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Treatments & Procedures

Pharmacological Treatments to Help Quit Smoking

Why is it so hard to quit smoking?

You have probably heard this before: "Smoking is so bad for you. Why do you do it?"

People start smoking for different reasons. They might think it will help calm their nerves, make them look more mature, or maybe at the time it just seemed sort of adventurous. Looking back, it was not the best choice. Many people really want to quit, but why is quitting so hard?

It is hard to quit smoking because the nicotine in cigarettes, cigars, and other tobacco products gets you hooked and keeps you hooked. Most people try as many as three times to quit before they are able to do so. Look at smoking cessation as a process instead of a one-time event. That way, if you do slip, you can focus on what you can do differently to prevent future slips and relapse. Don’t give up—you will get there.

You have probably heard a lot about how smoking is harmful, but here are some positive things you can look forward to when you do quit.

If you quit, you will:

  • Prolong your life
  • Improve your health
  • Feel healthier (Smoking can cause coughing, poor athletic ability, and sore throats.)
  • Look better (Smoking can cause face wrinkles, stained teeth, and dull skin.)
  • Improve your sense of taste and smell
  • Save money (Most smokers spend about $90 a month on cigarettes.)

Smoking increases complications for those who have diabetes.

While smoking can increase your chances of getting diabetes, it can also make managing diabetes more difficult for those who already have it. Smoking-related complications of diabetes could include retinopathy (eye disease), heart disease, stroke, vascular disease, kidney disease, nerve damage, and/or foot problems.

What options do people have?

Some people try quitting on their own before they go to their doctor, but your doctor can be very helpful. He or she may offer tips and suggest medicines, both prescription and over-the-counter, to help you "kick the habit." It is also important to tell your doctor what types of products you might use or are using to quit smoking. The doctor can make sure that suggested products will not interact with other medicines you are already taking. Remember, there is no "magic bullet" when it comes to quitting smoking. Quitting requires persistent effort.

Over-the-Counter Medicines

Nicotine-based medicines

Over-the-counter medicines that contain nicotine can be very helpful in fighting off cravings. These products will not remove all cravings, but you can use them instead of smoking to reduce your nicotine intake gradually and ease off of its addictive effects.

When you give your body a steady dose of nicotine all the time and then stop suddenly, you will have more side effects (withdrawal symptoms) that usually make quitting a lot harder. Withdrawal symptoms include irritability, headache, and the craving to smoke. Go slow and lower the dose gradually with nicotine-based products until you feel you are able to resist the cravings on your own. You will still have cravings, but they will be weaker. It is very important to have some form of social support when you decide to quit, no matter if you use products or not. Support can come from your doctor, counselor, support group, close friend, or a family member.

When considering a nicotine-based product to help you quit, be sure to tell your doctor about any conditions you might have, especially:

  • Asthma or breathing problems
  • Heart or blood vessel disease
  • High blood pressure
  • Stomach ulcer
  • Diabetes mellitus
  • Kidney disease
  • Liver disease
  • Overactive thyroid
  • Pheochromocytoma (PCC)

Over-the-counter treatments are typically used for up to 12 weeks as part of a smoking cessation program.

Additional things to consider when taking nicotine-based medicines

  • Do not smoke while you are using the nicotine-based medicines. You could risk overdosing on nicotine.
  • Tell your doctor about any medicines you are taking or any allergies you have.
  • Do not use the nicotine-based medicines if you are breastfeeding, are pregnant, or think you might be pregnant.
  • Keep this and all medicines out of the reach of children and pets.

Common brand names of the nicotine patch, gum, and lozenge include:

  • Nicorelief® (gum)
  • Nicorette® (gum)
  • NicoDerm® CQ® (patch)
  • Commit® (lozenge)
Transdermal nicotine patch

The patch is worn directly on the skin. Nicotine passes through the skin into your bloodstream. Some brands have patches with different strengths so you can gradually reduce your dosage. Nicotine patches are available without a prescription. If you are not sure what kind of patch to use, ask your doctor.

Always follow the instructions on the box, but here are some things to remember when using the nicotine patch:

  • Patches are supplied in child-resistant pouches; save the pouch for disposal of the patch.
  • Find a clean, dry part of the skin to apply it. Somewhere on your upper arm or torso usually works best. Try to find an area that has little hair and is without scars, cuts, burns, or rashes.
  • Right before applying the patch, wash your hands and the skin area with plain soap and water and dry completely. Avoid using any soap, lotion, hand cream, tanning lotion or oil, bath oil or insect repellent that contains aloe, lanolin or glycerin as a moisturizer since these agents can leave a moisturizing film on your skin, which can potentially interfere with the adherence of the patch.
  • When you have finished applying or removing the patch, wash your hands with water only.
  • Do not try to adjust the dosage by cutting the patch into sections.
  • Leave the patch on, even while bathing or swimming. If it falls off, do not try to re-apply it. Use a new one
  • Remove the patch according to the instructions on the box (usually after 16 to 24 hours).
  • Dispose by folding sticky ends of the patch together and putting in pouch.
  • When applying a new patch, choose a different place than before. Do not use the patch in the same place for at least a week.
  • Do not leave the patch on for longer than directed.
  • Remove the patch if you are going to do rigorous exercise. This might cause more nicotine to pass into your bloodstream.
  • If you are unsure how to use the product, be sure to ask your doctor or pharmacist to explain.
  • Remove the patch if you are having a magnetic resonance imaging (MRI) scan. Nicotine patches contain aluminum.
  • If you have vivid dreams or other sleep disturbances, try removing the patch at bedtime and applying a new one in the morning.

Common side effects of the nicotine patch:

  • Increased appetite
  • Mild headache
  • Irritation at the site of the patch, including itching, burning, or redness

There are other common or more serious side effects. Please read the information that comes with the product carefully, and be sure to contact your doctor if you have any questions.

Nicotine gum

Nicotine gum, like the patch, is a systemic way to receive nicotine. This means that the nicotine in the gum passes from the lining of your mouth right into your bloodstream. Like the patch, you will decrease the dosage during the recommended time (usually 12 weeks or sooner) if you are able to resist cravings on your own. Nicotine gum is sold without a prescription.

Always follow the instructions on the box, but here are some things to remember when using nicotine gum:

  • Use nicotine gum only when you feel the urge to smoke.
  • Slowly chew the gum until you begin to taste it or feel a tingling sensation in your mouth. Then stop chewing and park it between your cheek and gum. This helps release the nicotine. When the taste or tingling is almost gone, repeat these two steps for 30 minutes.
  • Use only one piece at a time.
  • Do not drink beverages (e.g., soft drinks, tea, coffee, and fruit juices) or eat food 15 minutes before or while chewing the gum.
  • Gradually decrease the number of pieces of gum you chew per day, until you reach three to six pieces per day. Some people can do this in less than 12 weeks. Do not chew more than twenty-four pieces in 1 day.
  • Try to have the nicotine gum handy at all times. You might try hard candy or using regular gum, if the nicotine gum is not available.
  • Nicotine gum can be difficult to use if you have dentures.

Common side effects of nicotine gum:

  • Belching (burping), gas, or heartburn
  • Increased appetite
  • Mild headache
  • Watery mouth
  • Jaw or muscle pain or fatigue
  • Sore mouth or throat
  • Nausea
  • Hiccups

There are other common or more serious side effects. Please read the information that comes with the product carefully and be sure to contact your doctor if you have any questions.

Nicotine lozenge

A nicotine lozenge, like the patch and gum, is a systemic way to receive nicotine. This means that the nicotine in the lozenge passes from the lining of your mouth right into your bloodstream.

Always follow the instructions on the box, but here are a few things to remember when using the nicotine lozenges:

  • Place the lozenge in your mouth; wait until it dissolves completely; and move it around from time to time without chewing. It takes around 20 to 30 minutes to dissolve.
  • Do not take more than one lozenge at a time or continuously use one lozenge after the other, this can cause hiccups, heartburn, or nausea.
  • Do not eat or drink 15 minutes prior to, during, or after use.
  • Do not use more than five lozenges in 6 hours or more than twenty lozenges in 24 hours.

Prescription Medicines

Nicotine nasal spray

Nicotine that can help you stop smoking also comes in the form of a nasal spray, available only by prescription. Like the patch and the gum, the amount taken is gradually decreased during a period of 12 weeks. It is to be used, like the gum and the patch, as part of a program that also includes support, education, and counseling.

Nicotrol NS® is one brand of nicotine nasal spray.

Always follow the instructions on the prescription label. Here are some other things to remember when using nicotine nasal spray:

  • Blow your nose prior to use.
  • You may gradually reduce your dose of nasal spray by skipping doses or using only half the usual amount.
  • Writing down the time you take the nasal spray and how much you take might be very useful when reducing your dose.

Common side effects of nicotine nasal spray:

  • Back pain
  • Constipation
  • Coughing
  • Indigestion or nausea
  • Runny nose
  • Sneezing
  • Watery eyes
  • Headache
  • A burning feeling in the back of the throat or nose

The nicotine nasal spray is not recommended for people with reactive airway disorders such as asthma. In addition, caution is urged in patients with chronic nasal disorders.

There are other common or more serious side effects. Please read the information that comes with the product carefully and be sure to contact your doctor if you have any questions.

Nicotine inhalant

A nicotine inhalant—available only by prescription—used for up to 6 months (initial treatment period up to 12 weeks followed by gradual reduction period of up to 12 weeks) can be part of a smoking cessation program. When the inhaler is used, nicotine passes from the lining of the mouth and throat (not the lungs) into the bloodstream. Like other nicotine products, you will decrease the dosage during the recommended time (usually several weeks) or until you are able to resist cravings on your own.

Nicotrol Inhaler® is one brand name of nicotine inhalant.

Always follow the instructions on the box, but here are some things to remember when using a nicotine inhalant:

  • Store the inhaler in a dry area at room temperature not to exceed 77° F or 25° C.
  • Write down the time you take the inhalant and how much you take. This might be very useful when reducing your dose.
  • The normal first dose is between six and sixteen cartridges per day.

Common side effects of nicotine inhalants:

  • Coughing
  • Indigestion
  • Mouth and throat irritation
  • Stuffy nose or runny nose

There are other common or more serious side effects. Please read the information that comes with the product carefully and be sure to contact your doctor if you have any questions.

Bupropion

Bupropion is more commonly seen under the brand names of Zyban® or Wellbutrin®. Zyban is specifically indicated for smoking cessation. It is not a nicotine-based medicine; it is an antidepressant that is only available by prescription. It is prescribed along with counseling and support to aid in smoking cessation. Bupropion might also be used to treat major depressive disorders. It usually takes 2 weeks for bupropion to take effect, so plan to quit smoking 2 weeks after beginning the treatment.

Before considering bupropion, be sure to inform your physician if you have a history of seizure disorder, bulimia, or anorexia nervosa.

Bupropion comes in tablets that are to be swallowed whole, not crushed, divided, or altered in any other way. Individual prescription strengths might vary, so if you are taking bupropion, be sure to follow the directions on the label. Ask your doctor or pharmacist any questions you have about how to take it, when to take it, any potential side effects, and the duration of treatment.

Common side effects of bupropion:

  • Dry mouth
  • Sweating
  • Insomnia
  • Rash
  • Headache
  • Dizziness
  • Anxiety
  • Restlessness
  • Irritability
  • Indigestion
  • Decreased appetite

There are other common or more serious side effects. Please read the Medication Guide that comes with the product carefully and be sure to contact your doctor if you have any questions.

Do not take bupropion if you have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days. Monoamine oxidase inhibitors are used to treat depression. Some examples include: tranylcypromine (Parnate®), phenelzine (Nardil®), and isocarboxazid (Marplan®). There are several products that might interact with bupropion, so be sure to tell your doctor about any over-the-counter and/or prescription medicines, as well as any herbal supplements you are taking.

While taking bupropion, immediately report any psychological changes (e.g., new onset depression) to your doctor.

Varenicline (Chantix®)

Varenicline, also known by the brand name Chantix, is a prescription medication that does not contain nicotine. This medicine helps to reduce the reinforcing effects of nicotine and can minimize the withdrawal effects from nicotine. It is recommended to set a quit date 1 week after initiation of varenicline therapy. Typically, this medication is taken for a minimum of 12 weeks accompanied by smoking cessation counseling. If you have stopped smoking, another 12 weeks of varenicline might be prescribed. If you have not stopped smoking after the first 12 weeks, stop taking this medication and return to your doctor for advice. Varenicline should be taken with food and a full glass (8 ounces) of water.

Varenicline can interact with over-the-counter and prescription medicines especially insulin, blood thinners, and asthma medications as well as with certain herbal supplements; therefore, it would be important to inform your physician of your entire medication regimen.

Contact your doctor immediately if you experience any psychological changes (e.g., new onset depression) while taking varenicline.

Common side effects of varenicline:

  • Nausea, which may dissipate over time
  • Headache
  • Insomnia

There are other common or more serious side effects. Please read the Medication Guide that comes with the product carefully and be sure to contact your doctor if you have any questions.

How could research benefit smokers who want to quit?

Researchers are testing a vaccine that could make quitting a lot less difficult. This type of treatment could potentially be used in a program, along with bupropion (Zyban) and counseling, to significantly reduce withdrawal symptoms.

References

Nides M.Update on Pharmacologic Options for Smoking Cessation Treatment. The American Journal of Medicine. (2008). Vol.121(4A)S20-S31.

Tom W-C. Smoking Cessation Drug Therapy: An Update. Pharmacist’s Letter/Prescriber’s Letter. January 2011-Vol.27-No. 270111

Leonard M. Medications Used for Smoking Cessation. Pharmacotherapy Update from the Cleveland Clinic Department of Pharmacy Newsletter Volume IX, No. III May/June 2006.

Can't find the health information you’re looking for?

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/15/2011…#13394