Quit-Smoking Drugs and Nicotine Patches and Gums

What can help you quit smoking?

From the WebMD Archives

Quitting smoking is never easy. But a growing number of smoking cessation aids make it easier than ever for smokers to break their addiction to nicotine.

Research suggests that medications and nicotine replacement therapies can double and sometimes even triple the chances that a smoker will successfully quit. Some of these treatments also help to minimize weight gain while quitting -- an important plus for many smokers who want to kick the habit.

With a growing number of options available, doctors are now able to create personalized treatment plans tailored to an individual smoker’s needs and preferences.

What’s right for you? Here are stop-smoking aids and drugs to consider:

Nicotine Replacement Therapies

The idea is simple. To help smokers manage nicotine withdrawal, nicotine replacement therapies deliver the potent drug in ways that are far healthier and safer than cigarettes. Ideally, ex-smokers can gradually reduce the amount of nicotine or stop nicotine replacement therapy all at once after they’ve broken the habit of smoking. Even when used for long periods of time, nicotine replacement therapies are far safer than smoking. Quit rates range from 19% to 26%.

Is it right for you? If you’ve tried to quit before and failed because the craving for nicotine was too strong, nicotine replacement therapies may help. Gum, lozenges, and patches are available over-the-counter. Nasal sprays and inhalers require a prescription. Gums and lozenges are handy to use and offer something for smokers to put in their mouths instead of a cigarette. Some smokers prefer inhalers because the process of inhaling mimics smoking a cigarette. All of these forms are about equally effective and they can be used in combination. Indeed, evidence suggests that combining patches with inhalers, gum, or nasal sprays improves long-term quit rates. But you cannot continue to smoke while using nicotine replacement therapy. You must quit tobacco before you take alternate forms of nicotine.

Expert advice: “Don’t be in too much of a hurry to go off nicotine replacement,” says Scott McIntosh, PhD, associate professor of community and preventive medicine at the University of Rochester in New York and director of the Greater Rochester Area Tobacco Cessation Center. “One common problem we see is people stopping too early and then experiencing cravings that they can’t resist.” McIntosh recommends using nicotine replacement therapies for two to three months. And after you’ve stopped using them, he recommends keeping some gum or lozenges handy just in case you suddenly experience an intense craving.

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Chantix (Varenicline)

Varenicline, the latest antismoking drug to win FDA approval, works by blocking nicotine receptors in the brain. It is sold under the trade name Chantix in the U.S. and Champix in other parts of the world. Chantix is usually prescribed for a 12-week period, with the option of another 12-week maintenance course. About 33% of smokers who use the drug successfully quit.

Is it right for you? Chantix is effective in lessening nicotine cravings and has helped many smokers successfully quit. Unlike Zyban, it should not be used in combination with nicotine replacement therapies (unless under a doctor’s supervision.) Chantix was approved in 2006. Side effects include nausea, vomiting,abnormal dreams, constipation, and flatulence. In 2009, the FDA required Chantix to have a boxed warning about serious neuropsychiatric events, including depression, suicidal thoughts, suicidal behavior, agitation, and hostility. Also, those who takeChantix may be at higher risk for heart attacks and strokes compared to those who don’t take the drug, the FDA says. Some serious side effect symptoms may be related to nicotine withdrawal.

Expert advice: “If you and your doctor decide to try Chantix, it’s important to monitor your moods and alert your doctor immediately if you notice any change,” says Steven Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of California, San Francisco. Some of the less serious but still unpleasant side effects of the drug, such as nausea, often go away over time.

Zyban (Bupropion SR)

Approved in 1997, Zyban acts on chemicals in the brain to ease nicotine withdrawal symptoms, making it easier for smokers to resist the craving to light up. The pills are usually taken twice a day for a period of seven to 12 weeks. Some ex-smokers may need to remain on Zyban for longer periods. About 24% of smokers who use Zyban successfully quit.

Is it right for you? Zyban is especially helpful for people with intense nicotine withdrawal symptoms. It can be used alone or in combination with nicotine replacement therapies such as patches or gum. The FDA has required Zyban to have a boxed warning for serious neuropsychiatric events, including depression, suicidal thoughts, suicidal behavior, agitation, and hostility. Some serious side effect symptoms may be related to nicotine withdrawal. The drug is not recommended for people with seizure disorders, bulimia, anorexia, or patients who are abruptly stopping use of alcohol or sedatives, or are using a monoamine oxidase (MAO) inhibitor. The most common side effects are dry mouth and insomnia.

Expert advice: Zyban should be started a week or two before your quit date to tame nicotine withdrawal symptoms. Like all drugs, it should be taken as recommended. Contact a health care provider right away if agitation, hostility, depressed mood, suicidal thoughts/behavior, or other changes in thinking or behavior develop.

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Counseling and Support

Counseling and support groups have been shown to improve a smoker’s odds of successfully quitting. Counseling takes many forms, from a doctor’s advice to a formal smoking cessation program such as those offered by medical centers and community health organizations. Online support in the form of quitlines has also proved very helpful. Counseling typically includes advice on how to recognize smoking triggers, strategies to resist cravings, how to prepare for your quit day, ongoing support during the first few months of quitting, and other assistance. Counseling can be combined with all forms of smoking-cessation aids.

Is it right for you? Counseling and support is invaluable for almost all smokers who want to quit. Personal preference is the most important criteria, so choose the kind of program that feels right for you. If you thrive in the company of other people, look for a smoking-cessation program that meets in your community. If you want to go it alone, check out the growing number of online support groups and quitlines. Good places to start include the National Cancer Institute’s web site on smoking cessation or the North American Quitline Consortium. You can also call the federal government’s quitline at 800-QUITNOW.

Expert advice: The more support and counseling you receive, research suggests, the better your odds of success.

Stop Smoking With a Combination of Aids

The best combination of approaches is the one that feels right to you. Experts say a few guidelines can help you and your doctor choose the most effective strategies.

  • If you’ve tried and failed to quit using one particular smoking cessation aid, such as nicotine replacement patches, for example, it’s wise to try another on your next attempt.
  • If previous attempts have ended because you gave into intense cravings, talk to your doctor about combining therapies such as nicotine replacement inhalers with drugs that will minimize those cravings.
  • If you’re reluctant to quit because you’re worried about weight gain, talk to your doctor about treatments that can minimize weight gain, and check out support groups that will encourage you to become more active.

Whatever combination of approaches you choose, make sure that you begin with a positive mental attitude. “Optimism and the belief that you can do it is one of the most powerful indicators for success,” says Bruce S. Rabin, MD, PhD, medical director of the University of Pittsburgh Medical Center Healthy Lifestyle Program.

WebMD Feature Reviewed by Louise Chang, MD on January 20, 2011

Sources

SOURCES:

Scott McIntosh, PhD, associate professor of community and preventive medicine, University of Rochester, New York; director, Greater Rochester Area Tobacco Cessation Center.

Steven Schroeder, MD, director, Smoking Cessation Leadership Center, University of California, San Francisco.

Bruce S. Rabin, MD, PhD, medical director, University of Pittsburgh Medical Center Healthy Lifestyle Program.

Rxlist: Zyban.

Tobacco Control, 2009; vol 18: pp 34-42.

Zyban prescribing information.

Chantix prescribing information.

FDA news release: "FDA: Boxed Warning on Serious Mental Health Events to be Required for Chantix and Zyban," July 1, 2009.

FDA: "Safety Review Update of Chantix and the Risk of Cardiovascular Adverse Events."

 

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