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Tips on Quitting
Nicotine Replacement Therapies and Bupropion SR

The U.S. Food and Drug Administration has approved five medications for smokers who wish to quit. Four medications work by "replacing" the nicotine found in cigarettes, and one medication, bupropion SR, is a nicotine-free pill. Nicotine replacement therapy has been shown to double the chances of success in quitting, although the treatment is somewhat more effective with males than females. Pregnant and nursing smokers should first try to quit without using these products and should not use any medication without consulting with their physician. Perkins, K. A. (1996). Sex differences in nicotine versus nonnicotine reinforcement as determinants of tobacco smoking. Experimental Clinical Psychopharmacology, 4, 166-177.

Public Health Service. (2000). Treating tobacco use and dependence. Washington, DC: U.S. Department of Health and Human Services.

Wetter, D., Fiore, M. C., Jorenby, D., Kenford, S., Smith, S., & Baker, T. (1999). Gender differences in smoking. Journal of Consulting and Clinical Psychology, 67, 555-562.

Nicotine Patch (available over the counter)

Nicotine Patch This product is a disposable adhesive patch that contains nicotine. The patch is applied to the upper arm or upper body once each day, varying the location to avoid skin irritation. Once the patch is applied, nicotine gradually enters the body by dissolving into the skin. Nicotine patches come in a variety of dosages, and it is common for smokers to start with a high dosage and gradually taper off as the craving for cigarettes diminishes. Research on the nicotine patch has found that treatments of 8 weeks or less are as effective as longer treatments, and that 16-hour patches are as effective as 24-hour patches. Public Health Service. (2000). Treating tobacco use and dependence. Washington, DC: U.S. Department of Health and Human Services.

Nicotine Gum (available over the counter)

Nicotine Gum Nicotine gum is chewing gum with nicotine. Instead of chewing it continuously, however, nicotine gum should be chewed only until a peppery or minty flavor is tasted. At that point, the gum should be left in place so that its nicotine is absorbed through the mouth. Nicotine gum comes in two dosages: 2 and 4 mg. Highly dependent smokers (e.g., those smoking 25 or more cigarettes per day) should use the 4 mg dosage. Generally, the gum should be used for up to 12 weeks with no more than 24 pieces per day. The best way to use this product is by following a fixed schedule in which at least one piece is chewed every 1-2 hours for 2-3 months. Herrera, N., Franco, R., Herrera, L., Partidas, A., Rolando, R., & Fagerstrom, K. O. (1995). Nicotine gum, 2 and 4 mg, for nicotine dependence: A double-blind placebo-controlled trial within a behavior modification support program. Chest, 108, 447-451.

Kornitzer, M., Kittel, F., Dramaix, M., & Bordoux, P. (1987). A double blind study of 2 mg versus 4 mg nicotine gum in an industrial setting. Journal of Psychosomatic Research, 31, 171-176.

Public Health Service. (2000). Treating tobacco use and dependence. Washington, DC: U.S. Department of Health and Human Services.

Nicotine Spray (available by prescription only)

Nicotine Spray Nicotine spray delivers nicotine through the nose. To administer the spray, smokers tilt their head back and squeeze a spray bottle that sends 0.5 mg of nicotine into each nostril. When using the spray, it is important not to sniff, swallow, or inhale through the nose (otherwise, nasal irritation can occur). The initial dose is 1-2 administrations per hour, increasing as needed for the relief of nicotine cravings up to a maximum of 40 administrations per day or 5 per hour. Treatment typically lasts 3-6 months. Public Health Service. (2000). Treating tobacco use and dependence. Washington, DC: U.S. Department of Health and Human Services.

Nicotine Inhaler (available by prescription only)

Nicotine Inhaler A nicotine inhaler has a mouthpiece with a cartridge that contains nicotine. When smokers puff on the mouthpiece, they inhale air that is saturated with nicotine. One advantage of a nicotine inhaler is that it satisfies the "hand-to-mouth" ritual that smokers miss when they quit. Unlike the nicotine from a cigarette, however, nicotine from an inhaler is absorbed through the mouth and throat rather than the lungs. Thus, an inhaler does not produce the "nicotine spike" that contributes to tobacco addiction. Nicotine inhalers are typically used for up to 6 months, with tapering off during the last 3 months. Fisher, E. B., Jr. (1998).Seven steps to a smoke-free life. New York: John Wiley & Sons.

Public Health Service. (2000). Treating tobacco use and dependence. Washington, DC: U.S. Department of Health and Human Services.

Bupropion SR (available by prescription only)

Zyban Bupropion SR is a non-nicotine pill marketed under the name Zyban. This treatment is an alternative to nicotine replacement therapy and has been shown to be an effective quitting aid with smokers who have a history of depression. Smokers using bupropion SR begin taking the medication 1-2 weeks before quitting, and they remain on a maintenance dosage for up to 6 months. Bupropion SR should not be used by smokers who have a history of seizures or eating disorders, who are using another form of bupropion (Wellbutrin or Wellbutrin SR), or who have used an MAO inhibitor in the past 14 days. Public Health Service. (2000). Treating tobacco use and dependence. Washington, DC: U.S. Department of Health and Human Services.

All five medications above have been shown to help smokers quit, though there is not yet conclusive evidence on which medications are most effective. For further information on specific medications, please see Joe Chemo's links on Products to Help Smokers Quit.

Note: To avoid a nicotine overdose, never smoke tobacco when using a nicotine patch, spray, or inhaler.

 
 

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