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Tobacco Cessation

For direct help to quit, please see our Smoking Cessation Resources page.

There are over 40 million current smokers in the United States.  Are you one of them? Have you tried to quit before? Have you been able to quit for periods of time but then started again? If so, you are not alone. Quitting smoking is tough but you can do it!

Quitting smoking is one of the single most important decisions you can make to improve and extend your life. There are over 45 million former smokers in the US who have been successful in breaking the addiction. Help is available!

Tobacco Cessation Methods

When it comes to quitting, a combination of methods is sometimes used. The United States Public Health Service states that combining medication with counseling to quit smoking is more effective than either method on its own.

Nicotine Replacement Therapy (NRT)

NRT is used to decrease the craving for nicotine and the symptoms that come from not using it, including irritability, trouble concentrating, depression, sleep problems, increased appetite, and headache. Do not smoke while using any kind of nicotine replacement method. If you do, you may experience serious side effects from nicotine overdose.

Several kinds of NRTs are available over the counter and with prescription:

Over the Counter:

The Patch

  • How it works: The patch releases a steady amount of nicotine, taking up to 3 hours to pass through the skin and into the bloodstream. Patches come in different sizes, and larger patches deliver more nicotine.
  • Using the patch: Patches are placed on a part of the body without much hair, often the upper arm, and stay on for 16-24 hours.
  • Common side effects: Dizziness, skin irritation, racing heartbeat, headache, muscle aches/stiffness, nausea, sleep problems and vomiting.

Gum

  • How it works: The gum is chewed and the nicotine is released.  This method delivers the nicotine to the brain more quickly than a patch.
  • Using the gum: Nicotine gum comes in different doses depending on how much a person smokes. A 2 mg dose is recommended for people who smoke 24 or fewer cigarettes per day and a 4 mg dose is recommended for people who smoke 25 or more cigarettes per day. Do not use more than 20 pieces of gum per day. The steps for proper use of the gum are:
    • No smoking before use.
    • No eating or drinking for the 15 minutes before you chew the gum and throughout the duration of the gum chewing.
    • Chew the gum for 30 minutes.
      • Chew slowly
      • Place the gum between your cheek and gums.  If the gum is chewed like ordinary gum and not left in the cheek, the nicotine will go right to the stomach, causing a stomach ache while still leaving a craving for a cigarette.
  • Use daily for a month then use as needed when you feel a craving.
  • Stop using after 3 months.
  • Nicotine gum is stickier than ordinary gum, so if it sticks to your dental work, stop using it and talk to your doctor or dentist.
  • Common side effects: Sleep problems and strange dreams, diarrhea, dry mouth, anxiety, sweating, mouth irritation.

Lozenge

  • How it works: The nicotine lozenge (a hard candy) releases nicotine as it dissolves.
  • Using the lozenge: Available in a 2mg and 4mg dose (recommended for people who have their first cigarette within 30 minutes of waking up).  Use no more than 20 lozenges per day. One lozenge will last for 20-30 minutes, and the nicotine will continue to work its way through the mouth lining after the lozenge is gone.
    • If you chew or bite the lozenge, the nicotine will be swallowed quickly and cause indigestion and heartburn.
    • No eating or drinking 15 minutes before using the lozenge or when it is in your mouth.
    • Do not use for more than 12 weeks.
    • If you feel you still need them after 12 weeks, contact your doctor.
  • Common side effects: Throat irritation, sore teeth and gums, indigestion

Prescription Inhaled Medications:

Nasal Spray

  • How it works: The lining of the nose absorbs nicotine quickly, allowing it to reach the bloodstream faster than any other treatment.
  • Using the nasal spray: A single dose is 1 spray in each nostril. Two doses per hour is the recommended amount.
    • Do not take more than 5 doses per hour or 40 doses in one day.
    • Common side effects: Nose and throat irritation

Inhaler

  • How it works: Nicotine is delivered into the mouth through a cartridge, and it enters the body more slowly than nicotine from cigarettes. Unlike cigarettes, the inhaler contains no carbon monoxide.
  • Using an inhaler: Each cartridge gives 400 whiffs of nicotine vapor. 80 whiffs contain about the same amount of nicotine as one cigarette. One cartridge lasts for 20 minutes of continued puffing; 4 mg of nicotine is dispensed and 2 mg are absorbed (this is about equal to 2 cigarettes).
    • Use no more than 16 cartridges a day, using the inhaler when you have a craving for a cigarette.
    • Treatment lasts for 8 – 12 weeks.
    • Common side effects: Throat and mouth irritation, cough (if cough does not go away, consult a doctor)

Prescription Oral Medications

Bupropion* (Zyban)

  • How it works: Helps smokers to quit by reducing cravings. You can continue to smoke up to a week while starting Zyban.  
  • Using Zyban: Start with 150 mg/day for 3 days, generally increasing to 300 mg/day on the 4th day. This can be taken as 150 mg twice a day, but waiting 8 hours between doses is recommended. Treatment last from 8 to 12 weeks.
  • Common side effects: Dry mouth, insomnia, dizziness. Do not take if you have a history of eating disorders or seizures or if you are using an MAO inhibitor or other bupropion medications such as Aplenzin or Wellbutrin, which are used to treat depression.

Verenicline* (Chantix) is the most recent medication to be approved by the FDA for smoking cessation.

  • How it works: Chantix cuts off the rewarding, pleasant effects of nicotine while getting rid of some withdrawal symptoms.
  • Using Chantix: Take a tablet twice a day for 12 weeks (12 weeks may be doubled to ensure patients stay smoke-free).
  • Common side effects: Nausea, gas, vomiting, headache, insomnia, abnormal dreams, change in taste

*The FDA warns that behavior changes like hostility, agitation, depression, and suicidal thoughts or actions while taking bupropion or verenicline have been reported. If you are using these medications, watch closely for these symptoms. If they occur, stop taking the medication and seek medical attention right away.