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Tag Archives: Addiction

Smoking is the most preventable cause of disease and death. In Canada, 45, 000 people die annually, and as many as half of all smokers will die due to tobacco use. Smoking is known to cause various types of cancer, COPD, heart disease, stroke and many other conditions such as influenza, peptic ulcers, osteoporosis, thyroid disease and cataracts. Despite the known risks, there are approximately 5 million Canadian smokers. Nicotine is the addictive chemical component in tobacco. It binds to the ‘reward’ receptors in the brain, which help people relax, improve mood and suppress appetite. Due to the continued stimulation of the reward pathway, people continue to smoke.

There are 2 primary options to smoking cessation; Cold Turkey or Medication. There have been many success stories of patients able to quit cold turkey, however it is much more difficult and shown to have an increased rate of relapse. It may be the most cost effective option, but these people suffer greatly from nicotine withdrawal symptoms, which include irritability, anger, restlessness, impatience, difficulty concentrating, depression and anxiety. These symptoms often start just a few hours after the last cigarette and are known to persist for weeks and months. Medications are available to help decrease these withdrawal symptoms, reduce the urge to smoke and help ease the patient to a continued smoke-free life.

Nicotine Replacement Therapy (NRT) is available over-the-counter in 4 forms; gum, patch, inhaler, and lozenge. There are different dosages available which is dependent on the amount of cigarettes the individual smokes. If you have questions regarding which dose you should start on and the proper technique to use the NRT, please speak to your pharmacist for assistance.

NRT provides nicotine in a safe form so the body does not have to endure nicotine withdrawal while a person adapts to not smoking. As opposed to cigarettes, NRT are medications that contain only nicotine and not the other harmful chemicals that are present in cigarettes. NRT is considered a ‘step down’ approach where the patient is exposed to a gradual decrease in the amount of nicotine in the blood. This enables the body to adjust to the changes in a slow and steady manner and experience less side effects.

The general length of therapy is 12 weeks, however this is NOT set in stone. It is also common practice to combine different forms of NRT such as using the patch and chewing gum. Some common side effects of the NRT include nausea, insomnia and local irritation if using the patch or inhaler.

The most commonly prescribed medication available for smoking cessation is Champix (Varenicline). Champix has recently been shown to have great success for smoking cessation. It works by binding to the same receptors as nicotine, which results in decreased cravings and withdrawal symptoms. Additionally, it decreases the pleasure that people get from smoking making the quitting process that much more effective.

The starting dose is 0.5mg once daily for the first 3 days, then 0.5 mg twice daily for the next 4 days, then 1mg twice daily thereafter. People are on Champix for 12 weeks, however many continue treatment for an additional 12 weeks to prevent smoking relapse. It should be taken with a glass of water with or without food. Common side effects include nausea, trouble sleeping and headache.

Caution: A patient may notice changes in their behavior, feeling depressed, agitated or not themselves. If this does occur, it is important to contact the physician.

Although there are medications and therapeutic options available, the single most important smoking cessation aid is a patients’ will and determination to quit. Having confidence and a support system are important for a smoker to kick the habit. Some other options for smoking cessation include hypnosis, counselling (individual and/or group), acupuncture, keeping busy, exercise (joining the gym or a class), or starting a new hobby. Studies have demonstrated that combining medication with advice or behavioural therapy increases the quit rates of up to 6 times. There are many support systems out there and available to help through the difficult time and it is important to know there is a light at the end of the tunnel.

“ The achievement of your goal is assured the moment you commit yourself to it” Mack R. Douglas.

Pharmacists are a great resource for information and support on your journey to quit smoking. Please come in and talk to us if you have any questions about smoking cessation.

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Unfortunately mixing alcohol with certain types of prescription medications can be dangerous.  Alcohol can increase the risk of severe CNS depression when taken with opioids, benzodiazepines and barbituates.  Alcohol can also affect drug metabolism (breakdown to active components), or the absorption of some drugs. Chronic alcohol intake can also cause problems with certain medications because of the effect it has on the liver and specific drug metabolizing enzymes.

Chronic alcohol use increases acetaminophen (Tylenol) metabolism increasing its conversion to metabolites toxic to the liver.  It is always best not to exceed four grams of acetaminophen a day, especially if you are a heavy or binge drinker because of the damage it can due to your liver.

Chronic alcohol use along with NSAIDS (Ibuprofen) or aspirin can increase the risk of GI bleeds.  However, an occasional drink with NSAID use is not likely an issue.

If you are a patient on warfarin alcohol can inhibit warfarin metabolism and increase your INR.  If you change your usual alcohol intake you should have your INR checked.

Certain antibiotics, and in particular metronidazole, has the potential when mixed with alcohol to make people quite ill.  When taken to together a patient may experience low blood pressure, shortness of breath, facial flushing, and nausea.

Diabetic patients taking hypoglycemics such as Glyburide or insulin are at risk of severe hypoglycemia (low blood sugar) when they drink alcohol.  These patients should limit alcohol to an occasional single drink.

Any patient on medication for sleeping should be careful of alcohol consumption because of the additive affects of drowsiness and respiratory depression.    Patients have been known to aspirate their own vomit and die from intoxication.  This could be more likely to happen if a person mixes alcohol with their sleep medication.

This same problem could exist when patients mix alcohol and opiates.

It is always wise to consult your pharmacist or physician if you receive a new prescription and intend to have a few alcoholic beverages.  Also please notify your physician or pharmacist if you are a chronic drinker.  Even if you are not planning to drink while taking your prescription previous liver damage could affect how well you metabolize your medication.  This could result in too high, or too low a dose for you.

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