Smoking Cessation Support Options

COLD TURKEY
With this method you simply stop smoking cigarettes. The success rate varies greatly with this method.

• Simple technique - no need for prescriptions
• No cost - you save money right away by not smoking
• You must be highly committed to your goal of quitting
• The withdrawal symptoms (such as a headache, irritability, or trouble sleeping) may be severe for some--especially if you smoke a lot or a cigarette with high levels of nicotine. Helpful hints are identified in the pamphlet "Clearing the Air" by the US Department of Health and Human Services.

CIGARETTE FILTERS
These filters are purchased separately from cigarettes and are attached to the cigarette prior to smoking. They work by reducing the amount of nicotine that is inhaled. The filters reduce the amount of nicotine by 25%, 50%, 70% and 90%. Each week you switch to the next level and you are ready to completely quit after the 4th week. You do not need a prescription to buy them.

NICOTINE FADING
With this method, you are taught how to reduce the nicotine level of cigarettes smoked by 30/60/90 percent over a 3 week period. During the fourth week, you stop smoking completely. You can learn how to make these changes in cigarettes by using the "Nicotine Fading" handout. This chart identifies which brands of cigarettes to use during each reduction period. This chart is helpful because most cigarette labels do not list the nicotine content. This method helps reduce the chances of withdrawal symptoms becoming severe. It has a 30 percent success rate after 12 months. One can also reduce the number of cigarettes smoked over a three week period and achieve the same effect.

A special note: Nicotine Replacement Products (Spray, Gum, Patch, Inhaler)

It is very important to not smoke while using any nicotine product as the combined amount of nicotine could cause unpleasant physical symptoms. It is also counter productive and can increase your need for nicotine overall. The costs vary but it is important to remember that all of them are cheaper than continuing to smoke.

NICOTINE NASAL SPRAY
This method involves using a nasal spray 1-5 times/hour to reduce the craving for nicotine. It is suggested that this be used 13-20 times per day. This is used for 8 weeks and then tapered for 4-6 weeks.

• Does not help break the habit side of the addiction as use product frequently during day when feel the need
• Does not mimic oral aspect of smoking
• Does need to be prescribed by a physician
• May cause nose irritation/runny nose

NICOTINE INHALER
With this method, one puffs on a white plastic cartridge (about 3 inches long) for about 20 minutes as needed throughout the day. This cartridge is about the equivalent of 2 cigarettes. Maximum dose is 16 cartridges per day. This is used for 12 weeks then tapered for 6-12 weeks.

• Does not help break the habit side of the addiction as use product frequently during the day when feel the need
• Does not break the oral aspect of smoking habit
• Does need to be prescribed by a physician
• May cause cough or throat irritation

NICOTINE GUM
With this method, you introduce nicotine into your body through chewing and "parking" nicotine gum. It is important to chew the gum until you get a peppery taste. Then "park" it between your gum and cheek and leave it there. You can purchase the gum at any pharmacy. Often you need to chew 10 to 20 pieces of gum each day over a three to six month period. You slowly reduce the amount of gum chewed each day during the last few weeks of the therapy. This method has a 20% success rate after 12 months.

• Does not help to break the habit of the addiction as it is used throughout the day in response to nicotine craving
• Minor side effects include lightheadedness, nausea, sore mouth, sore throat, hiccups and excess amount of saliva
• The gum is not recommended if you are pregnant, have had a heart attack or other heart problems
• If you are a long time smoker, you may have a greater chance of becoming dependent on the gum

NICOTINE SKIN PATCH
The skin patch releases nicotine through the skin and into your bloodstream. The patch can be purchased from most pharmacies. The usual dosage is to start with the 21 mg patch and taper to the 14 mg patch 4 to 6 weeks later followed by the 7 mg patch. The patch is worn 16 to 24 hours a day for 4-10 weeks. The patch is a good choice for you if you have a strong addiction to nicotine and are smoking a cigarette that has a high nicotine content. There is a 50 percent success rate at the end of a 3 month period.

• You first apply the patch upon awakening on your quit day.
• Common side effects are skin redness when the patch is removed and vivid dreams or restless sleep. You may remove the patch at bedtime if this is a problem.
• The patch is not recommended if you are pregnant or have a history of heart disease

ORAL MEDICATION
A medication called Zyban (bupropion HCL SR 150 mg) helps to reduce the withdrawal symptoms from nicotine. The Zyban is taken up to one to two weeks before you actually stop smoking (your quit date). You will stop smoking and continue taking the Zyban as recommended by your health care professional, usually 7 to 12 weeks. The most common side effects include dry mouth and difficulty sleeping. Zyban is not recommended for people with a history of seizures, an eating disorder, for women who are pregnant or breastfeeding or for people currently taking a monoamine oxidase (MAO) inhibitor. The cost and success rate are similar to the cost of the patch therapy.

• Some of these options can be combined, for example the patch and Zyban work well together for those who are very addicted to nicotine.
• There are also many smoking cessation group programs available, including those sponsored by the American Lung Association and the American Cancer Society.
• There are also many support and information systems available on the internet.

See related Patient Textbooks about Internal Medicine.

See related Patient Topics Child and Teen Health, Food, Nutrition and Metabolism, Internal Medicine, Preventing Disease and Staying Healthy, Pulmonary, Smoking and Youth, Smoking Cessation, Substance Abuse, Symptoms and Manifestations or Wellness and Lifestyle.

See related Provider Textbooks about Internal Medicine.

See related Provider Topics Child and Teen Health, Food, Nutrition and Metabolism, Internal Medicine, Preventing Disease and Staying Healthy, Pulmonary, Smoking Cessation, Substance Abuse, Symptoms and Manifestations or Wellness and Lifestyle.

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