Chantix

by Dr. Antonio Howell, MD

in Blog

Dr. Howell

Chantix and the patch used in combination

I cannot seem to quit with just one non-smoking aid at a time. I was successful once before when I took a high daily dosage of Wellbutrin and wore the patch at the same time. Can I wear the patch and take Chantix at the same time? -DW

Dear DW,

Chantix works by reducing the smoker’s craving for nicotine by binding to receptors in the brain and reducing the symptoms of withdrawal. Chantix (varenicline) also reduces the satisfaction a smoker receives when smoking a cigarette.


Clinical trials to date have shown that Chantix is more effective than currently available oral antismoking prescription medicines. In trials, 44% of the group treated with Chantix had stopped smoking after being treated for 12 weeks, as opposed to 11% of smokers taking the placebo.

Over the same duration, it was also shown that Chantix is twice as effective as the other leading non-nicotine replacement smoking cessation drug. So Chantix, or varenicline, works well alone but you should always talk with your doc first to avoid mixing meds that can harm you.

Chantix and nicotine (the active ingredient in the patch) work on the same cell receptors in your brain. Imagine a bio-chemical game of musical chairs.

Chantix and nicotine compete with each other for the same “seat”. And by “sitting” on these specific receptors in your brain they satisfy your urge to smoke.


According to PFIZER:

Nicotine replacement therapy (NRT) (aka the patch): Although co-administration of varenicline (1 mg BID) and transdermal nicotine (21 mg/day) for up to 12 days did not affect nicotine pharmacokinetics, the incidence of nausea, headache, vomiting, dizziness, dyspepsia and fatigue was greater for the combination than for NRT alone. In this study, eight of twenty-two (36%) subjects treated with the combination of varenicline and NRT prematurely discontinued treatment due to adverse events, compared to 1 of 17 (6%) of subjects treated with NRT and placebo.

Three things you should know about doing this DW:


  1. More stimulation of the nicotine receptors (the “seats”) in your brain may mean more side effects. You may have unpleasant feelings like nausea, headaches, vomiting, dizziness, flushing, and more.
  2. In a Pfizer study 8 out of 22 who took the two med combo (Chantix plus nicotine patch) had to stop because of the side effects.
  3. The long term effects of using these two meds together is not known.

Bottom line DW: Combining Chantix and the patch may work but be prepared to feel really sick.

FOR MORE INFO ABOUT CHANTIX OR NICOTINE PATCH SIGN-UP FOR EMAIL UPDATES

WHAT TO DO IF THIS DOESN’T WORK? DW tried Chantix alone and it did not work him. What if the Chantix + patch med combo does not work either?

What should you do then? Here is a suggestion inspired by a New England Journal of Medicine (NEJM) article I read that talks about using ZYBAN and the patch together. These two meds together, Zyban (bupropion) plus the patch worked well for most patients.

Always remember to talk to your doc first. A positive side effect of using the Zyban + patch combo is less weight gain. Only 1.1 kg or 2.42 pounds gained with this combo vs. 2.37 kg or 5.31 pounds.

Bottom line: Those who used Zyban + patch successfully quit smoking AND had 53% less weight gain than patients who used Chantix alone.

Update: Reported cases of patients successfully using two med combo

Jon O. Ebbert, Michael V. Burke, J. Taylor Hays, and Richard D. Hurt. Combination treatment with varenicline and nicotine replacement therapy. Nicotine Tob Res (2009) 11(5): 572-576.

A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. Jorenby, Douglas E; et al. 1999 NEJM Vol. 340 Num. 9

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{ 2 comments… read them below or add one }

1 Tracy November 20, 2011 at 8:28 pm

If you are using the nicotine patch and are on the 14mg patch and have been on it for one week and started the chantix when should you stop the patch and can you take cymbalta while on chantix to help to avoid the depression aspect of the side effects?

2 Dr. Antonio Howell, MD November 20, 2011 at 10:42 pm

Hello Tracy,

That is a great question. The limits of wearing the patch and taking Chantix depend on and how you feel while taking them. Bear in mind that by using both you may experience a little more upset stomach symptoms, nausea, etc. Therefore, the side effects increase a bit. You can slowly wean yourself off the patch for example 14 one week then down to seven another week and nothing afterwards. You could do this faster or slower again depending on how you feel.

The key is to realize that you are free from cigarettes. In addition, you should never look back at cigarettes as something you are missing out. You should look forward at the joy of being finally free and feel yourself happy.

I see no reason why you cannot continue your Cymbalta if you were already on it. Make sure you let all of your doctors know you are on Chantix just so they know to watch you for any side effects.

Above all Tracy pat yourself on the back for taking the positive step of quitting. You are an inspiration to everyone around you and to our readers as well. Thank you.

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