Of all the quit-smoking products to have come on to the market in recent years, varenicline - most commonly known by its brand name Champix - remains one of the most effective. While the side-effects can be extreme for a small minority of people, the pay-off is worth it, reveals one former smoker.
Sam Cherrington can still recall his first puff of a cigarette. He was 14 years old, with a group of classmates, atop the chalk hills of the South Downs on a school geography trip.
With that familiar cocktail of peer pressure and teenage rebellion, so Cherrington began his life as a smoker. A cadged cigarette here and there soon became a pack-a-day habit shortly after he turned 16.
By the time he was 30, Cherrington, a London-based graphic designer, was smoking up to 40 cigarettes a day. It was only upon the announcement that his partner was expecting their first child - accompanied by frequent shortness of breath - that he sought to quit for good.
Nicotine-free, taken in tablet form, Champix works by reducing the craving and withdrawal symptoms associated with giving up smoking. Cherrington was sold.
"The real clincher was that it didn't contain nicotine, as I didn't want to replace one form of nicotine with another, as I had done in the past with the patches and gums," he says.
Although many would-be quitters, like Cherrington, worry that using nicotine replacement treatments (NRT) such as patches and e-cigarettes means swapping one addiction for another, this isn't really true. The nicotine levels in licensed nicotine-containing products are much lower than in tobacco, and the way they deliver nicotine makes them less addictive than smoking.
More importantly still, they are very much safer than cigarettes - Dr Sarah Jarvis, GP and clinical director of Patient.info, points out: "Even when I was a medical student 30 years ago, we were taught that 'people smoke for the nicotine, but die from the tar'. The national guidance from NICE has changed in recent years, to suggest doctors should be recommending that people can use nicotine-containing products for as long as needed to prevent relapse, rather than simply in a course for a few weeks. They greatly increase the likelihood of quitting successfully compared with going cold turkey, especially if combined with expert support."
Sick and tired
Put on a 12- to 24-week course - the recommended duration - Cherrington's spirits were high when he began his course of treatment in May 2012. For the first three days, he was required to take one tablet a day, after which it became two. It was then that he was hit "like a juggernaut" with extreme nausea - the most common side-effect associated with Champix.
"I had been warned about it, but nothing prepares you for how miserable it actually is," he says. "I feel sick even thinking about it. It got so bad that I seriously considered giving up after the first week. It also impacted my sleep."
According to Dr Alex Bobak, a GP based in Wandsworth, south London - and one of the UK's foremost smoking cessation experts - roughly 30% of those prescribed varenicline report symptoms of nausea when the dosage goes up to one milligram, administered twice a day. There are, however, things that can be done to counter its impact.
"One of the best things you can do is line your stomach at breakfast," he says. "Also, one of the benefits of varenicline is that it has no known drug interaction, so you are able to use anti-nausea tablets in addition without any problem at all.
"I would say though that there is occasionally some confusion as to the side-effects between stop-smoking medications and nicotine withdrawal effects, which can be pretty awful from both a physical and psychological point of view. There's a lot of overlap."
Most effective treatment
In general, though, people tend to be able to cope with side-effects if they are given a 'heads-up' beforehand, argues Bobak, who has been an advocate of Champix since it was first licensed in the UK back in 2006.
Patients also need to keep in mind Champix's efficacy and success rate. According to a study, comparing varenicline to a placebo on 100 people, around 21 people who took the former stopped smoking, compared to just eight with the dummy drug. In other words, Champix almost trebled the rate of success.
"This is the most effective treatment for smoking cessation," affirms Bobak.
However, misconceptions still abound around prescription stop-smoking drugs, such as Champix - and Zyban (Bupropion). While Cherrington turned to varenicline after having "tried everything else", it should not be seen as a 'last-resort' medication, reveals Bobak.
"All treatments are equal and first-line, whether it's Champix, Zyban or a combination of nicotine replacement therapies," he says. "Given that we're talking about one of the most powerful common addictions going, it's absolutely paramount that people are given options."
Of course, Champix doesn't make you stop smoking. You still need the determination to succeed in order to break the habit. That's why it's a good idea to combine stop-smoking medication with counselling from your pharmacist to increase your chances. You can self-refer to your local stop-smoking service and speak with an advisor who will help you find the best method for you.
In the end, Cherrington remained on Champix for six months, having eventually acclimatised to the nausea by eating "breakfasts of epic proportions", as Bobak recommends. He has not smoked a cigarette for seven years. Does he credit this success to the medication? "Yes," he says, without missing a beat.