 INHALERS are the first hand-to-mouth delivery system for nicotine replacement therapy. Users simply inhale through the mouthpiece using deep or shallow puffs. Prescription only.
Today, smokers don’t have to tough it out alone. New medications, some over-the-counter and some prescription, can help take the edge off of nicotine withdrawal. The first thing to do is discuss the various methods with your doctor, to determine which method might work best for you.
See: Suggestions for the clinical use of pharmacotherapies
 NICOTINE GUM is a temporary aid that takes the edge off the craving without the intake of tars and poisonous gases. Prescription and over-the-counter.
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 THE PATCH helps relieve withdrawal symptoms by providing you with a steady amount of nicotine while avoiding the hazards of smoking. With the patch, you will step down your dosing until you no longer crave nicotine. Prescription and over-the-counter.
 THE LOZENGE is a form of hard candy that releases nicotine as it slowly dissolves inthe mouth. The lozenge will help to reduce nicotine cravings. You can buy it without a prescription.
 NICOTINE SPRAY delivers nicotine the fastest, so is good at reducing sudden cravings. Prescription only. |
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Reference: New York State Department of Health
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Non-Nicotine Replacement Therapy Drugs and by Prescription Only
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 ZYBAN is a non-nicotine pill which reduces craving for Nicotine.
• Bupropion hydrochloride (Zyban) was approved in 1997 to help smokers quit. The drug, available by prescription only, is also sold as an antidepressant under the name Wellbutrin.
• Common side effects include insomnia and dry mouth.
• Treatment with bupropion begins while the user is still smoking, one week prior to the quit date. Treatment is then continued for 7 to 12 weeks. Length of treatment is individualized.
• Dosing should begin at 150 mg/day given every day for the first 3 days, followed by a dose increase for most people to the recommended dose of 300 mg/day. The maximum recommended dose is 300 mg/day, given as 150 mg twice daily. An interval of at least 8 hours between successive doses is advised.
• People who have not made significant progress towards abstinence by the seventh week of therapy are unlikely to successfully quit during this attempt, and bupropion treatment should be discontinued.
• The average wholesale price for bupropion is approximately $2.50 per day.
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 CHANTIX (verenicline) Tablets
The newest drug approved by the FDA. Not available until August, 2006.
Common side effects include nausea, vomiting, and constipation.
Treatment with Chantix begins one week (7days) before your quit date. This allows Chantix build up in your body. You can keep smoking during this time. Make sure that you try to stop smoking on your quit date. Take Chantix after eating and with a full glass (8 ounces) of water. Treatment is up to twelve weeks. If you have completely quit smoking by twelve weeks, ask your doctor if another twelve weeks of Chantix may help you stay cigarette-free.
For the first three days you begin with one white tablet (0.5 mg) each day. Then from days four to seven you take the white tablet (0.5 mg) twice a day- one in the morning and one in the evening. From day eight to the end of the treatment you take the blue tablet (1mg) twice a day- one in the morning and one in the evening. Dosing may change based on a doctor’s opinion referring to your side effects.
Prescription only.
For more information visit www.chantix.com
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Nicotine Replacement Therapy
Nicotine replacement products help relieve some of the withdrawal symptoms people experience when they quit smoking. There are several nicotine replacement products currently available over-the-counter in the United States, including two nicotine patches, nicotine gum and the recently approved nicotine lozenges. A nicotine nasal spray and a nicotine inhaler are available only by prescription. A non-nicotine pill, known as Zyban, is also available as a smoking cessation treatment option. To be most effective, nicotine replacement products should be used in conjunction with a behavior change program.
Over-the-Counter
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Nicotine Patch
• The nicotine patch releases a constant amount of nicotine in the body. Unlike smoke which passes almost instantaneously into the blood through the linings of the lung, the nicotine in the patch takes up to three hours to make its way through the layers of skin and into the user's blood.
• The patches are similar to adhesive bandages and are available in different shapes and sizes. A larger patch delivers more nicotine through the skin.
• The patch must be worn all day, and cannot be put on and removed as a substitute for a cigarette. Most of the patch products are changed once every 24 hours. One particular patch is worn only during the waking hours and is removed during sleep.
• Studies have shown that it is much easier to give up the patch than it would be to give up cigarettes for two reasons. First, people usually develop cravings for things that provide immediate satisfaction, such as chocolate. With the patch, the nicotine level in the body stays relatively constant day after day. There is not immediate satisfaction, so there is little craving for a patch. Second, anything people do often, such as smoking, becomes a habit; since you apply the patch only once a day, there is no strong habit to break.
• Wearing the nicotine patch lessens chances of suffering from several of the major smoking withdrawal symptoms such as tenseness, irritability, drowsiness, and lack of concentration.
• Some side effects from wearing the patch can include:
- headaches
- dizziness
- upset stomach
- weakness
- blurred vision
- vivid dreams
- mild itching and burning on the skin
- diarrhea
• Average retail price for over-the-counter transdermal nicotine patches (starter box) is approximately $4/day.
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Nicotine Gum
• Nicotine gum delivers nicotine to the brain more quickly than the patch however, unlike smoke, which passes almost instantaneously into the blood through the lining of the lung; the nicotine in the gum takes several minutes to reach the brain. This makes the "hit" less intense with the gum than with a cigarette.
• Nicotine gum is not designed to be chewed like normal gum. Rather it is used in the "chew and park" method. When you insert a piece of gum into your mouth, chew it a few times to break it down, then park it between your gum and cheek and leave it there. The nicotine from the gum will make its way into your system via the blood vessels just under the lining of the oral cavity. If you continue chewing without parking, the nicotine will be released directly into the saliva in your mouth, which will eventually be swallowed, leaving you with a nasty stomachache and a craving for a cigarette.
• Nicotine gum contains enough nicotine to reduce the urge to smoke. The over-the-counter gum is available in 2mg doses (for smokers of 24 or fewer cigarettes each day) and 4mg doses (for smokers of 25 or more cigarettes each day). One piece of gum is one dose; maximum dosage should not exceed 24 pieces per day.
• Nicotine gum helps take the edge off cigarette cravings without providing the tars and poisonous gases found in cigarettes. It is a temporary aid that reduces symptoms of nicotine withdrawal after quitting smoking.
• Nicotine gum must be used properly in order to be effective. Steps for nicotine gum users follow include:
• Stop all smoking when beginning the nicotine gum therapy.
• Do not eat or drink for 15 minutes before using, or while chewing the gum (some beverages can reduce its effectiveness).
• Chew the gum slowly on and off for 30 minutes to release most of the nicotine. Parking the gum between the cheek and gum allows the absorption of nicotine into the lining of the cheek.
• Chew enough gum to reduce withdrawal symptoms (10-15 pieces a day but no more than 30 a day).
• Use the gum every day for about a month or so, then start to reduce the number of pieces you chew a day, chewing only what you need to avoid withdrawal symptoms.
• Discontinue use of gum after three months.
• The average retail price for nicotine gum is approximately $5/day for average usage during the first six weeks of use.
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Nicotine Lozenge
• Nicotine lozenge comes in the form of a hard candy, and releases nicotine as it slowly dissolves in the mouth. Biting or chewing the lozenge will cause more nicotine to be swallowed quickly and result in indigestion and/or heartburn.
Nicotine lozenge is available in 2mg or 4mg doses. One lozenge is one dose; maximum dosage should not exceed 20 lozenges per day.
Each lozenge will last about 20-30 minutes and nicotine will continue to leach through the lining of the mouth for a short time after the lozenge has disappeared. Do not eat or drink 15 minutes before using the lozenge or while it is in your mouth.
• The most common side effects of lozenge use are:
• Soreness of the teeth and gums
• Indigestion
• Irritate throat
• The average retail price for nicotine lozenge is approximately $6/day for average usage (12 doses) and up to $12/day for maximum usage (20 doses) during the first six weeks of use.
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By Prescription
Nicotine Nasal Spray
• Nicotine nasal spray, dispensed from a pump bottle similar to over-the-counter decongestant sprays, relieves cravings for a cigarette.
• Nicotine is rapidly absorbed through the nasal membranes and reaches the bloodstream faster than any other NRT product, giving a rapid nicotine "hit". This feature makes it attractive to some highly dependent smokers.
• The most common side effect due to the nasal spray is nose and throat irritations.
• Nicotine lozenge is available in 2mg or 4mg doses. One lozenge is one dose; maximum dosage should not exceed 20 lozenges per day.
• A usual single dose is two sprays, one in each nostril. The maximum recommended dose is 5 doses per hour or 40 doses total per day.
• The average retail price for nicotine nasal spray is approximately $5/day for average usage (13 doses) and up to $15/day for maximum usage (40 doses).
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Nicotine Inhaler
• The nicotine inhaler consists of a plastic cylinder containing a cartridge that delivers nicotine when you puff on it.
• Although similar in appearance to a cigarette, the inhaler delivers nicotine into the mouth, not the lung, and enters the body much more slowly than the nicotine in cigarettes. The nicotine inhaler is available only by prescription.
• Each cartridge delivers up to 400 puffs of nicotine vapor. It takes at least 80 puffs to obtain the equivalent amount of nicotine delivered by one cigarette.
• The initial dosage is individualized. The best effect is achieved by frequent, continuous puffing for 20 minutes. One cartridge will last for 20 minutes of continuous puffing and deliver 4 mg of nicotine; only 2 mg are actually absorbed. This is the equivalent of about 2 cigarettes. The maximum suggested dose is 16 cartridges per day.
• Side effects include irritation of the lining of the mouth.
• The average retail cost of the nicotine inhaler is approximately $45.00/package (42 cartridges).
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It is necessary with all types of nicotine replacement therapy to follow the doctor's orders and use these products only as prescribed and/or according to labeling. These products can also be dangerous for pregnant women.
The goal in using nicotine medications is to stop smoking completely. If you plan to take nicotine medications begin using them on the day you quit. If you continue to have strong urges to smoke or are struggling to stop smoking completely, ask your healthcare provider about additional help.
