Smoking is still the leading cause of preventable diseases and death in the United States, killing more than 480,000 Americans each year. The United States spends more than $300 billion on smoking related illnesses. These illnesses include lung cancer, coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease (COPD) and many more, leading to a decreased life expectancy of approximately 13 years for these people. Secondhand smoke also kills about 41,000 Americans, as well as 400 infants each year.1 Despite these unfortunate statistics, there are plenty of methods to quit smoking and improve overall health.
Nicotine has been proven to be an addictive chemical, which makes quitting so difficult. This is why there are so many methods and supporting resources available to help smokers quit. The first step in quitting is to pick and commit to a quit date. This part seems simple but is very important to the entire process. If a person cannot commit to a quit date, life will continue to happen and quitting will continue to be delayed. When picking a quit date it is important to give yourself plenty of time to prepare, so you can be fully committed to your plan. If you are having difficulty picking a quit date, click here for a resource to help get started. It is also important to know why you are quitting. Smoking can cause life threatening diseases like lung cancer, stroke, diabetes and much more. It can also harm others around and take time away from you and your family. There are multiple reasons to quit smoking, but finding the ones that hit home for you are great to hold on to. Learning how to handle triggers is also an important step in the process of quitting. Making a list of things to distract you from these cravings, like putting a puzzle together or taking a walk, are great ways to reduce the urge to smoke. Quitting can also save you a bunch of money over time. It may not seem like much at the time when you buy cigarettes, but a one pack per day smoker can save approximately $2,200 annually.1 Finally, it’s vital that you tell your friends and family that you are quitting. Do not be afraid to ask for help either. If you explain the reasons why you want to quit, your family will understand better and want to help any way they can. Support is a key aspect to the process of quitting, so involving loved ones will only help.
Along with all of the preparation done to quit smoking, there are also nicotine replacement therapies (NRT) to help patients stop smoking. These options try to replace the nicotine from cigarettes with other forms of nicotine delivery and help slowly reduce the amount of nicotine that enters the body every day.
Nicotine Replacement Therapies
A nicotine patch is an adhesive bandage that attaches to the skin and delivers small, constant amounts of nicotine to your bloodstream. This method mimics the feeling of smoking a cigarette, so you do not feel withdrawal symptoms, but allows your body to get accustomed to less nicotine per day. The first step in choosing your nicotine patch is figuring out what strength should be used. If you smoke more than 10 cigarettes per day, you start with the highest strength patch or “step 1” which is 21mg. The total duration of therapy is 10 weeks but the 21mg patch will be worn for 6 weeks. If these 6 weeks are successful, you will wear a 14mg patch for 2 more weeks after that. Finally, a 7mg patch will be worn for the remaining 2 weeks of therapy. If you smoke 10 or less cigarettes per day, your therapy will be a little different. The total duration will only be 8 weeks and begins with the 14mg patch for 6 weeks and finishes with the 7mg for the remaining 2 weeks. The patches can be worn for up to 24 hours at a time but if you have trouble sleeping at night, it can be removed before bedtime.2 This is a great method if you want to be able to slap something on every morning and not have to worry about it the rest of the day. It is also a discreet product because it can be worn in multiple places on the body that can easily be hidden with clothes. It is also easier to use for many people because they do not have to think about when to use it like other products.
Nicotine gum is another nicotine replacement therapy that mimics the effects of smoking cigarettes. The gum is dosed based on when the first cigarette of the day is. If you smoke your first cigarette within 30 minutes of waking up, you will need the 4 mg pieces of nicotine gum. If your first cigarette is after 30 minutes of waking up, you will need the 2 mg pieces of nicotine gum. The gum needs to be chewed using the “chew and park” method. This method is when you chew gum for about a minute or until you feel a tingling sensation in your mouth, then park the gum in the side of your mouth between your teeth and cheek until the tingling sensation goes away. Once the tingling goes away, you will begin chewing again. Repeat this process for about 30 minutes and then throw the gum away. Do not eat or drink 15 minutes before or while chewing the gum. The duration of this treatment is 12 weeks with the first 6 weeks allowing 1 piece of gum every 1 to 2 hours as needed, the next three weeks allowing 1 piece of gum every 2 to 4 hours, and the final three weeks allowing 1 piece of gum every 4 to 8 hours.3 Nicotine gum is a great choice of therapy if someone needs to keep their mouth active because they are used to smoking cigarettes. It may not be a great choice if you have dental problems or difficulty chewing but if this is not an issue, nicotine gum can be a great way to alleviate the cravings by simply chewing some gum.
The final nicotine replacement therapy is nicotine lozenges. The lozenges are dosed based on the first cigarette of the day exactly like the nicotine gum with the strengths being 2 and 4 mg. The duration of treatment is also 12 weeks and each treatment interval is the same as the gum. The maximum lozenges to be used in a day is 20 or no more than 5 within 6 hours. Like the nicotine gum, there is a technique that needs to be used to ensure you are using the lozenges correctly. This technique is called the “roll technique”. To do this, a lozenge is put in the mouth between the gum and cheek and simply rolled around for about 20 minutes so it can completely dissolve. The lozenge should not be chewed, swallowed or sucked on because this can alter the rate at which the body is absorbing the nicotine. Do not use the lozenge while eating or within 15 minutes of drinking coffee, fruit juice, beer or soft drinks.4 Like the gum, lozenges are a great option to eliminate cravings while still being discreet in the process. Many people say the lozenges taste better than the gum as well and it is not as big of a burden on the mouth.
While all of these options are proven to support people in the process of quitting smoking, they do come with some adverse effects. The patches have been known to cause some shoulder or arm pain and itching. The gum can cause some sore throat, hiccups and itching. The lozenge can cause mouth irritation, nausea and heartburn. While side effects are expected but not necessarily ideal, the long term benefits of quitting smoking will definitely be worth it in the long run. The patient should NOT smoke while on any of these therapies due to the risk of nicotine overdose. You and your doctor or pharmacist can weigh the risks and benefits of each option to help pick the correct nicotine replacement therapy for you.
Along with nicotine replacement therapies, there are medication therapies as well. Varenicline and Bupropion are both proven therapies to aid in the process of quitting. Each therapy is unique and has its pros and cons just like the patch, gum and lozenges.
Varenicline, better known by its brand name Chantix, is a non-nicotinic medication that works by mimicking the effect of nicotine in the brain. Chantix is dosed over a 12 week period with the patient getting 0.5 mg daily on days 1 to 3 and 0.5 mg twice daily on days 4 to 7. The maintenance dose of 0.5 mg twice daily is then continued for 11 weeks. Smoking should be decreased by 50% every 4 weeks with total abstinence by week 12. Some common adverse effects include nausea, abnormal dreams, headache, irritability, suicidal ideation and depression. One differentiator of Chantix that many patients enjoy is the fact they do not have to quit smoking “cold turkey” on their quit date like other therapies.5 As long as the patient has enough willpower to slowly taper off smoking while on Chantix, this can be a great choice of therapy.
Bupropion SR (Zyban)
Bupropion sustained release (Zyban) is a non-nicotine medication that was originally indicated for the treatment of depression but now has an off-label use for the treatment of tobacco dependence. Bupropion is dosed over a 12 week period with 150 mg given once daily, initially, for 3 days, then increased to 150 mg twice daily based on response and tolerability. Therapy should begin at least 1 week before the scheduled quit date to ensure the medication has time to begin working. Bupropion can cause some nausea, vomiting, weight loss, increased heart rate, constipation and dry mouth. A benefit of this medication is that it can be used in combination with a nicotine replacement therapy which has shown increased efficacy when compared to nicotine replacement therapy alone.6
All of these are effective and proven options to help quit smoking. Each method has its pros and cons but the key is picking the right one for you. An attempt to quit smoking is a step in the right direction and can change your life forever. Don’t be afraid to reach out to your doctor or a pharmacist here at Josefs Pharmacy for more information on quitting or to help you get started.
- Centers for Disease Control and Prevention. (2021, April 7). Burden of Cigarette Use in the U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html
- Accessdata.fda.gov. 2021. Nicotine Patch Package Insert. [online] Available at: <https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020165s023lbl.pdf> [Accessed 23 May 2021].
- Accessdata.fda.gov. 2021. Nicorette Gum Labeling. [online] Available at: <https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/018612s061_020066s042lbl.pdf> [Accessed 23 May 2021].
- Accessdata.fda.gov. 2021. Nicorette Lozenge Labeling. [online] Available at: <https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021330Orig1s016lbl.pdf> [Accessed 23 May 2021].
- Lexicomp.com. 2021. Varenicline. [online] Available at: <http://www.crlonline.com.proxy.campbell.edu/lco/action/doc/retrieve/docid/patch_f/512661?cesid=arfg5yYz6Hu&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dchantix%26t%3Dname%26va%3Dchantix> [Accessed 23 May 2021].
Lexicomp.com. 2021. Bupropion. [online] Available at: <http://www.crlonline.com.proxy.campbell.edu/lco/action/doc/retrieve/docid/patch_f/6485?cesid=4rzRR5ZRudF&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3DbuPROPion%26t%3Dname%26va%3DbuPROPion> [Accessed 23 May 2021].