November 16, 2015

Quitting cigarettes is tough, we know, but meds can help.


Medication softens the withdrawal symptoms you feel as you quit smoking and makes it easier to cut back your nicotine intake until you do not use cigarettes at all.

Although nicotine is the main addictive substance in tobacco smoke, nicotine replacement medications work by giving you controlled doses of nicotine — without the 7,000 other harmful chemicals that cigarettes contain.

Studies show that people are about 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 those who don’t use those tools.

There are seven FDA-approved medications to help people quit smoking. Three are over-the-counter; the rest require a prescription. Below is a guide — just in time for the American Cancer Society’s Great American Smokeout on Nov. 17.

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 of nicotine or 2 mg.
  • Lozenges. They dissolve in your mouth, like cough drops. Lozenges come in 4 mg and 2 mg strengths.

Oral forms of nicotine replacement medications (gum, lozenges, inhalers and nasal spray — more on those last two, below) are short-acting, meaning you should use them throughout the day 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, 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 nicotine replacement medications:

  • An inhaler. It’s a cartridge with a mouthpiece that delivers nicotine through the mucous membranes in your mouth. You control the dosage by the number of cartridges you use each day, with the aim of tapering off over several months. Don’t try substituting e-cigarettes for an inhaler; they’re not the same!
  • Nasal spray. Nicotine gets into your bloodstream from being absorbed by the lining of your nose. One spray to each nostril delivers about 1 mg of nicotine.

Prescription non-nicotine medications:

  • Varenicline, known by the branded name Chantix.
  • Bupropion, known by the branded name Zyban.

These come in pill form. Like nicotine replacement, they 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.


For more information on medications to help you quit smoking, see the American Cancer Society’s guide to quitting smoking.

To work with a counselor to help you create a plan for quitting, call the Tennessee Tobacco Quitline, 1 800-784-8669, or use it online at

November is Lung Cancer Awareness Month. Those at highest risk for lung cancer are ages 55 to 74; and current or former smokers with 30 or more pack years. See if  lung cancer screenings are right for you.