For many, part of their 2019 reset included a resolution to quit using tobacco. Here, Michael Genday, Pharm.D. Candidate, Anteneh Mekonnen, Pharm.D. Candidate, and Dustin Linn, Pharm.D., BCPS, BCCCP, offer an overview of the most common products on the market and what consumers need to know.
Background
Tobacco smoke contains more than 7,000 chemicals. Some of these chemicals are known to cause cancer and damage lung tissue, leading to emphysema, chronic bronchitis and asthma attacks. In addition, tobacco smoking can cause heart attacks and strokes. Tobacco smoking is responsible for 480,000 deaths each year in the United States.
There are numerous benefits to quitting tobacco, including:
- May significantly reduce the risk of premature death
- May lower the risk of lung cancer and other cancers
- Reduces the risk of developing chronic obstructive pulmonary disease and other respiratory symptoms
- Coronary heart disease risk is significantly reduced within 1-2 years of smoking cessation
- Reduces the risk for stroke
Nicotine found in tobacco products is a highly addictive substance, making it difficult to quit even if someone is motivated to do so. Over-the-counter and prescription-only tobacco cessation products combined with counseling is the best way to stop nicotine dependence. No one particular tobacco cessation product is right for each person, so talk to your pharmacist or doctor before using any of the products listed below.
Nicotine Replacement Therapy
Nicotine gum
- Available in 2 mg and 4 mg strengths
- The 2 mg gum is recommended for patients smoking less than 25 cigarettes per day; the 4 mg gum is recommended for patients smoking 25 or more cigarettes per day.
- The gum should be chewed slowly until a “peppery” or “flavored” taste emerges, then “parked” between the cheek and the gums to facilitate nicotine absorption through the oral mucosa.
- The gum should be slowly and intermittently “chewed and parked” for about 30 minutes or until the taste dissipates.
- Do not chew more than 24 pieces per day.
Nicotine lozenge
- Available in 2 mg and 4 mg strengths.
- The 2 mg lozenge is recommended for those who smoke their first cigarette more than 30 minutes after waking, and the 4 mg lozenge is recommended for people who smoke their first cigarette within 30 minutes of waking.
- The lozenge should be allowed to dissolve in the mouth rather than chewed or swallowed.
- Do not use more than 20 pieces per day.
Nicotine patch
- A new patch should be placed daily on a relatively hairless location, typically between the neck and waist, rotating the site to reduce local skin irritation.
- Patches should be applied upon awakening.
- For those who experience sleep disruption, the patch can be removed prior to bedtime.
Nicotine inhaler
- A dose from the nicotine inhaler consists of a puff or inhalation.
- Recommended dosage is 6–16 cartridges/day.
- Recommended duration of therapy is up to 6 months. The dose should be tapered during the final 3 months of treatment.
- Best effects are achieved by continuous puffing of the inhaler over 20 minutes and using at least six cartridges/day.
- This method is available by prescription only.
Nicotine nasal spray
- One dose is equal to one spray per nostril (0.5 mg/spray).
- Minimum dose is 8 doses per day and the maximum dose is 40 mg per day.
- Do not sniff, swallow, or inhale through the nose while administering doses, as this increases irritating effects.
- The spray is best delivered with the head tilted slightly back.
- Do not use for more than 3 months.
Most nicotine replacement products listed above will cost around $40-$90/month depending on the quantity needed. All nicotine replacement products have similar adverse effects that can include:
- Increased heart rate
- Hypertension
- Nicotine dependence
Non-Nicotine Replacement Therapy
Bupropion
- The most common adverse effects are insomnia, dry mouth, nausea and constipation.
- This may be a good option for those who also have a diagnosis of depression.
- Begin taking this medication 1 week before the quit date with 150 mg daily for 3 days, then 150 mg twice daily for up to 7-12 weeks.
- This method is available by prescription only.
Varenicline
- The most common adverse effects are vivid dreams, nausea and insomnia.
- Begin taking this medication 1 week before the quit date. Take 0.5 mg once daily for 3 days, then 0.5 mg twice daily for 4 days, followed by 1 mg twice daily for 3 months.
- This method is available by prescription only.
