Antidote: Chantix

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One out of five Americans still smokes, and smoking leads to cancer and heart disease. It is also known that quitting smoking cuts down on the risks of these killers dramatically.

Helping patients to quit smoking is an art. Some do it cold turkey, some need Chantix, some respond to Wellbutrin (an antidepressant) and some do well with the nicotine products (patch, gum, nasal spray or lozenge). Because of this variance, it is important for me to have several arrows in my therapeutic quiver, and Chantix, a nicotine blocker, is an important arrow.

I prescribe Chantix cautiously, and avoid it in patients who are anxious, have difficulty sleeping, or have a history of psychiatric problems. The drug isn't for everyone. But different methods work for different patients, and Chantix is an important option. At least 20-40% of patients respond to Chantix, many of whom do not respond to other treatments.

Now along comes a new report from Johns Hopkins published in July's Canadian Medical Association Journal, reviewing 14 previous studies on Chantix involving 8,200 smokers or users of smokeless tobacco, 4900 of whom took Chantix. The report uncovered a 72% increased risk of a heart attack, stroke, or other cardiac event in patients who took Chantix, which translates into 1% of the users.

But this is a very small risk when compared to the risk of smoking. And it also isn't clear whether it was the Chantix itself or something about the users of the drug or another factor that led to the slightly increased risk of a cardiovascular event. The report raises an eyebrow, but in my opinion should neither stop nor significantly slow use of such an important drug.

Amid the usual media hype and overzealous targeting of an important treatment, it is important to remember that smoking is the problem, not Chantix.

Marc Siegel MD is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is author of the new book, The Inner Pulse; Unlocking the Secret Code of Sickness and Health

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