Anyone who has ever tried to quit "cold turkey" knows how hard it is
However, there are several medications to aid you in your quitting process. They include:
Non-Prescription Nicotine Replacement Therapy
The nicotine patch is similar to an adhesive bandage. It must be applied to a non-hairy area below the neck and above the waist. The site of placement should be rotated with each application.
The patch releases a constant amount of nicotine in the body.
The patch must be worn all day and cannot be put on and removed as a substitute for a cigarette. Most of the patch products are changed once every 24 hours. One type of patch is worn only during the waking hours and is removed during sleep.
Studies have shown that it is much easier to give up the patch than it would be to give up cigarettes for two reasons:
- First, the patch does not provide immediate satisfaction. With the patch, the nicotine level in the body stays relatively constant day after day, so there is little craving.
- Second, anything people do often, such as using tobacco, becomes a habit; since you apply the patch only once a day, there is no strong habit to break.
People who wear the nicotine patch are less likely to suffer from withdrawal symptoms. These include tenseness, irritability, drowsiness, and lack of concentration.
The patch comes in 21 mg, 14 mg, and 7 mg. A 15 mg patch is also available to wear for 16 hours/day. Follow package directions or directions from a healthcare provider for dosing.
Side effects from wearing the patch may include:
- Skin irritation
- Sleep problems
Nicotine gum is not designed to be chewed like normal gum. Rather it is used with the "chew and park" method. The nicotine from the gum will be absorbed into your system through the inside of your mouth. If you continue chewing without parking, the nicotine will be released directly into your saliva. The nicotine will eventually be swallowed, leaving you with an upset stomach and a craving for a cigarette.
Nicotine gum contains enough nicotine to reduce the urge and helps take the edge off cravings. However, nicotine gum won't expose you to the tars and poisonous gases found in cigarettes. It is a temporary aid that reduces symptoms of nicotine withdrawal after quitting.
Nicotine gum must be used properly in order to be effective. Steps for nicotine gum users to follow include:
- Stop all smoking when beginning the nicotine gum therapy
- Do not eat or drink for 15 minutes before using, or while chewing the gum (some beverages can reduce its effectiveness).
- Chew the gum slowly on and off for 30 minutes to release most of the nicotine. Parking the gum between the cheek and gum allows the absorption of nicotine into the lining of the cheek.
- Chew enough gum to reduce withdrawal symptoms (10-15 pieces a day but no more than 24 a day).
- Use the gum every day for about a month or so. Then start to reduce the number of pieces you chew a day, chewing only what you need to avoid withdrawal symptoms.
- Discontinue use of gum after three months.
The over-the-counter gum is available in 2 mg doses (for smokers of 24 or fewer cigarettes each day) and 4 mg doses (for smokers of 25 or more cigarettes each day). One piece of gum is one dose; maximum dosage should not exceed 24 pieces per day. Nicotine gum should not be used with dentures.
Side effects from nicotine gum
- Mouth soreness
The nicotine lozenge comes in the form of a hard candy and releases nicotine as it slowly dissolves in the mouth. Biting or chewing the lozenge will cause more nicotine to be swallowed quickly and result in indigestion and/or heartburn.
Each lozenge will last about 20-30 minutes. Nicotine will continue to filter through the lining of the mouth for a short time after the lozenge has disappeared.
Nicotine lozenge is available in 2 mg or 4 mg doses. One lozenge is one dose; maximum dosage should not exceed 20 lozenges per day. Be sure to follow package directions.
Side effects from nicotine lozenge
- Soreness of the teeth and gums
- Throat irritation
Prescription Nicotine Replacement Therapy
Nicotine nasal spray is dispensed from a pump bottle similar to over-the-counter nasal sprays.
Nicotine is rapidly absorbed through the nasal membranes and reaches the bloodstream faster than any other NRT product. This feature makes it attractive to some highly dependent smokers. However, it may be more addictive than other NRT.
A usual single dose is two sprays, one in each nostril. The maximum recommended dose is 5 doses per hour or 40 doses total per day.
Side effects from nasal spray
- Nose and throat irritation
The nicotine inhaler is a plastic cylinder that contains a nicotine cartridge. The inhaler delivers nicotine when you puff on it.
The inhaler looks similar to a cigarette. However, the nicotine from the inhaler is absorbed by the mouth, not the lungs.
The initial dosage is individualized. Each cartridge delivers 4 mg of nicotine over 80 to 100 inhalations (approximately 20 minutes of active puffing); only 2 mg are actually absorbed. This is the equivalent of about 2 cigarettes. The maximum suggested dose is 16 cartridges per day.
WARNING: If cigarette smoking continues while using NRT, nicotine toxicity may occur.
Side effects from nasal spray
- Irritation of the lining of the mouth
Non-Nicotine Prescription Medications
Bupropion hydrochloride (Zyban®) is an oral tablet used to help smokers quit. The drug is also sold as an antidepressant under the name Wellbutrin®.
Treatment with bupropion begins while still smoking, one week prior to the quit date. Treatment is then continued for 7 to 12 weeks. Length of treatment is individualized.
Dosing should begin at 150 mg/day given every day for the first 3 days. Then for most people the dose will increase to 150 mg twice daily. It is advised to wait 8 hours between doses.
To avoid insomnia, the second dose should be taken in the early evening.
It is not recommended for people with seizure disorders or certain psychiatric disorders.
If the medication has not helped by the seventh week, then it probably wonï¿½t for this quit attempt. The medication should be stopped.
Side effects may include
- Dry mouth Constipation
Varenicline (Chantix®) partially binds to nicotine receptors in the brain, making it less desirable to continue smoking.
It works in two ways -- by cutting the pleasure of smoking and reducing the withdrawal symptoms that lead smokers to light up again and again.
Treatment with varenicline begins while still smoking, one week prior to the quit date. Treatment is then continued for 12 weeks.
Dosing should begin at 0.5 mg/day given every morning for the first 4 days. Then 0.5 mg twice daily for 4 days, followed by 1 mg twice daily.
If the medication has not helped you quit by the 12th week, then it probably won't this quit attempt. You should try to identify what prevented you from quitting. By addressing those issues, future quit attempts may be more successful.
Side effects may include
- Nausea (experienced by up to 30% of users)
Slowly increasing the dose can help with the nausea.
- Sleep disturbances
- Vivid dreams
- In some severe cases, behavioral changes, agitation, depressed mood, and thoughts of suicide.
In 2008 the Food and Drug Administration (FDA) issued a Public Health Advisory after receiving reports of changes in behavior, agitation, depressed mood, and thoughts of suicide in patients taking varenicline (Chantix®).
If you have a current, untreated, or unstable mental disorder, you should not take varenicline (Chantix®).
You should contact your health care provider as soon as possible if you notice any changes in mood or behavior while you are taking varenicline (Chantix®).
Many insurance companies may cover the cost of medications used for smoking cessation. If not, some states offer free Nicotine Replacement Therapy through 1-800-QUIT-NOW, if you do not have health insurance.