Nicotine Replacement Therapy
Before discussing this possibility is it important to remember: YOU MUST QUIT SMOKING ENTIRELY BEFORE STARTING TO USE ANY NICOTINE REPLACEMENT PRODUCT.
If you feel that you are severely addicted to cigarettes, you may wish to consider using a nicotine substitute product:
- Nicotine gum
- Nicotine patch
- Nicotine nasal spray
- Nicotine inhaler
People usually develop cravings for things that develop immediate satisfaction, such as chocolate or cigarettes. Since nicotine replacement provides nicotine, but not the quick nicotine uptake of cigarettes, it’s easier to give up nicotine replacement than it is to give up cigarettes.
With the patch, the nicotine level in your body stays relatively constant day after day. There is no immediate satisfaction, so there is less craving for a patch. As a result, “quitting” nicotine replacement after you’re securely off cigarettes is generally pretty easy.
Nicotine patches, gums, inhalers, and nasal sprays are expensive. But during the first year alone, a pack-a-day smoker who successfully quits smoking will more than pay for the medication with the money saved from not buying cigarettes.
Here are some important things that you should know about nicotine replacement products:
1) Nicotine patches and nicotine gum are available over-the-counter. The nicotine nasal spray and nicotine inhaler are currently available only by prescription from a doctor.
2) These products provide a small amount of nicotine that will help relieve many of the withdrawal symptoms that a smoker may feel when quitting.
3) The goal is to be free of both cigarettes and the nicotine substitute within three to six months.
As mentioned in the beginning of this section, you must quit smoking completely before you use any nicotine replacement.
This means that you must not smoke while using these products. If you do, you may develop serious side effects caused by an overdose of nicotine.
Nicotine replacement must not be used by pregnant or nursing women. With any nicotine substitute, it’s always wise to check with your doctor to see if there are medical reasons you should not use these products.
This is a drug in gum form, with enough nicotine to reduce your urge to smoke. The gum releases small amounts of nicotine, which is absorbed into the body through the mucous membranes of the mouth. This cuts down on withdrawal symptoms and makes it easier to break the smoking addiction. It tastes very different from regular gum, because it is a medicine.
You can buy nicotine gum from drug stores, mass merchandisers, and supermarkets. Package instructions explain how the gum is used. Most smokers chew 10 to 15 pieces of gum a day. However, you can have up to 30 pieces. It’s important to use as many you need to feel comfortable without cigarettes.
Use only one piece of gum at a time. Chew it slowly very slowly until you feel a tingle in your mouth. When the peppery taste is present, shift the gum between your cheek and gum. When the tingle is gone, chew a few more times to get it back. Then shift the gum to different parts of your mouth. Repeat this procedure for about 30 minutes to release most of the nicotine. The majority of the time, the gum should be just sitting in your mouth. Do not chew continuously and swallow the saliva as you would with regular gum. The nicotine from the gum must be absorbed through the mouth – it is ineffective if swallowed. The nicotine does not reach the bloodstream if it goes to the stomach, and it can cause heartburn or hiccups.
Another important point is: Do not use nicotine gum while you are drinking. This will wash the nicotine down to the stomach. Wait several minutes after drinking liquid before chewing the gum. This is particularly important if you have been, or will be, drinking acidic beverages such as orange or grapefruit juice, since the acidic quality of these drinks changes the “environment” of the mouth and interferes with the amount of nicotine that’s absorbed.
Begin using the gum after you quit smoking, and use it every day for at least two or three months after quitting. The first three months are when relapse is most likely to happen. Remember that you must not chew the gum and smoke cigarettes.
As your urges to smoke decrease, you will gradually reduce your use of the gum. However, there are two cautions:
1) It’s better to use the gum a little longer than to risk a relapse by tapering off the gum too early and too quickly.
2) Even after you stop using the gum, continue to carry some with you just in case. Better to relapse to the gum than to cigarettes.
The nicotine patch is applied to your skin. Over a prolonged period of time, the nicotine dissolves right through the skin and enters the body. Nicotine from the patch replaces some of the nicotine you were getting from cigarettes. This can relieve some of the physical symptoms associated with quitting smoking, so you can concentrate on your behavioral and psychological addiction to cigarettes.
You can buy the patch without a prescription – but as always, it’s best to check with your doctor to see if the patch is right for you. You may not be able to use the patch if:
- You are taking certain prescription medicines, or
- You have cardiovascular disease or certain other health conditions.
Even if you have been told not to sue the patch because of a medical condition, you may want to check back with your doctor from time to time, to see if your condition, or the medical advisories have changed. For example, physicians were initially concerned that nicotine patch use might be dangerous for cigarette smokers who have coronary artery disease. However, a recent study found that the patch is a safe way for such people to quit smoking, and may improve blood and oxygen flow to the heart. Some research has suggested that the patch is safe and effective for teenage smokers, but patch use is currently not advised for people under 18 years of age.
The nicotine patch is safe but (as with any medication) it must be used with caution. Most important, you should never smoke while using the patch.
Some side effects from normal use of the patch can include headaches, dizziness, upset stomach, diarrhea, weakness, or blurred vision. Vivid dreams also may result from an interrupted sleep pattern when you quit smoking.
Some people report a mild itching or burning on the skin where the patch is applied, which usually goes away in about an hour. If the irritation continues you can try moving the patch to a different spot. If it persists, remove the patch and contact your doctor.
Some patches contain more nicotine than others. Some smokers start with the strongest patch. Then after several weeks, you can switch to a medium-strength patch for a few weeks, and possibly a lower-strength patch for the last few weeks. On the other hand, some people prefer the simplicity of a single-strength patch.
If you do use the nicotine patch, each morning you will apply a new nicotine patch to a clean, dry, nonhairy part of your upper body or arm. Don’t apply creams on the skin where you will put the patch. Press the patch firmly on your skin. It should stick to the skin well, allowing you to do all of your usual activities, including bathing.
One brand of the nicotine patch is removed at night, lowering the level of nicotine in the bloodstream, to give the body a rest. Other brands are worn at night as well as during the daytime, and are changed once every 24 hours. When you remove the patch, put a fresh patch on a new area of your upper body. Do not reuse a skin area for at least one week.
The nicotine patch isn’t magic. It can’t automatically wipe out all your cravings for nicotine. Cravings are diminished and may not last with the patch, but don’t expect them to disappear immediately. Even if you still crave cigarettes sometimes while wearing the patch, you are less likely to suffer from several of the major smoking withdrawal symptoms, such as tension, irritability, feeling sleepy, and having a hard time concentrating.
Nicotine replacement therapy can also be administered via a nasal spray, or by the newest method, an oral inhaler, which was approved by the Food and Drug Administration in 1997.
These products are available only by prescription. Contact your doctor to see if the nicotine spray or inhaler is right for you.
As with all nicotine replacement products, you cannot start using the nasal spray and the inhaler until you have completely stopped smoking. If you do use nicotine spray or a nicotine inhaler, you must not smoke any cigarettes, or use any other form of tobacco, such as cigars, pipes, or chewing tobacco.
The spray delivers nicotine through the nose. The inhaler delivers nicotine into the mouth, which produces a sensation in the back of the throat similar to that produced by tobacco smoke. However, both devices provide nicotine at a lower level than cigarettes, and they do not contain any of the cancer-causing tars and toxins found in tobacco products. For example, ten puffs on the inhaler provides about the same amount of nicotine as one puff on an average cigarette.
With the nicotine spray and inhaler, dosage is flexible and can be individualized according to your personal withdrawal symptoms. Both devices deliver nicotine to the blood-stream in a matter of minutes. This fast onset of action reduces nicotine cravings quickly.
Unlike the nicotine patch, gum, and nasal spray, the nicotine inhaler has the advantage of satisfying the “hand-to-mouth” ritual smokers miss when they quit. The inhaler consists of a mouthpiece connected to a cartridge containing nicotine. When a smoker puffs on the mouthpiece, the inhaled air becomes saturated with nicotine, which is absorbed through the mucous membranes of the mouth and throat, as happens with nicotine gum.
This route of absorption isn’t the same as that of cigarettes. A majority of the nicotine from a cigarette is absorbed directly into the lungs, which causes a “nicotine spike” that smokers feel almost instantly. It’s this spike a smoke gets when taking a puff or a drag that contributes to the high addictive properties of tobacco.
Is Nicotine Replacement Unhealthy?
Many people worry that nicotine replacement products are just as bad as smoking cigarettes. They’re definitely not. They do not have all the tars and poisonous gases that are found in cigarettes. They provide less nicotine than a smoker would get from cigarettes. And they’re designed to help people get off nicotine, not to keep them on nicotine.
But it is important to realize that nicotine replacement therapies will not work for everyone. They are not a cure-all. They are just temporary aids that can help you make it through the tough initial withdrawal period after you’ve quit smoking.
What needs to be understood is that nicotine is not the only dangerous element of the smoking habit. Certain moods, times of day, or activities all become strong triggers that make you crave a cigarette. Nicotine replacement isn’t a cure for these. That’s why anyone who uses the nicotine patch, gum, nasal spray, inhaler, or other products should also make a concerted effort to change their behavior patterns.
The Non-Nicotine Pill:
There is a new prescription pill that’s designed to help smokers quit. Again, it’s still not a magic pill. It does not eliminate the urges to smoke. Those urges still require a serious effort to overcome.
The pill is Zyban, the trade-name for a sustained-release tablet of bupropion hydrochloride. The same drug has been sold under the trade-name Wellbutrin SR. Now it’s being marketed as the first non-nicotine prescription treatment for smoking addiction.
How does the pill work for smokers? The drug boosts the body’s levels of two “brain chemicals,” dopamine and norepinephrine – the same thing happens with nicotine. Actions of these chemicals in the brain give people a sense of energy and well-being. Nicotine produces the same feelings.
According to the advertisements, using bupropion allows smokers to get the same feeling, while weaning themselves off nicotine. For many people, this helps to reduce withdrawal symptoms and lessens the urge to smoke. But like the other nicotine replacement products, the pill should be used in combination with a quit-smoking behavior modification program.
In one study, the non-nicotine pill helped more smokers to quit than the nicotine patch. Using both the pill and the patch was even more effective, but the combination poses the risk of increasing blood pressure.
Zyban is usually taken twice a day – one pill in the morning and one in the early evening. It takes about a week for the pill to reach an effective level in the body. Therefore, smokers must start taking the pill before they quit smoking. Then you set a Quit Day within one to two weeks after starting treatment. Most smokers then take the pill for a total of 7 to 12 weeks.
The non-nicotine pill is available only by prescription. It’s especially important to get a doctor’s advice, because Zyban is certainly not right for everyone. The drug is not recommended for:
- Women who are pregnant or breast-feeding.
- People with a history of eating disorders, such as bulimia or anorexia nervosa.
- Anyone who is currently taking or has taken a monoamine oxidase inhibitor (MAO) medication for depression.
- People already taking Wellbutrin, Wellbutrin SR, or other medicines that contain buproprion hydrochloride.
- People who have a seizure disorder, such as epilepsy.
Seizures disorders are a special concern. Buproprion is known to cause seizures in approximately 1 out of every 1000 people taking buproprion hydrochloride. Although this is a small risk, it may be an important factor for people deciding whether or not to use this drug. Other common side effects include dry mouth and difficulty in sleeping.
The Role of Drugs in Quitting.
The introduction of buproprion as an aid in smoking cessation is probably a sign of things to come. Better understanding of how smoking influences the brain will probably lead to better drugs to help smokers quit. So don’t worry. Try your best now. But also recognize that your efforts to quit are going to receive more types of assistance in the future.
Buproprion also illustrates the fact that quitting smoking requires attention to both the biology and psychology of smoking. Buproprion is helpful when used with education programs and support from health professionals or with an intensive self-help program. As with all these help tools to quitting, there is still no magic cure. Buproprion will help smokers quit, but they have to take the first step and continue to work to keep temptations from undermining their efforts.
If patches, pills and sprays don’t appeal to you, then you might be interested in techniques that are often categorized as alternative medicine.
Two alternative therapies – hypnosis and acupuncture – have sparked particular interest as aids quitting smoking.
Hypnosis is a state of attentive and focused concentration that is induced by the use of “therapeutic suggestion.” The hypnotic trance state resembled other forms of deep relaxation. People cannot be hypnotized involuntarily and they do not follow hypnotic suggestions that are against their wishes. People who want to be helped are the best hypnotic subjects.
When employed by psychologists, physicians, and others trained in its use, hypnosis may help in quitting smoking. Ask your doctor for a referral, or contact your local or state psychological association for the names of licensed psychologists in your area who practice hypnosis. Like other therapies, though, it’s not a magic solution that can be used alone. Hypnosis cannot make you quit or automatically eliminate all your desires to smoke. It should be part of a systematic quit smoking program.
Acupuncture is an ancient Chinese therapy that involves stimulating specific anatomic points in the body. This regulates or corrects the flow of “chi” (or energy) in the body, and thus restores health. Puncturing the skin with a needle is the most typical method of acupuncture. As with all other therapies, acupuncture works best for smoking cessation when it’s used in combination with a serious effort to quit and a behavior modification strategy to support their effort