Quitting smoking isn't easy!

Nobody says that quitting smoking is easy. The nicotine in cigarettes exerts a physical and mental hold on the smoker that presents a formidable barrier to quitting. For some people, nicotine is as addictive as heroin or cocaine, according to the U.S. Agency for Health Care Policy and Research.

It is not surprising, therefore, that fewer than 25 percent of smokers are able to quit on the first attempt, Cravings for a cigarette make life intolerable for many smokers. Withdrawal symptoms like irritability, anxiety, headache, depression, lack of concentration and restless-ness overcome will power and cause relapse. Today, however, there are a host of nicotine replacement products that can help smokers reduce their craving and withdrawal symptoms. In fact, studies found that using a nicotine replacement therapy can double the chances of quitting. Some products like the nicotine patch and nicotine gum are available in over the-counter forms while others like nicotine nasal spray and nicotine inhalers are available by prescription only. The FDA approved these nicotine replacement products after initial trials showed they were safe and effective.

It is always a good idea

To check with your physician before using any nicotine replacement product to make sure that it is sate and appropriate for you. Pregnant women and people with heart or blood vessel problems can’t use some products. People who take medications for other conditions such as asthma or depression, also need to be monitored carefully because the dose of their medications to treat these conditions may need to be adjusted. Quitting smoking, with or with-out nicotine replacement, affects breathing and other body functions.

Because nicotine addiction isn’t just physical, smokers also need some kind of support, either informal support from family and friends or a formal stop-smoking pro-gram, when they use nicotine replacement products. Individual and group programs are useful because they teach smokers behavioral techniques, like deep relaxation so they can reduce feelings of stress that lead them to light up. Nicotine replacement products deliver small, steady doses of nicotine into the body to lessen the craving for nicotine when smoking stops. Although the patch, gum, nasal spray and inhaler deliver nicotine into the blood, they don’t contain the tar and monoxide that are largely responsible for cigarettes’ dangerous effects on the body.

Medication that doesn’t replace nicotine, but instead reduces craving is another option. Zyban (chemical name bupropion hydrochloride) was approved by the FDA in 1997. It is the only aid that contains no nicotine.

What kind of treatments are available?

Nicotine Patch

The FDA approved the nicotine patch, which looks like an adhesive bandage, as a prescription in 1993, Four years later it became available in over-the-counter forms. The nicotine patch releases a constant amount of nicotine through the skin. It is applied every morning to a different area of dry, non-hairy skin for about 16 to 24 hours. Most people us the patch for 6 to 12 weeks.

According to the American Lung Association, giving up the patch has been shown to be easier than giving 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 bloodstream stays relatively constant day after day. Since there is immediate satisfaction from the patch, people don’t develop a craving. Also, people usually smoke multiple times a day and smoking becomes a habit. Since the patch is applied only once a day, there is no strong habit to break.

Obviously, the patch is not a good choice for people with allergies to adhesive tape. Side effects like insomnia and headache can occur, so keep your physician informed of any unusual symptoms — even if you don’t think they’re related to the patch.

The nicotine patch is sold over-the-counter under the brand names Nicoderm and Nicotrol and by prescription under the names Habitrol and Prostep.

Nicotine Gum

The FDA approved Nicorette gum (nicotine polacriiexl) for prescription sale in 1984 and began allowing its sale without prescription in 1996. The gum releases nicotine into the bloodstream through the lining of the mouth. Unlike ordinary gum, it is chewed differently — as a specific 30-minute regimen. Nicorette must be chewed slowly until a slight, peppery taste develops and then the gum is “parked” between the cheek and gum until the taste is almost gone. This is repeated for about 30 minutes per piece.

There are two dose levels tailored to how much a person smokes. Those who smoke 26 or more cigarettes each day usually use the gum at a 4-milligram dose level, while less heavy smokers rely upon the 2-milligram version. Most people find that chewing 9 to 12 pieces a day controls their urge to smoke. The maximum number of pieces that can be safely chewed is between 20 and 30, depending on the dose selected. Most people use the gum every day for about a month or so and then begin reducing the number of pieces. Finally, they chew only when they want to avoid withdrawal symptoms. The gum is usually used for about three months. Some people develop a sore jaw or upset stomach, but these side effects often disappear when the gum is used correctly.

Other available treatments

Nicotine Nasal Spray

The FDA approved Nicotrol Nicotine Nasal Spray for sale by prescription in 1996. The nicotine is inhaled into the person’s nose from a pump bottle like those used with antihistamines. The nicotine is absorbed through the nasal lining into the blood stream. Usually one milligram of nicotine is administered with each spray. People often use the spray as needed up to 30 times each day for 12 weeks including a tapering off period. Common side effects include nasal sinus infection. People who have allergies, asthma or nasal or sinus conditions generally choose another product.

Nicotine Inhaler

The FDA approved the Nicotrol Nicotine inhalation System for prescription use in 1997. The nicotine enters the person’s mouth through a plastic mouthpiece. Although it is called an inhaler, it does not deliver nicotine to the lungs like a cigarette does. Almost all of the nicotine travels only as far as the mouth, where it is absorbed through the mucous membranes. The inhaler may be used for three months. Side effects such as coughing or throat irritation may occur. People with asthma or a pulmonary disease should discuss their situation with their physicians; other forms of nicotine replacement may be more advisable.


Zyban (bupropion hydrochloride) was approved by the FDA for smoking cessation in 1997. It is a reformulation of the antidepressant Wellbutrin. Although scientists aren’t sure how Zyban reduces symptoms of withdrawal, it seems to have an effect on the chemicals in the brain associated with nicotine addiction. The length of therapy varies but is usually 6 to 12 weeks. Some common side effects are dry mouth, dizziness, difficulty sleeping and skin rash. There is also a chance that one out of every 1,000 people taking the drug may have a seizure.

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