Medications to Help You
Quit Smoking
By Roland Larrabee, M.D.
Nicotine replacement products provide low doses of nicotine that do not contain the contaminants found in smoke. They relieve cravings for nicotine and ease the symptoms of withdrawal, doubling the chances of long-term success. It should be noted that nicotine replacements are most effective in moderate to heavy smokers. They appear to have little effect for light smokers (less than 15 cigarettes a day).
Replacement products include nicotine patches, gums, nasal sprays, and inhalers. A British study indicated that about 20% of people who use nicotine replacement products and have some support from health professionals will abstain for at least a year and about 10% will remain nonsmokers. (Unfortunately this rate is not much better than using fake products, although adding the antidepressant Zyban is improving this rate.) In spite of the obvious health benefits from nicotine replacement treatments, only about a quarter of HMOs reimburse smokers for these aids.
Tips for All Nicotine Replacement Products:
Not cheating on the very first day of nicotine-replacement use increases the chance of quitting permanently by tenfold.
The more cigarettes a patient smokes, the higher the dose of nicotine replacement may be required at the start.
There is no evidence yet that one form of nicotine replacement is any better than another, but individual preferences vary. Compliance rates also vary and are highest for the patch, intermediate for the gum, and lowest for the spray or inhaler. The different forms can also be used together. In some studies, combining the patch with another form improved quitting rates.
Adding a counseling program may boost the effect of any nicotine replacement program. One study reported a quit rate of 30.5% after a year in patients who wore the patch and attended a quit-smoking program.
Nicotine replacement and the antidepressant Zyban are equally effective, and can be used together to boost success rates even further. Zyban may be particularly useful in addition to nicotine replacement in ensuring long-term abstinence in people who suffer from depression because of or independently of withdrawal.
No one should smoke while using nicotine replacement. It can cause nicotine to build up to toxic levels.
Nicotine replacement helps prevent weight gain while it is being used, but people are still at higher risk for gaining weight when they stop all nicotine.
Nicotine patches
Nicotine patches, or transdermal nicotine, delivers nicotine through the skin and can be an effective way to quit smoking. The quit rate for patch users is around 20% after six months, twice the rate of those who try to quit cold turkey. Nicotine patches are available over the counter, but it is best to consult a doctor before using them, particularly people with any medical problems. They are probably the best nicotine replacement products for people with asthma or other chronic lung problems.
Nicotine Gum
Nicotine gum (Nicorette), available over the counter, has also been effective for a number of people. Some prefer it to the patch because they can control the nicotine dosage and chewing satisfies the oral urge. Long-term dependence may be a problem with this method. Although such dependence is probably safer than smoking, research is needed to confirm this, and experts recommend chewing the gum for no more than six months.
The Nicotine Inhaler
The nicotine inhaler resembles a plastic cigarette holder. It comes with a number of nicotine cartridges, which are inserted into the inhaler and "puffed" for about 20 minutes, up to 16 times a day. The dose is gradually decreased. It requires a prescription in the US. A number of studies have reported that the inhaler triples abstinence rates (between 17% and 28%) compared with placebo (6% to 9%) after six months.
Using a combination of the inhaler and the patch may be particularly effective. In one study, the combination led to an abstinence rate of over 60% after six weeks. While this percentage dropped off over time, it was still a marked improvement over the use of the inhaler and a placebo patch.
The Nicotine Nasal Spray
The nasal spray satisfies immediate cravings by providing doses of nicotine rapidly and thus may play a useful role in conjunction with slower-acting nicotine replacement therapies. (Nicotine levels peak within five to ten minutes after administering the spray.) The spray can irritate the nose, eyes, and throat, so it may not be suitable for those with allergies or sinus infections. Most people, however, can tolerate the side effects, which usually subside within the first few days.
Bupropion (Zyban)
The unique antidepressant bupropion (Zyban) is proving to be a strong aid in the quitting process. It differs from most other antidepressants because it increases the effects of dopamine, the brain chemical that appears to play a strong role in nicotine addiction. People should take Zyban only as directed by their physician.
In people who are not depressed, there is no noticeable effect on mood. People who are depressed generally report better spirits and more energy, although in a few cases depression worsened.
People tend to maintain their weight after quitting while they are on the drug. A 2001 study indicates that Zyban is most effective while it is being taken, and some people may need to take it for a year or longer to increase the duration of abstinence and perhaps maintain weight loss.
Even if people return to smoking after taking Zyban, they can use it again with considerable success. In one 2001 study, those who were retreated with the drug still had a significantly better abstinence rate (20% at 12 weeks) than those on placebo (3%).
Dr. Larrabee is Associate Director of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.