Quitting cigarettes is tough, we know, but meds can help.
Medication softens the withdrawal symptoms you feel as you quit smoking. It makes it easier to cut back your nicotine intake until you do not use cigarettes at all.
Nicotine is the main addictive substance in tobacco smoke. Nicotine replacement medications approved by the FDA (the patch, gum, lozenge and nasal spray) work by giving you a dose of nicotine that’s smaller than what cigarettes contain, and it’s delivered more slowly, so it is safer.
Studies show that people are two to three times more likely to be smoke-free six to 12 months after their quit dates if they use nicotine replacement or other medication, plus counseling, compared with people who don’t use those tools.
Dr. Hilary Tindle, the founding director of the Vanderbilt Center for Tobacco, Addiction and Lifestyle, points out a major benefit of quitting smoking, and the medications that can help that process:
Quitting lowers the risk of lung cancer. So these medications are a tool to help people achieve a potentially life-saving goal. (Those at highest risk for lung cancer are ages 50 to 80 who smoke, or used to, with a 20-pack year smoking history. Lung cancer screenings are available for this group.)
There are six FDA-approved medications to help people quit smoking, Tindle said. Three are over-the-counter. The rest require a prescription.
Over-the-counter nicotine replacement products:
- The patch. Wear it stuck to your skin for a steady dose of nicotine for either 16 or 24 hours. Wear it in a different spot day to day. Over time, switch to lower-dose patches. This is a form of long-acting nicotine replacement therapy; it’s designed to give you a consistent dose of nicotine throughout the day to allow your body to slowly get used to lower levels of nicotine.
- Gum. It delivers nicotine through the mucous membranes in your mouth. It comes in two strengths, 4 mg or 2 mg of nicotine.
- Lozenges. They dissolve in your mouth, like cough drops. Lozenges also come in 4 mg and 2 mg strengths.
Oral forms of nicotine replacement medications (gum, lozenges and nasal spray) are short-acting, meaning you should use them throughout the day in the moment, to help manage cravings and withdrawal symptoms.
Two forms of nicotine replacement are better than one! People who smoke every day and try to quit with the help of these products tend to have greater success when they combine the patch and lozenge (or patch and gum), compared with using only one.
In a “patch plus” strategy, Tindle said, you put the patch on daily and use the gum or lozenge as needed – for example, if you know you’ll have strong cravings after a meal. Be aware that the nicotine replacement medications don’t kick in as fast as a cigarette’s nicotine, which is one reason they’re less addictive than cigarettes. They can take about 15 to 20 minutes to begin working.
Prescription medications:
- Nasal spray. This contains nicotine, which gets into your bloodstream by being absorbed by the lining of your nose. One spray to each nostril delivers about 1 mg of nicotine.
- Varenicline, known by the branded name Chantix. It is a pill that does not contain nicotine.
- Bupropion, known by the branded name Zyban. Like varenicline, it is a pill that does not have nicotine.
Varenicline and bupropion act in the brain to reduce cravings and ease withdrawal symptoms. Often doctors prescribe them for people to begin taking before their target quit date. They can also be prescribed in combination with nicotine replacement medications.
Talk to your doctor about what kind of medication is best for your effort to quit smoking, and what help and side effects to expect from each.
Do you need a lung screening?
People at highest risk for lung cancer are ages 50 to 80; and have smoked within the past 15 years, with a 20 pack-year history (a pack a day for 20 years, or the equivalent, such as a half-pack a day for 40 years). See if lung cancer screenings are right for you.
