Smoking and Quitting Smoking (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Smoking and quitting smoking facts
- What problems are caused by smoking?
- What is addictive disease and why is smoking considered addictive?
- What are the signs of cigarette addiction?
- Why should someone quit smoking?
- What are the steps in quitting?
- Getting ready to quit smoking
- On the day you quit smoking
- Staying quit
- What methods can help a person quit smoking?
- Behavioral modification and self-help literature to quit smoking
- Nicotine replacement therapy to quit smoking
- What prescription products are available for smoking cessation?
- How are nicotine-containing products used safely?
- What is in the future for smoking?
- Smoking FAQs
- Find a local Internist in your town
What methods can help a person quit smoking?
Several methods are available to assist those who decide to quit smoking. The main categories of methods are:
- Changing the behavior that is associated with smoking
- Self-help literature
- Nicotine replacement therapy
- Prescription smoking cessation aids
Each method actually offers several different options. Moreover, combinations of the methods usually are necessary, and no one combination will work for everyone. In fact, it may be necessary to try several different methods or combinations of methods before success is achieved.
Behavioral modification and self-help literature to quit smoking
Due to the addictive nature of nicotine, some form of behavioral modification is often necessary for successful cessation of smoking. Educational programs, hypnosis, and aversion therapy (learning how to avoid cigarettes) are a few options. Smokers may be counseled to avoid specific triggers or situations that lead to smoking. For example, instead of awakening and grabbing a cigarette at the bedside or smoking immediately after a meal, people may be encouraged to replace the urge to smoke with another activity, such as, taking a walk or reading a book.
Numerous medical associations and societies, for example, the American Cancer Society, American Heart Association, and the American Lung Association, have developed brochures to help smokers quit smoking.
Nicotine replacement therapy to quit smoking
Nicotine replacement therapy (NRT) became available over the counter in the 1990's. The purpose of nicotine replacement therapy is to substitute another source of nicotine while cigarettes are discontinued. By this means, the habit of smoking is eliminated, even though the addiction to nicotine remains intact. But at the same time, nicotine replacement therapy eliminates the symptoms of withdrawal that can trigger more smoking. In addition, behavioral counseling to change smoking-related behavior usually is necessary. Once cigarettes have been replaced during nicotine replacement therapy, the amount of nicotine is then gradually reduced.
Currently, there are different forms of nicotine replacement therapy available over-the-counter and include:
- nicotine transdermal systems or patches (Nicoderm CQ and Nicotrol),
- nicotine polacrilex resin or gum (Nicorette), and
- nicotine lozenges (Commit).
Learn more about: Nicotrol
The nicotine patch (Nicoderm CQ and Nicotrol) contains nicotine that is stored within a specially designed support or matrix. Once applied, the nicotine transdermal system steadily releases nicotine that is absorbed across the skin and into the blood stream. The gum contains nicotine that is released slowly upon chewing and "parking". Parking refers to the action of shifting the gum to one side of the cheek after chewing in order to speed the absorption of nicotine. Nicotine lozenges contain nicotine within a hard candy that allows for slow release of nicotine as the candy dissolves in the mouth. A program for slowly weaning users from nicotine replacement products is provided by each product's manufacturer.
The nicotine patch, Nicoderm CQ, is available in three strengths; 21, 14, and 7 mg. People are advised to begin with the 21 mg patch if they smoke more than 10 cigarettes per day or the 14 mg patch if they smoke less than 10 cigarettes per day. After six weeks of wearing the initial patch strength, the next lowest patch strength is worn for two weeks. If therapy was started with the 21 mg patch, an additional two weeks is required for the 7mg patch. A maximum of eight or 10 weeks, depending upon the strength of the first patch used, is recommended for a successful quitting program. The Nicoderm CQ patch can be worn for 16 hours (from awakening until bedtime) or 24 hours if the urge to smoke is great upon awakening.
Nicotrol is available as a 15 mg patch, and should be worn no more than 16 hours per day. Nicotrol may be worn for up to six weeks.
The side effects commonly seen with patches are burning, itching, or redness at the site of the patch, headache, insomnia, nervousness, dizziness, cough, rash, joint aches, painful menstruation, and changes in taste.
The gum, Nicorette, is available in a variety of flavors in 2 strengths; 4 and 2 mg. Patients are advised to begin with the 4 mg piece of gum if they smoke more than 25 cigarettes per day or the 2 mg piece if they smoke fewer than 7 cigarettes per day. No more than 20 pieces of the 4 mg strength or 30 pieces of the 2 mg strength should be chewed in one day. Initial weaning from treatment should begin after 2 to 3 months and be completed by 4 to 6 months. The most common side effects with Nicorette are aching jaws or soreness of the gums, changes in taste, abdominal (gastrointestinal) discomfort, hiccups, nausea, vomiting, and belching.
Commit nicotine lozenges are available in 2 or 4 mg doses. One dose consists of one lozenge, and no more than 20 doses should be consumed in one day. The manufacturers of Commit recommend choosing the proper dosage based upon when you usually have the first cigarette of your day. According to the manufacturer's instructions, if you smoke within 30 minutes of getting up in the morning, you should use the stronger 4 mg dose. If not, you should use the 2 mg lozenges.
Biting or chewing nicotine lozenges instead of allowing them to dissolve can lead to indigestion or heartburn. You should not eat or drink anything while the lozenge is in your mouth. The lozenges will last for about 20-30 minutes when allowed to dissolve in the mouth. The most commonly reported side effects with nicotine lozenges are indigestion, throat irritation, soreness of the teeth or gums, insomnia, nausea, hiccups, coughing, heartburn, headache, and flatulence.
How effective is nicotine replacement therapy?
Approximately 25% of patients successfully stop smoking with nicotine patch therapy. The success rate with nicotine gum is similar. There have not yet been studies to compare the effectiveness of nicotine lozenges to the patch or gum. The rate of success for nicotine replacement therapy increases 35% to 40% when intensive behavioral counseling is added.
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