Chantix-induced euphoria. Since the launch of Chantix, the side effect that's emerged as the most troubling is "emotional disorder." Last month, the FDA issued a warning to healthcare professionals, alerting them to "reports of suicidal thoughts and aggressive and erratic behavior in patients who have taken Chantix." According to the warning, many of these cases will experience "depressed mood, suicidal ideation, and changes in emotion and behavior within days to weeks of initiating Chantix treatment." The warning also directs doctors to monitor patients taking Chantix for behavior and mood changes, and cautions patients to be careful when driving or using heavy machinery. And yet, in a three-page Chantix advertisement that appears in an issue of a popular magazine published this month, the caution about driving and using machinery is noted, but there's no mention of behavioral changes, depression, or suicidal ideation. Chantix is sure to be a popular drug, so if you know any smokers who are thinking of taking it, fill them in on this disturbing side effect they might not be aware of. Better yet, let them know there are safer techniques to help them put down their cigarettes and never look back. In the e-Alert "Smoke Gets In Your Eyes" (11/8/07), I looked at three smoking cessation therapies that don't require drugs to be effective. You can find that e-Alert at this link: http://www.hsibaltimore.com/ealerts/ea200711/ea20071108a.html Source:
"2007 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements" MedWatch, U.S. Food and Drug Administration, Chantix item posted 11/20/07, fda.gov | 
