SMOKING CESSATION THERAPIES

Nicotine Anonymous has no opinion on nicotine replacement therapy or any medical intervention. If you choose to go that route, it’s okay. You are still welcome in Nicotine Anonymous. I used the patch for 10 days on my last quit in 1998. It was the best I could do. I consider my quit date the date I stopped smoking, but for the purpose of nicotine anonymous it is the day I quit using nicotine. This page has been placed here only to keep the quitter informed and with options. It is up the individual for the method of recovery.

Pro's

Cold Turkey

Information for Nicotine Patches

Recommendations for Dosing of Nicotine Patches:

Transdermal System

Dosing Regimen

Nicoderm

Light smokers (</= 10 cigarettes/day): one 14-mg/24-hr patch for 16 or 24 hr/day for 6 weeks, then one 7-mg/24-hr patch for 16 or 24 hr/day for 2 weeks

Heavier smokers (> 10 cigarettes/day): one 21-mg/24-hr patch for 16 or 24 hr/day for 6 weeks, then one 14-mg/24-hr patch for 16 or 24hr/day for 2 weeks, then one 7-mg/24-hr patch for 16 or 24hr/day for 2 weeks.

Nicotrol

People who smoke 10 or more cigarettes/day: 15 mg/day for 6 weeks

Considerations

Eight weeks of treatment has been shown to be as effective as longer treatment periods.
Individualize treatment based on specific characteristics such as previous experience with the patch, number of cigarettes smoked/day, and degree of addiction (Fagerstrom test).
Tapering (step-down dosages) may benefit some but is not required with nonprescription patches.
Pregnancy: Smoking cessation without pharmacologic treatment should first be encouraged. Use during pregnancy and breast feeding only if benefits of smoking cessation outweigh the risks. CONTACT PHYSICIAN FIRST!
Heart disease: Use patch in smokers less than 4 weeks post-myocardial infarction (MI), those with cardiac arrhythmias, those with severe or worsening angina, or those with uncontrolled hypertension -- CONTACT PHYSICIAN FIRST!
Local reactions to the patch: Up to 50% of smokers who use the patch will experience a local skin reaction (burning, severe itching, redness of skin). The 16-hour systems have a lower incidence of these types of reactions. Treatment with hydrocortisone or triamcinolone cream +/- an oral antihistamine will usually help. Rotating patch sites will also help. Less than 5% will need to discontinue the patch because of local irritation.
In people who smoke fewer than 10 cigarettes/day, either pharmacologic treatment or "cold turkey" may be appropriate.
A 24-hour regimen may benefit those people with severe nighttime/early morning cravings.

Consultation

Patches should be applied once daily to a hairless location between the neck and waist as soon as the person awakens. Use a different site daily. The same site should not be used more than once a week. Remove the 16-hour system at bedtime.
If adverse reactions occur, contact the your pharmacist. Adverse reactions include local skin reactions, nicotine withdrawal, nicotine excess, and sleep disturbances.
Use only 1 patch at a time, 1 patch per day.
Do not smoke while wearing the patch.
Weight gain: People usually gain less than 10 pounds. Deal with smoking cessation first, then with the weight issue.
There are no activity restrictions while wearing the patch.
Disposal of used patches: Keep both new and used systems away from children and pets. Even a used patch may contain up to 60% of the original nicotine content.

Nicotine Gum

Information for Nicotine Gum

Recommendations for Dosing of Nicotine Chewing Gum:

Chewing Gum

Dosing Regimen

Nicorette

The gum is available in doses of 2 mg and 4 mg per piece (the 4-mg dose is for highly dependent smokers, smokers who request it, or smokers who failed on 2mg). One piece of Nicorette should be chewed and "parked" between the cheek and gum intermittently over 30 minutes every 1-2 hours for 6 weeks, then every 2-4 hours for 3 weeks, then every 4-8 hours for 3 weeks. People using the 2-mg strength should not exceed 30 pieces/day. People using the 4-mg strength should not exceed 20 pieces/day.

Considerations

Smokers who smoke 25 or more cigarettes/day or score at least 6 on the Fagerstrom test may receive additional benefit from the 4-mg dose.
10-12 doses of the 2-mg or 4-mg nicotine gum provide one third to one half of the usual daily nicotine intake of the people who smokes 30 cigarettes/day.
Because of delayed absorption (up to 30 minutes before effects are felt), recommend that smokers use the gum on a regular scheduled basis (eg, 1 piece/hr) instead of when the person has the urge to smoke.
Tapering may be beneficial with nicotine gum.
Clinical studies found greater efficacy in people who chewed more than 9 pieces/day.
Side effects include mouth irritation, sore jaw muscles, indigestion, nausea, and hiccups. Many of these may be related to improper use.
Individualize treatment plan based on specific characteristics such as previous experience with the patch, number of cigarettes smoked per day, and degree of addiction (Fagerstrom test).
Pregnancy: Smoking cessation without pharmacologic treatment should first be encouraged. Use during pregnancy and breast feeding only if benefits of smoking cessation outweigh the risks. CONTACT PHYSICIAN FIRST!
Heart disease: Use the gum in smokers less than 4 weeks post-MI (Heart Attack), those with cardiac arrhythmias, those with severe or worsening angina, or those with uncontrolled hypertension -- CONTACT PHYSICIAN FIRST!
In people who smoke less than 10 cigarettes per day, either pharmacologic treatment or "cold turkey" may be appropriate.

Consultation

Chewing technique: The gum should be chewed until a peppery taste emerges, then parked between cheek and gum to facilitate nicotine absorption through the oral mucosa.
Gum should be slowly/intermittently chewed for about 30 minutes.
Acidic beverages (eg, coffee, juices, soft drinks) interfere with the cheek's mucus membrane absorption of nicotine, so eating/drinking anything except water should be avoided for 15 minutes before and during chewing.
Many people do not chew enough gum to get the maximum benefit (too few pieces/day or not enough weeks of therapy). USE THE GUM ON A SCHEDULED BASIS OF 1 PIECE EVERY 1-2 HOURS FOR AT LEAST 1 MONTH. After 1 month, discuss tapering.
Do not smoke while using the gum.
Use with caution with recent major dental work or in those with dentures.
Weight gain: People usually gain less than 10 pounds. Deal with smoking cessation first, then with the weight issue.
There are no activity restrictions while chewing nicotine gum.
Keep both used and unused gum away from children and pets.
Side effects include mouth irritation, sore jaw muscles, indigestion, nausea, and hiccups. Many of these may be related to improper use.

Bupropion

ONLY CAN BE PRESCRIBED BY A PHYSICIAN WITH A RECOMMENDED TREATMENT PLAN. THIS IS FOR INFORMATION ONLY. DO NOT SELF TREAT! FOLLOW THE INSTRUCTION OF YOUR PHYSICIAN ALWAYS.

Bupropion is first-line therapy for those who have failed other NRTs, in combination with the nicotine patch, or in those who specifically request this modality to facilitate a quit attempt. Information on the use of bupropion is provided in Table 5. Drug interactions with bupropion are important to be aware of, and one should avoid this agent in smokers with a history of seizures. Smokers could be started on bupropion 1-2 weeks prior to the quit date, and total duration of therapy should last no longer than 12 weeks with no tapering of the medication. Commonly reported side effects are headache, insomnia, and dry mouth. Combination therapy with bupropion and the nicotine patch are considered to be an option in smokers based on prior quit attempts, number of cigarettes per day (> 30 cigarettes per day), and Fagerstrom test (score of 6 or greater). Because of the higher cost of bupropion, nicotine patches were often more attractive to consumers as first-line therapy.

Information for Bupropion

Recommendations for Dosing of Bupropion:

Brand Name Dosing Regimen

Zyban Start therapy 1-2 weeks prior to the quit date. Begin with 150 mg daily for 3 days; if this is tolerated, the dosage should be increased to 150 mg twice daily. Treatment should be continued for 7-12 weeks.

Considerations

First non-nicotine product marketed for smoking cessation
Zyban modulates the level of dopamine and norepinephrine, 2 chemicals associated with craving and withdrawal symptoms.
Individualize treatment based on specific characteristics such as previous experience with the patch and gum, number of cigarettes smoked per day, and degree of addiction (Fagerstrom test).
Zyban can be used with the nicotine patch.
Pregnancy: Smoking cessation without pharmacologic treatment should first be encouraged. Use during pregnancy and breast feeding only if benefits of smoking cessation outweigh the risks.
Heart disease: in smokers less than 4 weeks post-MI (Heart Attack) those with cardiac arrhythmias, those with severe or worsening angina, or those with uncontrolled hypertension -- CONTACT PHYSICIAN FIRST! (if Zyban is used concomitantly with the patch)
Must be started prior to the quit date.
In smokers who smoke fewer than 10 cigarettes per day, either pharmacologic treatment or "cold turkey" may be appropriate.
The most common complaints with Zyban are insomnia and dry mouth.
Zyban is a weak inducer of cytochrome P-450 enzymes. Monitor closely when used with phenobarbital, phenytoin, and carbamazepine. Contact physician if bupropion is used in any person with a known seizure history.

Consultation

Therapy should be initiated 1-2 weeks prior to designated quit date.
Most common adverse effects are headache, insomnia, dry mouth, and rhinitis.
Weight gain: People usually gain less than 10 pounds. Deal with smoking cessation first, then with the weight issue.
There are no activity restrictions while using bupropion.
Keep this and all medications away from children and pets.

Nasal Spray Inhaler and Nicotine Inhaler

ONLY CAN BE PRESCRIBED BY A PHYSICIAN WITH A RECOMMENDED TREATMENT PLAN. THIS IS FOR INFORMATION ONLY. DO NOT SELF TREAT! FOLLOW THE INSTRUCTION OF YOUR PHYSICIAN ALWAYS.

The nicotine nasal spray is an alternative for smokers who have failed to stop smoking through nicotine patch or nicotine gum therapy, but bupropion is an equally effective and more convenient method for this group. Because of its quick onset of action, the nicotine nasal spray may benefit heavy smokers (those smoking 2 packs or more per day) and smokers with higher levels of nicotine addiction. Frequent dosing and education is vital to success with the nicotine nasal spray. The method of delivery may cause bothersome adverse effects, limiting the use of this product by many people.

The Nicotrol Inhaler is a very expensive alternative that adds no added efficacy over the other methods. People who rely on the hand-to-mouth ritual may derive the greatest benefit from the nicotine inhaler.

Recommendations for Dosing of Nicotine Nasal Spray and Nicotine Inhalation System

Nasal Spray Dosing Regimen

Nicotrol NS (10 mg/mL) One or two 1-mg doses (each dose is two 0.5-mg sprays, 1 in each nostril) per hour initially, increased as needed. Do not exceed 5 doses per hour or 40 doses per day. Use full dose for up to 8 weeks, then gradually decrease dose over 4-6 weeks.

Nicotine Inhaler Dosing Regimen

Nicotrol Inhaler Smokers should be titrated to the appropriate dose (10 mg nicotine cartridge -- 4 mg delivered). Initially, people should use 6-16 cartridges throughout the day to relieve withdrawal symptoms. After 12 weeks of treatment, a gradual reduction in dosage is recommended.

Credit to www.MEDCEU.com " Smoking Cessation Methods" MEDCEU is available and accredited for use in virtually ALL STATES and the District of Columbia! Provider Number CEP12680. * The above document has been modified to meet the needs of a layman.

Varenicline (Chantix)

Varenicline (Chantix) is a newer medicine developed specifically to help people stop smoking. It works by interfering with nicotine receptors in the brain, which has two effects. It lessens the pleasurable physical effects a person gets from smoking, as well as reducing the symptoms of nicotine withdrawal.

Several studies have shown varenicline can more than double the chances of quitting smoking. Some studies have also found it may be more effective than bupropion, at least in the short term.

Reported side effects of varenicline have included headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence (gas), and changes in taste. Although these side effects can occur, in general, Varenicline is well-tolerated. Since Varenicline is a new drug, research has not been done to determine if it is safe to use along with nicotine replacement products.

A third of the nation's nearly 50 million smokers attempt to quit each year, according to the American Cancer Society, and that has made smoking-cessation products an $800 million business in the United States alone. The products include gum and patches sold over the counter; pills, inhalers and nasal sprays sold by prescription; and even more exotic products like nicotine-infused lollipops sold on the Internet.

Still, addiction to nicotine remains. The medical field has accepted that fact since the mid-80's, when the Food and Drug Administration approved, by prescription, products like gum to give would-be quitters a substitute comparable to cigarettes in price and nicotine content, but without other cigarette toxins.

Now some scientists and former smokers are voicing misgivings. No one disputes that cigarettes, which are laced with toxic additives like ammonia, pose far graver health risks than nicotine alone, but nicotine is also classified as a poison, and in recent studies it has been shown to break down into a substance that causes abnormal cell growth. In 2001, researchers at Stanford University found that nicotine speeds the growth of malignant tumors by stimulating the formation of the blood vessels that feed them, a process called angiogenesis.

For people addicted to nicotine, using the replacement products properly can be difficult. A study financed by GlaxoSmithKline , the pharmaceutical company that manufactures Nicorette and other stop-smoking products, found last November that more than a third of nicotine gum users continued chewing beyond the 12 weeks recommended under F.D.A. guidelines.

Even the companies that make nicotine-replacement products acknowledge problems with treating this particular addiction. Dr. Kenneth Strahs, GlaxoSmithKline's vice president for research and development in smoking control, said, "I wish we could tell you that if you took one piece of our gum it would be enough, but that's not the case. Nicotine addiction is a chronic relapsing condition."

When the F.D.A. approved over-the-counter sales of Nicorette gum and the NicoDerm CQ patch in 1996, sales of the two products soared. GlaxoSmithKline reported $578 million in global sales of over-the-counter nicotine replacements during 2003, down from $606 million the year before as other companies jockeyed for market position.

How effective these products really are remains a debate. Some ex-smokers and smoking-cessation experts oppose using nicotine at all when trying to quit. "It's like the difference between snorting cocaine and freebasing it," said Mr. Palagonia. He has neither smoked nor chewed nicotine gum for a decade now after years of meetings at Nicotine Anonymous, a 12-step program.