Smoker Patch

Smokers who want to give up cigarettes may be able to double their chances of success by wearing nicotine patches before quitting, new research suggests.

Quit-Smoking Aids: What Works?

Quit-Smoking Drugs and Nicotine Patches and Gums

What can help you quit smoking.

Reviewed by

Louise Chang, MD

WebMD Feature Archive

Quitting smoking is never easy. But a growing number of smoking cessation aids make it easier than ever for smokers to break their addiction to nicotine.

Research suggests that medications and nicotine replacement therapies can double and sometimes even triple the chances that a smoker will successfully quit. Some of these treatments also help to minimize weight gain while quitting -- an important plus for many smokers who want to kick the habit.

Recommended Related to Smoking Cessation

Snus: Stealth Health Risk

If you use snus, do you win or lose.

Snus -- alternately pronounced snoose or snooze -- is a smokeless, flavored tobacco product very different from snuff. When placed between cheek and gum, it doesn t make you spit.

Even its critics admit that snus is less harmful than other forms of smokeless tobacco. And it is far less harmful than cigarette smoking.

So is snus a good thing.

It would be a good thing if everyone who smoked cigarettes or dipped snuff switched to snus instead. It would be a good

Read the Snus: Stealth Health Risk article

With a growing number of options available, doctors are now able to create personalized treatment plans tailored to an individual smoker s needs and preferences.

What s right for you. Here are stop-smoking aids and drugs to consider:

Nicotine Replacement Therapies

The idea is simple. To help smokers manage nicotine withdrawal, nicotine replacement therapies deliver the potent drug in ways that are far healthier and safer than cigarettes. Ideally, ex-smokers can gradually reduce the amount of nicotine or stop nicotine replacement therapy all at once after they ve broken the habit of smoking. Even when used for long periods of time, nicotine replacement therapies are far safer than smoking. Quit rates range from 19 to 26.

Is it right for you. If you ve tried to quit before and failed because the craving for nicotine was too strong, nicotine replacement therapies may help. Gum, lozenges, and patches are available over-the-counter. Nasal sprays and inhalers require a prescription. Gums and lozenges are handy to use and offer something for smokers to put in their mouths instead of a cigarette. Some smokers prefer inhalers because the process of inhaling mimics smoking a cigarette. All of these forms are about equally effective and they can be used in combination. Indeed, evidence suggests that combining patches with inhalers, gum, or nasal sprays improves long-term quit rates. But you cannot continue to smoke while using nicotine replacement therapy. You must quit tobacco before you take alternate forms of nicotine.

Expert advice: Don t be in too much of a hurry to go off nicotine replacement, says Scott McIntosh, PhD, associate professor of community and preventive medicine at the University of Rochester in New York and director of the Greater Rochester Area Tobacco Cessation Center. One common problem we see is people stopping too early and then experiencing cravings that they can t resist. McIntosh recommends using nicotine replacement therapies for two to three months. And after you ve stopped using them, he recommends keeping some gum or lozenges handy just in case you suddenly experience an intense craving.

Chantix Varenicline continued

Is it right for you. Chantix is effective in lessening nicotine cravings and has helped many smokers successfully quit. Unlike Zyban, it should not be used in combination with nicotine replacement therapies unless under a doctor s supervision. Chantix was approved in 2006. Side effects include nausea, vomiting,abnormal dreams, constipation, and flatulence. In 2009, the FDA required Chantix to have a boxed warning about serious neuropsychiatric events, including depression, suicidal thoughts, suicidal behavior, agitation, and hostility. Some serious side effect symptoms may be related to nicotine withdrawal.

Expert advice: If you and your doctor decide to try Chantix, it s important to monitor your moods and alert your doctor immediately if you notice any change, says Steven Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of California, San Francisco. Some of the less serious but still unpleasant side effects of the drug, such as nausea, often go away over time.

Zyban Bupropion SR

Approved in 1997, Zyban acts on chemicals in the brain to ease nicotine withdrawal symptoms, making it easier for smokers to resist the craving to light up. The pills are usually taken twice a day for a period of seven to 12 weeks. Some ex-smokers may need to remain on Zyban for longer periods. About 24 of smokers who use Zyban successfully quit.

Is it right for you. Zyban is especially helpful for people with intense nicotine withdrawal symptoms. It can be used alone or in combination with nicotine replacement therapies such as patches or gum. The FDA has required Zyban to have a boxed warning for serious neuropsychiatric events, including depression, suicidal thoughts, suicidal behavior, agitation, and hostility. Some serious side effect symptoms may be related to nicotine withdrawal. The drug is not recommended for people with seizure disorders, bulimia, anorexia, or patients who are abruptly stopping use of alcohol or sedatives, or are using a monoamine oxidase MAO inhibitor. The most common side effects are dry mouth and insomnia. 

Expert advice: Zyban should be started a week or two before your quit date to tame nicotine withdrawal symptoms. Like all drugs, it should be taken as recommended. Contact a health care provider right away if agitation, hostility, depressed mood, suicidal thoughts/behavior, or other changes in thinking or behavior develop.

Counseling and Support

Counseling and support groups have been shown to improve a smoker s odds of successfully quitting. Counseling takes many forms, from a doctor s advice to a formal smoking cessation program such as those offered by medical centers and community health organizations. Online support in the form of quitlines has also proved very helpful. Counseling typically includes advice on how to recognize smoking triggers, strategies to resist cravings, how to prepare for your quit day, ongoing support during the first few months of quitting, and other assistance. Counseling can be combined with all forms of smoking-cessation aids.

SOURCES:

Scott McIntosh, PhD, associate professor of community and preventive medicine, University of Rochester, New York; director, Greater Rochester Area Tobacco Cessation Center.

Steven Schroeder, MD, director, Smoking Cessation Leadership Center, University of California, San Francisco.

Bruce S. Rabin, MD, PhD, medical director, University of Pittsburgh Medical Center Healthy Lifestyle Program.

Rxlist: Zyban.

Tobacco Control, 2009; vol 18: pp 34-42.

Zyban prescribing information.

Chantix prescribing information.

FDA news release: FDA: Boxed Warning on Serious Mental Health Events to be Required for Chantix and Zyban, July 1, 2009.

It s never easy to quit smoking. But research shows that medications and nicotine replacement therapies can double the chances that a smoker will successfully quit.

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