The nicotine in cigarettes causes an addiction and unpleasant feelings of withdrawal when a person tries to quit. Some people quit on their own, without outside help. But many smokers find it hard to break the habit of smoking while overcoming nicotine withdrawal symptoms. The good news is that there are many sources of support, including nicotine replacement therapy.
Nicotine replacement therapy provides the body with nicotine - generally in the form of a gum or patch - without the other harmful parts of tobacco. These aids can help a person concentrate more on quitting the habit of smoking by relieving the symptoms of withdrawal.
It is desirable to combine nicotine replacement therapy with other quit smoking programs. Studies have shown that using nicotine replacement therapy to handle the physical addiction along with a program that helps you change your behaviour, can double your chance of success.
All of the medications cited here are effective in improving the success rate for quitting and staying quit. They are all more effective when used according to instructions, and together with self help materials or counselling.
The patch is now sold without prescription in Canada due to its relative safety. It comes in different dosages, and in different brands. Some patches are meant to be worn for 24 hours while others are designed to be taken off at night (16 hour patches). You need to put on a new patch every day. Dosages typically range from 7 mg to 21 mg. See your doctor before using the patch if you are pregnant, breast feeding, suffer from angina, have irregular heart beat, or just had a heart attack.
Patches continuously deliver a small amount of nicotine through your skin. The nicotine helps take the edge off the effects of quitting. However, because you don't get large amounts of nicotine and because it is delivered continuously (instead of the peaks and valleys in nicotine levels that occur with smoking) you may still have cravings to smoke or experience some withdrawal.
People typically use patch therapy for 3 months. However, heavy smokers may benefit from using the patch for a longer period. Many smokers start at the highest dosage and then switch to lower dosages after 4 weeks and then again at 8 weeks. Once again, heavy smokers may find that the biggest dosage is necessary for longer periods of time. A common error is to quit the patch sooner than recommended. Never cut a patch in half.
The nicotine from a patch does not cause cancer or nicotine addiction.
The most common side effects are skin irritation and sleep disturbance. If you get skin irritation you can switch brands, move the patch around on your skin, or use some lotions which may help. Sleep disturbance is usually temporary and may be related to nicotine withdrawal, rather than the patch. If you continue to have sleep disruption (including nightmares), you can take the patch off at night or try a 16-hour patch. Your pharmacist or doctor can be helpful with suggestions on side effects, and the correct use of the patch. Be sure to carefully read the instructions that come with the patch.
Nicotine chewing pieces are sold without prescription in Canada. They come in different dosage levels, usually in 2mg and 4mg units. You have control over how many pieces of gum you chew per day. For most smokers this is between 2 and 10 pieces. Therefore, unlike the patch that continuously delivers nicotine, chewing pieces produce more of the peaks and valleys you may feel with smoking. However, like patches, chewing pieces only help take the edge off. They may not entirely eliminate all craving and withdrawal. Therefore, it is important to use chewing pieces with some other form of help such as a self help program, or counselling.
The gum needs to be used properly to work. Rather than chew it like gum, it is important to bite it a few times and then park it between your cheek and gum for a few minutes before biting it again and repeating the process. Read the instructions carefully or ask your pharmacist for help.
Before using nicotine chewing pieces, if you are pregnant, breast feeding, suffer from angina, have irregular heart beat, or have recently suffered a heart attack, check with your doctor if any of these is good for you.
Most people use the chewing pieces for about 3 months. Some individuals (particularly those who were heavy smokers) use it for much longer periods of time. It is possible to become addicted to chewing pieces, although this is relatively rare. However, because chewing pieces do not contain all the other harmful chemicals found in tobacco smoke, they do not cause cancer or the many other serious health problems associated with smoking.
The most common side effects associated with the use of nicotine chewing pieces are burning in throat, hiccups, or dental problems. These are often related to how you chew the gum. Read the instructions that come with the gum, or see your doctor or pharmacist if you have trouble.
This is an antidepressant that has been found to help people with nicotine withdrawal. It is a pill that requires a medical prescription. It needs to be started before your quit date, usually 7-10 days before, as it takes time to build up in your bloodstream.
It should not be taken if you are pregnant, breast feeding, have a history of seizures, anorexia or bulimia, taking MAO inhibitors (monoamine oxidase inhibitors), or are allergic to bupropion hydrochloride. Caution is also advised if you are alcohol dependent, taking St John's wort or on SSRI (selective serotonin reuptake inhibitor) antidepressants. The most common side effects are: dry mouth and insomnia.
Buproprion may be used in combination with either the nicotine patch or nicotine chewing pieces.
Bupropion is not a magic pill, but it can help control carvings and withdrawal. Like other medications for quitting smoking, it should be used in combination with a behavioural treatment as found in self help material or as directed by a counsellor. It is important to set a clear quit date, usually 7 to 10 days from beginning the pill, and to make a strong commitment to quit.