Saying that you’re going to quit smoking is easy. What’s harder is not lighting up over the long term and, ideally, forever. That’s why smokers struggle with quitting. It takes an average of five to 15 times to quit smoking before most people are successful, according to health experts.
Nicotine replacement therapy can make the quest to stop smoking more comfortable. “The nicotine is delivered to the body to help prevent nicotine withdrawal while the person quitting works on the behaviors, thoughts and emotions that might trigger them to want to smoke,” says Thomas Ylioja, clinical director of health initiatives programs and a tobacco cessation expert at National Jewish Health in Denver. Along with NRT, there are oral medications that can help lower your desire to light up.
Nicotine replacement therapy is made with medical-grade nicotine. It’s different from the nicotine that’s in cigarettes because cigarettes also contain various dangerous chemicals. That makes the nicotine from the patch less pleasurable. Nicotine replacement therapy can increase your chances of quitting smoking by 50% to 60%, according to a 2018 review article published by Cochrane.org, a global, independent network that summarizes evidence-based health information.
Nicotine replacement therapy comes in several forms:
— A patch you can wear up to 24 hours. It delivers nicotine through the skin so you receive a steady dose. You can find patches over-the-counter.
— Gum and lozenges that deliver nicotine through the mouth and into the bloodstream. These are used when you have in-the-moment cravings. Gums and lozenges also are available over the counter.
— A prescription oral inhaler that you puff on. The nicotine reaches your oral tissues and then goes into your blood.
— A prescription nasal spray. Both the inhaler and nasal spray help with in-the-moment cravings. The oral inhaler and nasal spray are less commonly used than the patch, gum and lozenges.
How to Use Nicotine Replacement Therapy
You place a nicotine patch on your skin every morning and wear it for up to 24 hours. The patches have different dosing usually based on how often you smoke — the more you smoke, the higher-dose patch you would use. Then, you eventually work your way down to a lower-dose patch, Ylioja says. Always read the packaging instructions to make sure you’re using a dose that’s right for you.
Gums, Lozenges, Inhalers and Sprays
You use gums, lozenges, inhalers and nasal sprays when something is happening that may spark desire for a cigarette, says Dr. Panagis Galiatsatos, an assistant professor in the Division of Pulmonary and Critical Care Medicine, co-director of Medicine for the Greater Good, director of the Tobacco Treatment Clinic at Johns Hopkins Bayview in Baltimore and volunteer medical spokesperson for the American Lung Association. For instance, when you’re at a weekly poker game with some buddies and others around you are lighting up. Or, you had a stressful encounter with your boss.
It’s possible to use more than one type of nicotine replacement therapy, says J. Lee Westmaas, scientific director of behavioral research for the American Cancer Society. You may wear a patch and then have the gum or lozenges on hand for when you need them. Talk to your doctor if you would like to use more than one type of NRT to make sure that’s the best approach to help you quit smoking.
People may choose one type of nicotine replacement therapy over another based on personal preference or what a doctor has recommended. Or, you may use the type of therapy available for free through your state’s quit line. By calling 800-QUIT-NOW, you can connect to your state’s quit line. Some of them offer free initial nicotine replacement therapy. You may try one type of NRT and not like it and then decide to try another type of nicotine replacement therapy.
Nicotine replacement therapy is commonly used for eight to 10 weeks. “This helps the body slowly get rid of the nicotine and avoid the worst of withdrawal symptoms,” Ylioja says. However, you could need the products even longer. Galiatsatos often has patients stop smoking slowly, aiming for a 50% reduction in smoking by three months. That means a longer time period during which you may need nicotine replacement therapy.
Side Effects of Nicotine Replacement Therapy
Each type of nicotine replacement therapy has some side effects, although health experts say they are minimal.
Side effects of the patch, gums and lozenges include:
— Skin irritation where you place the patch. A cortisone cream can help with any irritation.
— Trouble sleeping. This may prompt you to wear the patch while you’re awake and not while sleeping, Ylioja says.
— Weird dreams or nightmares.
— Racing heart.
— Irritation in the mouth for gums and lozenges. If they irritate the mouth in one location, you can try moving them around a bit, Galiatsatos advises.
The gums and lozenges are not designed to be swallowed. You may get an upset stomach if you swallow them, Ylioja adds.
Some side effects, such as a racing heart, may mean the dose of nicotine is too high for you. It’s possible to lower the dosing to make it more tolerable or try a different type of nicotine replacement therapy.
For the nicotine nasal spray, you may experience an irritated throat, runny nose or a hot feeling in the back of your nose. For the nicotine inhaler, side effects include coughing, heartburn and indigestion.
Check with a doctor before using nicotine replacement therapy if you’re pregnant or breastfeeding as the evidence of NRT safety during pregnancy isn’t clear enough. The American College of Obstetricians and Gynecologists only recommends it after a detailed discussion of risks and benefits. If you have uncontrolled high blood pressure or a recent heart attack, you may be able to use NRT but you’ll want to let your doctor know first.
Oral Medications to Help You Quit Smoking
In addition to nicotine replacement therapy, there are oral medications that can aid you to quit smoking. These are particularly useful if you smoke more than a pack a day or wake up at night to smoke.
One medication is bupropion, a common antidepressant that researchers found also led some participants to help stop smoking. It does so by helping you to avoid nicotine withdrawal when quitting.
The other medicine is varenicline, which blocks the nicotine receptors in the brain and takes away the pleasure of smoking. It also lowers the symptoms of nicotine withdrawal. It was designed to help those who want to quit smoking.
A third medication called cytisine is not widely available in the U.S., Westmaas says. There are other drugs sometimes recommended to help stop smoking such as clonidine and nortriptyline, but they aren’t approved by the Food and Drug Administration for that purpose.
Both bupropion and varenicline are used twice a day. You start bupropion a week before the date you plan to quit and take it for three months. Similarly, you take varenicline one to four weeks before you plan to quit and use it for at least three months. “When you reach your quit date, most people find they no longer even want to smoke,” Ylioja says.
It’s possible to use both oral medications and nicotine replacement therapy. The American Thoracic Society released guidelines in 2020 on smoking cessation and recommended varenicline as their first choice, but also recommended varenicline along with a nicotine patch to help quit smoking. The guidelines favor varenicline over bupropion. Galiatsatos was a co-author of the guidelines.
Side Effects of Oral Meds to Quit Smoking
Side effects of bupropion include:
— Dry mouth.
— Feeling depressed or anxious or having suicidal thoughts.
— Stuffy nose.
You shouldn’t use bupropion if you have had or currently have:
— A bad injury.
— Bipolar illness.
— Cirrhosis, which is a chronic disease of the liver.
— An eating disorder such as anorexia or bulimia.
— Heavy alcohol dependence.
Side effects of varenicline include:
— Changes in taste.
— Mood or behavior changes.
— Trouble sleeping.
For both bupropion and varenicline, let your doctor know if you start to feel depressed or have thoughts of suicide while using the medication.
Counseling to Help You Quit Smoking
Even with nicotine replacement therapy and oral medications, you should still get counseling to help you quit smoking. Counseling can help someone learn about their triggers for smoking and how to cope with those triggers, Westmaas says.
Counselors also offer encouragement and emotional support. The combination of quit-smoking medications and assistance from a counselor can significantly increase your chances of quitting successfully. There are counselors available in person, online and through the state quit line phone numbers.
Remember to have patience with yourself as you try to quit. “If you can increase the amount of time you’re smoke-free from the last time you tried to quit, you should consider that a success,” Westmaas says. Try to learn from each attempt to quit.
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