Consider Nicotine Replacement Therapy

For many smokers, an effective quit method will include a combination of emotional support from others, a change in daily habits, and a form of therapy through the use of nicotine substitutes. When smokers try to cut back or quit, the absence of in their body leads to withdrawal symptoms. Nicotine substitutes treat the very difficult withdrawal symptoms that almost 90% of all smokers say is the reason they cannot quit smoking. These substitutes reduce the symptoms of nicotine withdrawal during the quit process, allowing the smoker to concentrate on the psychological aspects of quitting smoking.

 Nicotine replacement therapy offers several advantages for those trying to quit: 

• Nicotine replacement is a cleaner form of nicotine.  It avoids the thousands of poisons and tar that are found in cigarette smoke.
• Nicotine replacement delivers a smaller dose of nicotine into the body.
• Nicotine replacement therapy has been proven to double your chances of quitting smoking for good.

There is also another quit medication call bupropion which is available by prescription. Make sure to discuss with your health care provider which medication best suits your needs. Consider all the options, such as how much you smoke, whether you need oral or hand stimulation, cost, and the overall speed and effectiveness of each method. You may also want to check to see if your insurance company covers any of the cost of these medications. 

Bupropion 
Bupropion hydrochloride or Zyban™, is a pill that is available with a prescription. The pill does not contain nicotine and helps to decrease nicotine cravings and withdrawal symptoms by stimulating the chemicals in the brain affected by nicotine. Bupropion also is known as the antidepressant Wellbutrin™. You do not have to stop smoking when you first start taking Bupropion, but it is recommended that you set your quit date for 2 weeks after beginning Bupropion. Once you stop smoking, you will continue to take the pills for 7-12 weeks, as prescribed by your health care provider.  

Although easy to use, users of Bupropion may experience some side effects. The most common side effects include dry mouth, trouble sleeping and nervousness.  You should not take Bupropion if you have seizures, have or had an eating disorder, are taking Wellbutrin™ or another medication containing bupropion hydrochloride or are taking or have taken a monoamine oxides inhibitor (MAO). In addition, you should discuss the following with your health care provider to see if Bupropion is still right for you: alcohol use, being or planning to be pregnant and breastfeeding. 

Nicotine Inhaler or Puffer 
Known as Nicotrol™, the inhaler is available only with a prescription and gives the user a dose of nicotine that is absorbed through the lining of the mouth. The inhaler is hollow and about the size of a cigarette; a nicotine-filled cartridge is placed inside the inhaler. One advantage to the inhaler is that it may help with the physical craving for nicotine and the psychological need to have something in your hand that is associated with smoking. To use the inhaler, you place a nicotine cartridge in the inhaler and then “puff” to get the nicotine into your mouth. The dosage will vary by person but it can take around 80 “puffs” to get the amount of nicotine that is in one cigarette. The inhaler may need to be used frequently, about 6 cartridges a day, particularly at the beginning of the quitting process.  Some people may dislike the frequent use of the inhaler, and it may cause mouth and/or throat irritation. 

Nicotine Spray
The nasal spray, known as Nicotrol NS™, is available only with a prescription and delivers nicotine through the nasal membranes of the nose. This method of nicotine delivery is quicker than that experienced with the nicotine gum or inhaler. A single spray into each nostril will deliver one dose. Although the actual dosage and frequency will be determined by your health care provider, it can vary from 8 - 40 doses a day. Users may experience mouth, nose, sinus, and/or throat irritation with the use of the nicotine spray.  If you have allergies or asthma, you may not be able to use NicotrolNS™. 

Nicotine Patch
There are two types of nicotine patches. Habitrol™ or Prostep™ require a prescription and Nicotrol™ and Nicoderm CQ™ do not. Nicotine is delivered in a steady amount throughout the day through the skin and therefore is slower in its release than other medications. The patch is used by applying it to a different part of the upper body every day; the less hairy, unshaven areas of skin often are better.

Although some patches are available without a prescription, it is recommended that you talk with your health care provider to start at the right dosage for you and then decrease to smaller dosages. The length of usage will vary by person and can continue from 4 weeks to 3 months. The patch is available in 16-hour and 24-hour increments. Individuals may experience skin irritation from use of the patch. It is important not to use any other forms of tobacco or nicotine when using the patch in order to avoid overdose. Nicotine will continue to be in your system for several hours after you take off the patch. Individuals who have had allergic reactions to adhesive tape or other patches should not use the patch. Be sure to speak with your health care provider about any of the follow, even if they occurred in the past, if you are thinking about using the patch: ulcers; kidney, liver or skin disease; overactive thyroid; high blood pressure; heart attack, irregular heartbeat or chest pain from a heart condition; diabetes needing insulin injections; or any other serious illness. In addition, other drugs, even over-the-counter products such as headache or pain medications, can affect the effect of nicotine patches for you. Make sure you properly dispose of the patch once you have used it by putting it in foil or back in its own wrapper and throwing it in a garbage can that cannot be accessed by pets or children.

Nicotine Gum
Nicotine gum, or Nicorette™ offers another form for delivering nicotine that is available without a prescription and is absorbed through the lining of the mouth. To use the gum, you will need to chew it briefly and then place in between the inside of your cheek and gum line. The nicotine is inside the gum, and after the quick chew, it is released into the lining of the mouth to be absorbed. Your stomach cannot absorb the nicotine so if you continue to chew it and swallow the saliva, you may become nauseated. You will know to stop chewing when you have a peppery taste or feel a slight tingling sensation in your mouth. When that taste or feeling disappears, you will need to chew the gum briefly again.  The gum is available in different dosage levels and it takes approximately 30 minutes for the nicotine to be absorbed completely from the gum. You cannot drink, eat, or chew anything else 15 minutes before you use the gum or while it is in your mouth. You should not be using any other form of tobacco or nicotine while using the gum. It is recommended that you speak with your health care provider while using the gum so that you do not overuse it or become addicted. You will need to decrease the frequency of use as your cravings for nicotine decrease. Also talk with your health care provider about your medical history as well as using the gum with other drugs, even caffeine or over-the-counter headache or pain medication. You will want to speak with your dentist before using Nicorette™ if you have any dental or jaw problems.  Side effects of using Nicorette™ may include bleeding gums, indigestion, nausea, sore throat, slight swelling of the mouth or hiccups. Be sure to continue to talk with your health care provider about any side effects you experience as these can differ by person or become more severe. Addiction to and overdose of nicotine gum is possible and symptoms may include the following: dizziness, fast and irregular pulse, vomiting, exhaustion, shakes, vomiting, fainting, and headaches.

Nicotine Lozenge
After several years of testing, the FDA recently approved the first over-the-counter nicotine-containing lozenge that benefits a smoker trying to quit by providing constant oral stimulation in an easy-to-control dose. The lozenge comes in the form of a hard candy, and releases nicotine as it slowly dissolves in the mouth. Studies show that the nicotine lozenge is as effective as other nicotine replacement therapies when used as directed. Like the nicotine gum, the nicotine lozenge delivers nicotine to the brain more quickly than the patch, making it easier to tailor dosage according to need. One lozenge is a “dose.” Simply place the lozenge in your mouth and let it dissolve, moving it back and forth from time to time. Each lozenge will last about 20-30 minutes, and nicotine will continue to leach through the lining of the mouth for a short time after the lozenge has disappeared.

The manufacturer recommends you use at least 9 lozenges per day for the first 6 weeks, and that you not use the lozenge for more than 12 weeks in allTake care not to eat or drink 15 minutes before using the lozenge or while it is in your mouth. The most common side effects of lozenge use are soreness of the teeth and gums, indigestion, and irritated throat. Do not bite into or chew the lozenge, as this will cause more nicotine to be swallowed quickly and result in indigestion and/or heartburn.

Comparison of Nicotine Replacement Products

(Adapted from Schmitz J., Henningfield J, Jarvik M, "Pharmacologic Therapies for Nicotine Dependence." In Principles for Addiction Medicine, 2^nd ed., 1998).