US Pharm. 2019;44(7):13-14

Fighting the Addiction to Nicotine

When a person smokes a cigarette or an e-cigarette, nicotine is quickly delivered through the lungs into the bloodstream and carried to the brain, giving the user a pleasant feeling. As a result of both the physical and psychological addiction caused by nicotine, the smoking habit is tough to break. Although quitting is not easy, there are many proven programs to help smokers reach their goal. Most smoking-cessation programs use a combination of education, self-help, and group meetings, as well as nicotine-replacement products or drugs such as bupropion and varenicline, to help relieve the symptoms of nicotine withdrawal.

Health Risks of Smoking

The number one reason people quit smoking is to improve their health and avoid future health problems. Tobacco smoke contains many cancer-causing chemicals. In addition to cancer, smoking contributes to heart diseases such as heart attack and stroke, and lung diseases such as bronchitis and emphysema. Smoking is also dangerous for pregnant women and their babies. 

The benefits of smoking cessation are many, including a rapid normalization of blood pressure and heart rate, improvement in breathing and blood circulation, and better lung function. Over the long term, smoking cessation results in a much lower chance of developing many of the cancers caused by smoking. This includes cancer of the lungs, throat, kidney, bladder, and pancreas, among others. People who stop smoking will live years longer than those who continue to smoke, regardless of their age when they stop.

Support for Smoking Cessation

There are two parts to cigarette addiction and, therefore, two goals of smoking cessation—the physical withdrawal from nicotine and the psychological withdrawal from the act of smoking itself. For some smokers, the physical withdrawal is the most challenging part of quitting, and for others, it is breaking the smoking habit. Several approaches have proven useful to help people manage the psychological part of cigarette addiction, including education provided by a physician, individual or group counseling, and cessation programs that deliver treatments using mobile phones.

Treatments to Ease Withdrawal Symptoms

The primary symptoms of nicotine withdrawal include depression, difficulty concentrating, increased appetite, weight gain, irritability, restlessness, and trouble sleeping.

Most people who smoke at least 10 cigarettes a day will benefit from nicotine replacement to ease the symptoms of nicotine withdrawal. There are many forms of nicotine used in replacement therapy, including chewing gum, lozenges, skin patches, nasal sprays, and inhalers. They vary in cost and how quickly and for how long they act, and each has side effects specific to the dosage form. The nicotine skin patch, chewing gum, and lozenges are available without a prescription, while nicotine nasal spray and oral inhalers require a prescription. Sometimes a combination of nicotine products can be used more effectively than a single product, such as adding a short-acting nicotine gum to a longer acting nicotine skin patch.

Two prescription medications approved for use in smoking cessation are bupropion SR (Zyban) and varenicline (Chantix). Bupropion is an antidepressant that helps ease nicotine-withdrawal symptoms and can be used with nicotine-replacement products. It can cause adverse effects such as dry mouth and dizziness, and it should not be used in people with seizure disorders or eating disorders. Varenicline works to ease nicotine-withdrawal symptoms while blocking the effects of nicotine. Typical side effects include nausea, bloating, constipation, and difficulty sleeping. Using varenicline with nicotine-replacement products worsens these side effects. Pregnant women or smokers with kidney disease should not use varenicline.

All medications used in smoking-cessation programs can cause side effects, but often switching to another drug or lowering the dose can eliminate the problem. Since no single form of nicotine replacement has proven to work better than another, it is a good idea to choose a type that fits the pattern of withdrawal symptoms of the individual.

Your pharmacist can answer any questions you may have about prescription or OTC medications you may be taking for smoking cessation.