Stop Smoking

Varenicline, from about $89 for the starting pack, and it is taken differently from almost everything else here: you keep smoking for the first week. The tablet is started one to two weeks before a chosen quit date, titrated upward over the first days, and the quit date falls after the drug has reached steady state. Starting it on the morning you stop wastes most of its advantage.

It works on two fronts at once. By partially stimulating the nicotine receptor it blunts withdrawal; by occupying that receptor it makes a cigarette smoked during treatment markedly less rewarding. That dual action is why head-to-head trials have generally placed it above nicotine replacement and bupropion on abstinence at twelve months.

Nausea is the common complaint and it is dose-related and food-related — taking the tablet after a full meal with a large glass of water removes it for most people. Vivid, strange dreams are frequent and harmless. The neuropsychiatric warnings that once dominated the label were substantially revised after a large randomised safety trial, but mood change, agitation or any emergence of suicidal thinking remains a reason to stop and contact the prescriber the same day rather than wait.

A full course runs twelve weeks, and the relapse data strongly favour completing it rather than stopping as soon as cravings fade.

Choosing a quit date that will hold

The schedule builds the quit date into the treatment: tablets start one to two weeks before it, and by the time it arrives the drug is at steady state and cigarettes have usually become less satisfying. Picking the date well matters — avoid a week containing a known stressor, tell the people around you, and plan what replaces the cigarette in the situations where it was automatic.

A lapse after the quit date is not a failure and is not a reason to stop the tablets. Most successful quitters have lapsed; the ones who do badly treat a lapse as proof the attempt is over.

Making the course tolerable

Nausea affects about a third of users and is the commonest reason for stopping early. Taking each dose after a full meal with a large glass of water resolves it for most people; reducing to 0.5 mg twice daily resolves most of the rest while remaining effective. Vivid dreams are frequent, harmless, and often the thing people remember most.

What improves the odds beyond the medicine

Behavioural support roughly doubles the chance of success on top of medication, and the combination outperforms either alone. Book it before the quit date rather than after a lapse. Remove cigarettes, lighters and ashtrays on the day. Change the routines that contained smoking rather than trying to resist them unchanged. And plan for alcohol, which is the commonest single trigger for a first cigarette.

One benefit rarely mentioned: smoking is an independent risk factor for erectile dysfunction through vascular damage, and improvement after stopping is measurable within months in younger men.

Mood, dreams and what to report

Vivid or disturbing dreams are the most frequently reported effect of varenicline and are usually tolerable; taking the evening dose with the evening meal rather than at bedtime helps. Mood is the one to watch properly. Agitation, low mood, unusual irritability or any thought of self-harm during the course needs to be reported promptly, particularly in anyone with a history of depression. The large trials found the overall risk lower than earlier warnings suggested, but the individual exceptions are what matter to the individual. Nicotine withdrawal itself also lowers mood for the first fortnight, which makes telling someone close to you what to look out for more useful than monitoring yourself.