What are your Options?
Nicotine Replacement Therapy (NRT)
NRTs nicotine is absorbed much slower as compared to nicotine from cigarettes. They do not fuel nicotine addiction with instant dopamine release. Currently 5 NRT dosage forms are available on the market. Nicotine inhaler and nasal sprays require a prescription, but anyone 18 years or older can purchase nicotine gum, transdermal patches and lozenges over the counter. Comparing all NRTs, none is superior.
The choice is a matter of preference! Patients with stomach ulcers, worsening angina or who recently (within 2 weeks) had a myocardial infarction should seek the help of a health care professional.)
Be aware: Smoking increases liver enzymes (CYP 1AC) which metabolize caffeine. Be mindful of your caffeine intake during smoking cessation, the effect may be much stronger! (This may also affect other medications you are taking. Check with your pharmacist!)
Prescription: Zyban (Bupropion)
Bupropion is on the market under two brand names. First in 1985 the FDA approved the drug under the brand name Wellbutrin, an antidepressant for major depressive disorder; about ten years later, starting with the idea antidepressants could be of use for smoking cessation, Zyban was approved.
The special appeal for patients to use Zyban for smoking cessation is either due to comorbid depressive symptoms or to take advantage of the drug’s adverse side effect: weight loss.
Of course, there are always side effects to be considered which are associated with medications! similar to all antidepressants, bupropion has a boxed warning about potentially increased risk of serious neuropsychiatric adverse reactions. Also, special considerations should be given to patients who experience anxiety or those who have uncontrolled hypertension.
Zyban [Highlights of Prescribing Information] Research Triangle Park, NC: GlaxoSmithKline; 2017.
Prescription: Chantix (varenicline):
Varenicline is not an antidepressant. It is simply marketed for smoking cessation, since it binds to the nicotine receptors in the brain, essentially blocking dopamine to be released. Consequently, the addictive cycle is interrupted and smoking becomes less rewarding. Patients are still allowed to smoke for the first week while starting Chantix.
In comparison to Zyban, Chantix has proven to be more efficacious. However, one of the drawbacks: it is very NAUSEATING! 30% of patients experienced this adverse effect in clinical trials.
To avoid this side effect the medication is tapered over the first week to reach the dose of 1 mg twice daily. It may also be readjusted to a tolerable dose for the patient. Other rather common side effects, experienced by more than 5% of patients, include abnormal dreams, insomnia and vomiting.
Chantix [product labeling]. New York, NY: Pfizer; 2014.
Acupuncture for addictions is well established and used all over the world. The most known and studied regimen used is the National Acupuncture Detoxification Association (NADA) protocol, developed by physician and acupuncturist Dr. Michael Smith, in the mid 1970’s at Lincoln Hospital in South Bronx, New York.
The NADA protocol consists of 3 – 5 standardized (same points for everyone) auricular acupuncture points. Benefits include reduced cravings, relief of acute withdrawal symptoms as well as anxiety and sleep disturbances.
Patients typically report an overall sense of well-being, feeling more relaxed, lighter & energized, leading to discovery of inner peace and strength.
Stuyt E, Voyles C. The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives. Substance Abuse and Rehabilitation. 2016; Substance Abuse and Rehabilitation 2016; 7:169–180.