Medical Support to Help You Stop Smoking Todd A.

Hoover, MD, DHt When you are ready to quit smoking, you can stack the deck in your favor in a number of ways. One of the most powerful tools you can use is medication to reduce craving for nicotine. At this time the Food and Drug Administration has approved seven different medicines to assist people to stop smoking. 1. Nicotine gum 2. Nicotine patch 3. Nicotine lozenges 4. Nicotine nasal spray 5. Nicotine inhaler 6. Buproprion SR (Zyban, Welbutrin SR, and others) 7. Varenicline tartrate (Chantix) Of these medications, the Nicotine patch, gum and lozenges are available over the counter. All of the Nicotine based medications act in a similar manner. Generally, the dosage is matched to the current level of nicotine in the daily consumption of cigarettes. After a few weeks the dosage is lowered. And then a few weeks later, the nicotine is stopped. These medications work best when the patient has stopped smoking prior to use. Forms like lozenges and gum may help replace the ritual of smoking making them more effective for certain patients. Studies have shown that use of a constant delivery source, such as the nicotine patch, in combination with an on demand form like lozenges is the most effective method for using nicotine therapy.i The function of the nicotine medication is to lessen craving by gradually withdrawing the main drug causing the dependency on smoking. Because cigarette smoke also contains other chemicals that cause dependence, nicotine alone may not be sufficient during the withdraw reactions that occur after stopping smoking. Buproprion SR is an antidepressant medication, which has been shown to help stop craving for cigarettes in a review of 49 trials using this medicine.ii Many patients who stop smoking experience some level of depression. This medication may be well suited for those patients, and may be used as the first line of treatment for smoking cessation. Buproporion SR requires a prescription from your doctor. Side effects from this medicine include suicidal thoughts and seizures. You should not use this medicine if you are pregnant, breastfeeding, have diabetes, or are taking a monoamine oxidase inhibitor medicine. Varencicline tartrate is a medicine that works by blocking the receptors for nicotine. By doing this, the medicine helps reduce some of the withdraw effects and craving. This medication has

been associated with a number of side effects including nausea, mood changes, agitation and suicidal thoughts. This medicine is only available by prescription. As you can see, there are a number of medications which are used as supportive treatments when you are ready to quit smoking. In addition, you may wish to review some of the articles in the integrative medicine section of the portal. Both Acupuncture and Homeopathic medicine have been reported to help in some of the withdraw symptoms associated with smoking. Therapists, coaches, and support groups can help maximize your likelihood of success.

Megan E. Piper, Ph.D., Stevens S. Smith, Ph.D., Tanya R. Schlam, Ph.D., Michael C. Fiore, M.D.,

M.P.H., Douglas E. Jorenby, Ph.D., David Fraser, M.S., and Timothy B. Baker, Ph.D.. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch

Gen Psychiatry. 2009;66:1253-1262.

ii

John R Hughes, Lindsay F Stead, and Tim Lancaster. Antidepressants for smoking cessation."

Cochrane Database Syst Rev. 2007 Jan 24;(1):CD000031.