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Smokers now have Help

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A new medication, varenicline, promises to help smokers who are keen on quitting the habit, to do so with ease and comfort.
Quitting smoking can be hard for smokers as nicotine, the substance in tobacco that gets you hooked, is one of the most addictive substances known to man.  Stopping suddenly is sometimes associated with intense craving, mood swings, abnormal behaviour and depression making smokers continue with their habit indefinitely till a major health event like heart attack or cancer shakes them out of it.
The addictive effect of smoking is due to nicotine that gets attached to a site in the brain called alpha-4-B-2 receptor and triggers neurochemical pathways that provide the sense of pleasure that go with it. Varenicline works by geting attached to the same site in the brain, thereby blocking nicotine from getting to it. Why Varencline particularly seems to work is because apart from blocking nicotine, it exerts a mild stimulatory effect of its own, just enough to prevent symptoms of craving and withdrawal, but not strong enough to serve as a nicotine replacement.
The beneficial effects of Varenicline have been proven in studies involving more than 4000 smokers who were given either the drug or a placebo (non-active similar looking pill) in a blinded manner, with quitting rates being 3 times higher in those getting the drug.
Manufacturers recommend a slow build-up with 0.5 mg of the drug once and then twice daily for a week, and then to the normal dose of 1.0 mg twice a day for 12 weeks. The “muhurat” or “target quit date” should be around the 7th to 10th day. The 11 weeks of therapy that follows provides the transition to a “smoke free” life. The drug is expensive, therapy costing around Rs 7000/-., but one could argue that it is less than the cost of cigarettes and the health bills due to smoking . Never the less it is an additional burden for a well meaning puffer who seems to have recently acquired good sense and intention to transform himself.
Does it work with those addicted to other forms of tobacco such as Gutka? It should, theoretically, but direct hard proof from research studies of its usefulness in Indian Gutka chewers is lacking.
Of equal concern is that all those who take the drug do not succeed in quitting tobacco. The answer here is easy though. Without adeqaute motivation and will power, no drug or strategy ever works. As they say, “You can take a horse to the water but can’t make it drink”. If you seriously wish to quit, you surely can. 
As published in HT City ( Hindustan  Times ) dated 7 november , 2010.
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