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Author: David Rossmiller, M.D.
Clinic: Vadnais Heights Clinic

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      Spring is a time of new beginnings, and a good time to become tobacco-free. If you are interested in tobacco cessation, your Family HealthServices Physician can assist you with tobacco cessation strategies that may include prescription or over-the-counter medications. Medications increase your chances of successfully quitting smoking to as much as 50%. Stopping smoking or chewing tobacco is always a challenge because it is a true addiction, and the body likes the effects of the drugs on the brain. Even with good medical support, it is not unusual to fail a tobacco cessation program, and the key is to keep trying until you are successful. Recording a smoking log to look for triggers to smoking desire, setting up a designated smoking area, not carrying tobacco products on your person, and not allowing smoking in the home or car are some initial steps in the tobacco cessation process.

 

     Nicotine Replacement therapy (NRT) is a primary treatment to help people quit tobacco product use. NRT is available in four different delivery systems, the most common being a daily transdermal patch that releases a continuous dose of nicotine through the skin. The patch nicotine strength is decreased every few weeks to wean the level of nicotine in the body. Another common NRT is nicotine gum, which is "chewed and parked" inside the cheek, where the nicotine is absorbed into the blood stream. Initially, a piece of nicotine gum is chewed every two hours, and then the time interval is lengthened to taper its use. If the gum is chewed continuously, the jaw muscles become very sore and the temporomandiblular joints become painful.

 

   Two newer forms of NRT are the nasal spray inhaler and the oral inhaler. The nasal spray is initially squirted into the nose 1 -2 times per hour, and then the number and frequency of sprays are decreased over time. The nasal spray achieves the highest nicotine levels, making it useful in very heavy smokers. Common side effects include nasal irritation, sore throat and cough. The oral inhaler is puffed like a cigarette, but not inhaled into the lungs, with effects similar to nicotine gum. All forms of NRT cost approximately the same as smoking one pack of cigarettes per day. Your doctor can help you pick the NRT that is right for you.

 

      Buproprion (Zyban) indirectly decreases your craving for tobacco by altering dopamine levels and decreasing stimulation of the brain's pleasure centers. Buproprion is more effective when combined with NRT. Side effects of Zyban include headache and sleep disturbance, and it sometimes helps to take at a lower dose for the first week. Zyban costs about $80 per month, which is about the price of a pack-a-day addiction. Because some patients should not use Zyban, you need to check with your doctor to determine if it is an option for you.