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Wellbutrin vs Chantix
Introduction
Wellbutrin is a norepinephrine, dopamine reuptake inhibitor (NDRI), and nicotinic acetylcholine (NACH) receptor antagonist. In contrast, Chantix is a partial nicotinic acetylcholine (NACH) receptor agonist. Both drugs block neuronal acetylcholine nicotinic receptors but target different receptors and act in different ways, with Wellbutrin blocking alpha(3)beta(2), alpha(4)beta(2), and alpha(7) nicotinic receptors and Chantix partially blocking alpha4/beta2, weakly blocking alpha3beta2 and alpha6-containing, and completely blocking alpha (7) nicotinic receptors.
About Wellbutrin and Chantix
What is Wellbutrin?
Bupropion (The generic name for Wellbutrin) is a nicotinic receptor antagonist and a norepinephrine and dopamine reuptake inhibitor (NDRI). That means it blocks the reabsorption of norepinephrine and dopamine back to the brain from the bloodstream. It is also a mild nicotinic acetylcholinergic receptor antagonist. That means Wellbutrin takes the place of acetylcholine at nicotinic acetylcholinergic receptors. 1986 saw the FDA's initial approval of Bupropion.
In a way, Bupropion traps certain neurotransmitters, namely norepinephrine, dopamine, and acetylcholine, in the brain for longer periods. It is from a class of medications known as atypical antidepressants. It belongs in this category as it works differently from common antidepressants and has milder side effects.
What conditions is Wellbutrin approved to treat?
The FDA approves Wellbutrin to treat smoking cessation. It is used to prevent the relapse of patients who have attempted to quit smoking.
How does Wellbutrin work for Smoking Cessation?
Wellbutrin helps to quit smoking by reducing nicotine withdrawal symptoms in the patient. Nicotine stimulates the brain's reward pathway by attaching itself to receptors on neurons, causing the release of dopamine, the reward neurotransmitter. Over time, the continuous or repetitive stimulation of nicotine receptors creates dependence in the brain. Once you stop smoking, the withdrawal causes symptoms like irritability and headaches with an intense craving for nicotine.
Wellbutrin prevents the reuptake of dopamine and epinephrine in the brain and essentially traps them in the brain for longer periods. This eases withdrawal symptoms by maintaining the presence of dopamine, which is involved in the reward pathway for nicotine, blocking nicotine antinociception.
Wellbutrin also eases the symptoms of nicotine withdrawal through nicotine receptor antagonism. This is when it binds to receptors that acetylcholine molecules would have bonded with, similarly to the way nicotine does.
What is Chantix?
Varenicline (the generic name for Chantix) is the world’s first approved partial nicotinic receptor agonist. It is a type of medicine that stimulates the brain's reward pathway by selectively attaching itself to nicotinic receptors located presynaptically on neurons.
This way, it stimulates the neurons as if it was acetylcholine or nicotine, taking the place of certain neurotransmitters and encouraging the production of another neurotransmitter, dopamine. The FDA approved Chantix in 2006. It is relatively new, and its long-term effects are still unknown. However, it is a highly promising drug in its class.
What conditions is Chantix approved to treat?
The FDA approves Chantix as an aide for smoking cessation. It is one of the only two FDA-approved medications for smoking cessation which do not contain nicotine.
How does Chantix work for Smoking Cessation?
Nicotine is a partial nicotinic acetylcholinergic receptor agonist, just like Varenicline. It binds with nicotinic acetylcholinergic receptors found on neurons in place of acetylcholine and partially stimulates the receptor, unlike a nicotinic acetylcholinergic receptor antagonist, which binds to the same site but does not stimulate the receptor. Binding with the nicotinic acetylcholinergic receptor polarizes the neuron's cell membrane and carries a nerve impulse, releasing dopamine.
Chantix is also a partial nicotinic acetylcholinergic receptor agonist. It stimulates the neuron membrane the same way that nicotine would, but at a much smaller scale. Therefore, it produces a neurotransmitter involved in the nicotine reward pathway, dopamine, but in a much smaller amount. However, this small amount of dopamine is enough to curb the cravings for nicotine and ease withdrawal symptoms. Chantix is also offered alongside NRT or Nicotine Replacement Therapy as a form or combination therapy.
Effectiveness
How effective are Wellbutrin and Chantix for treating Smoking Cessation?
Both Wellbutrin and Chantix have clinically proven success in preventing people who quit smoking from relapsing. They both interfere with the nicotine reward pathway and block nicotinic acetylcholinergic receptors. However, Wellbutrin inhibits dopamine reuptake and blocks nicotinic receptors without stimulating a response in the neuron cell membranes. In contrast, Chantix stimulates dopamine by blocking the nicotinic receptors and eliciting a response in the neuron cell membrane the same way nicotine does on a lower level. In short, Wellbutrin is a nicotinic acetylcholinergic receptor antagonist, while Chantix is a nicotinic acetylcholinergic receptor agonist.
Wellbutrin has mild antagonistic properties and maintains dopamine in the bloodstream. However, it does not completely replace nicotine in the nicotine reward pathway as Chantix does. Unlike Chantix, Wellbutrin has the additional action of norepinephrine and dopamine reabsorption inhibition, making it effective for long-term smoking cessation despite relatively mild nicotinic receptor antagonism. Therefore, Chantix is considered the better option, especially in short-term treatment. Chantix was shown to have a higher efficacy rate in the first four weeks, 44.0%, versus a Placebo with 17.7% and Slow Release Bupropion having 29.5%. However, the difference becomes negligible in the long term.
Wellbutrin is known to have the same efficacy as Nicotine Replacement Therapy (NRT) while Chantix is more efficacious than standard-dose Nicotine replacement therapy due to its agonistic action on the nicotinic receptors in the brain. However, Chantix is as effective as high-dose Nicotine Replacement Therapy (NRT) but is still considered the most effective form of mono-therapy.
Several pragmatic observational studies and randomized explanatory studies have proven that 1 out of 5 smokers will abstain from smoking in one year using Wellbutrin. Chantix has been proven to be the best mono-treatment available for smoking cessation.
Side Effects
What are the most-common side effects of Wellbutrin?
The most common side effects of Wellbutrin include:
- agitation
- dry mouth
- insomnia
- headache
- nausea
- vomiting
- constipation
- stomach pain
- dizziness
- ringing in the ears
- vision problems or blurred vision
- loss of interest in sex
- sore throat
- muscle pain
- itching or skin rash
- increased sweating
- increased urination
- tremor
- changes in appetite
- weight loss or gain
- joint aches
- strange taste in the mouth
- diarrhea
- seizures (especially at higher doses).
Are there any potential serious side effects of Wellbutrin?
* If you experience any of these serious side effects, seek medical help immediately
Potentially serious side effects of Wellbutrin are:
- seizure (convulsions)
- confusion
- unusual changes in mood or behavior,
- blurred vision
- tunnel vision
- eye pain or swelling
- seeing halos around lights
- fast or irregular heartbeat
- racing thoughts
- increased energy
- reckless behavior
- feeling extremely happy or irritable
- talking more than usual
- severe problems with sleep
- severe headache
- confusion
- slurred speech
- arm or leg weakness
- trouble walking
- loss of coordination
- feeling unsteady
- very stiff muscles
- high fever
- profuse sweating, or tremors
What are the most-common side effects of Chantix?
Common side effects of Chantix include
- nausea (may persist for several months),
- stomach pain,
- indigestion,
- constipation,
- gas,
- vomiting,
- headaches,
- weakness,
- tiredness,
- unusual dreams,
- sleep problems (insomnia),
- headache, dry mouth, or
- unpleasant taste in your mouth.
Are there any potential serious side effects of Chantix?
* If you experience any of these serious side effects, seek medical help immediately
Potentially dangerous side effects of Chantix include
- burning feeling in feet/toes,
- unusual pain in the legs when walking,
- seizure (convulsions),
- thoughts about suicide or hurting yourself,
- restlessness,
- strange dreams,
- sleepwalking,
- trouble sleeping,
- mood or behavior changes
- depression,
- agitation,
- hostility,
- aggression,
- chest pain or pressure,
- pain spreading to the jaw or shoulder,
- nausea,
- sweating,
- sudden numbness or weakness,
- slurred speech, and
- problems with vision or balance
Contraindications and interactions
Warnings and general precautions for Wellbutrin and Chantix
Both Wellbutrin and Chantix are contraindicated for people who have seizure disorders. They are not FDA-approved for patients younger than 18 years old. There is not enough sufficient data indicating whether Wellbutrin or Chantix is safe for consumption by pregnant and or breastfeeding women. While a major link with birth defects has not been detected, it is generally recommended not to use them.
Contraindications and important interactions for Wellbutrin and Chantix
Contraindications
Wellbutrin
Individuals with Bulimia Nervosa should not take Wellbutrin
Individuals with Anorexia Nervosa should not take Wellbutrin
Individuals with Hypertensive disease should not take Wellbutrin
Chantix
You should not take Chantix if you have adverse skin reactions to Chantix
Drug/Medication Interactions
Wellbutrin
Do not take Wellbutrin if you’re taking Benzodiazepines
Do not take Wellbutrin if you have abruptly ceased taking antiepileptic drugs
Aripiprazole (Abilify)
Amphetamine/methamphetamine (Adderall)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Quetiapine (Seroquel)
Tramadol
Trazodone
Sertraline (Zoloft)
Fluoxetine (Prozac)
Chantix
Chantix has no known Drug/Medication Interactions
Food/Beverage/Supplement Interactions
Wellbutrin
Wellbutrin should not be combined with caffeinated drinks
Wellbutrin should generally not be combined with alcohol, as it may increase your risk for seizures. If you are prone to drinking alcohol, speak about this interaction with your doctor
Chantix
Cost Comparison
How much do Wellbutrin and Chantix cost?
Wellbutrin has generic forms available, which offer significant cost savings.
For the brand name versions of Wellbutrin:
The price of 60 tablets of Wellbutrin SR (100 mg) averages around $500, which works out to $16–32/day, depending on your dose.
For the generic version of Wellbutrin (bupropion), costs are significantly lower. Bupropion (100 mg tablets) is available in packs of 30 capsules and above, with approximate costs of $0.25 to $0.80 per day for dosages of 100 mg/day, or between $0.50 and $1.50 per day if you are taking more typical dosages of 200 to 300 (or even 450) mg/day.
A single 1mg tablet for Chantix is $2.61, totaling $156.6 for 60 pills. Starting and continuation packs are available for $148.5.
If you have a higher dosage of Wellbutrin, then Chantix is the less expensive option. However, price is not the only consideration when choosing the appropriate drug.
Popularity of Wellbutrin and Chantix
So far, Chantix has been proven more effective than Wellbutrin, but it is still prescribed less often than Wellbutrin. Due to its less expensive price and promising short-term results, Chantix is growing in popularity.
Conclusion
Takeaway
Wellbutrin and Chantix both interfere with the nicotine reward pathway of the brain. Wellbutrin is a norepinephrine, dopamine reuptake inhibitor, and mild nicotinic acetylcholinergic receptor antagonist, while Chantix is the world’s first partial nicotinic acetylcholinergic receptor agonist.
Nicotine stimulates acetylcholine receptors on neurons, causing the secretion of dopamine, a reward hormone. This creates a chemical dependency on nicotine in the brain. Wellbutrin prevents dopamine reuptake, trapping it in the brain for longer while binding where nicotine would on neuron cells without stimulating the neuron membrane and eliciting a reaction.
Chantix binds with nicotinic receptors the exact same way as nicotine does and partially stimulates the membrane, causing dopamine secretion at a lower level.
Wellbutrin has more contraindications than Chantix which doesn’t have any drug-related contraindications. Chantix is the less expensive option of the two. However, generic versions of Wellbutrin are much more affordable.