Nicotine Addiction


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NICOTINE REPLACEMENT PRODUCTS

What they do: provide nicotine without smoking

How they work: They help lessen the body's craving for nicotine and reduce withdrawal symptoms. They come in several forms: gum, patch, nasal spray, inhaler, lozenge and e-cigarettes.

Side effects: : gum (dizziness, headache, nausea); nasal spray (runny nose, throat irritation, coughing, sneezing, watery eyes); patch (dizziness, headache, nausea, vomiting, diarrhea); inhaler (mouth and throat irritation, runny nose, sinus pressure, headache, gas); lozenge (heartburn, sore throat, mouth problems, irregular or fast heart beat). For a more complete list of side effects, visit this NIH page and scroll down to Nicotine. For more information on e-cigarettes visit Medline Plus

A special note about the dangers of vaping (using e-cigarettes):
Some people use e-cigarettes to help them stop smoking. But vaping is still bad for your health. Regular cigarettes have about 7,000 chemicals, many that are toxic. While e-cigarettes have fewer chemicals, it is not known exactly what those chemicals are and how they affect your health over time. That means you are exposing yourself to all kinds of chemicals that are not understood and probably not safe.

A 2019 study found that both vaping and smoking were linked to a similar increase in the risk of heart attacks. Using both of them at the same time was riskier than using either alone.

E-cigarettes are not the best tool to stop smoking: Although they’ve been marketed as an aid to help you quit smoking, e-cigarettes are not FDA-approved for smoking cessation. A recent study found that most people who used e-cigarettes to kick the nicotine habit ended up continuing to smoke both traditional and e-cigarettes. While they help some people quit, they also increase the risk of relapse in some former smokers.

Health alert about vaping: The growing number of cases of severe lung disease and death in people who use e-cigarettes highlights their danger. As of mid September, 2019, the number of people who became sick with a severe lung illness linked to vaping more than doubled to 530 cases in 33 states, including 8 deaths. Most cases were in teens and young adults. Experts believe this is most likely due to a contaminant in the inhaled vapors.

Availability: Nicotine gum, patch, lozenges and E-cigarettes (vaping) can be bought.

Research: A 2018 systematic review of nicotine replacement products showed they can increase the chances of successfully quitting by 50% to 60%.

For more information on these products: www.nlm.nih.gov/medlineplus/ency/article/007438.htm

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BUPROPION (brand names Zyban and Wellbutrin)

What it does: An antidepressant drug that can be used to help some people stop smoking.

How it works: Although it does not contain nicotine, it can help people resist the urge to smoke. Bupropion is often used for 7-12 weeks, beginning 1 or 2 weeks before smoking is stopped. It can be used for smoking cessation maintenance for up to six months.

Side effects: Insomnia, dry mouth, dizziness, headache, nausea, constipation. For a more complete list of side effects, visit this NIH page.

Availability: By prescription from a physician

Research: Treatment with bupropion is associated with improved ability to resist cue-induced craving and a reduction in cue-induced activation of limbic and prefrontal brain regions. A reduction in craving is associated with reduced activation in prefrontal brain regions. Culbertson CS, Bramen J, Cohen MS, et al. Effect of bupropion treatment on brain activation induced by cigarette-related cues in smokers. Arch Gen Psychiatry. 68(5):505-15, 2011.

For more information on this medication: www.nlm.nih.gov/medlineplus/druginfo/meds/a695033.html

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VARENICLINE (Chantix)

*Please note that FDA regulators have reported that a connection between Chantix and serious psychiatric problems including depression, agitation and suicidal behavior is "increasingly likely." A report from The Institute for Safe Medication Practices also linked Chantix to a wide array of health and safety problems. They include accidents and falls, potentially lethal heart rhythm disturbances, heart attacks, seizures, diabetes and various psychiatric disturbances.

Chantix is a prescription medication sold in tablet form. It is generally prescribed for 12 weeks. If you quit smoking during that time, your doctor may prescribe Chantix for another 12 weeks to enhance long-term success.

What it does: This is the first treatment that specifically targets the neurobiological mechanism of nicotine dependence.

How it works: Studies show that the drug successfully stimulates dopamine (the brain's pleasure chemical) and blocks nicotine receptors. This reduces nicotine withdrawal symptoms and cravings, helping to prevent a full relapse. The drug also blocks the effects of nicotine if you begin to smoke again.

Side effects: Nausea, vomiting, gas, heartburn, vomiting, headache. For a more complete list of side effects, visit this NIH page.

Availability: By prescription from a physician

Research: Researchers found Chantix to be more effective than a placebo in helping people quit smoking. In two studies, Chantix helped more people quit smoking than did bupropion (Zyban), the only other nicotine-free drug used as a quit-smoking aid.
Foulds J, Steinberg MB, Williams J, et al. Developments in pharmacotherapy for tobacco dependence: past, present and future. Drug Alcohol Rev. 25(1):59-71, 2006.

A 2011 review found that varenicline remained the most effective single therapy for smoking cessation with a good side effect profile.  Williams JM, et al. Varenicline for tobacco dependence: panacea or plight? Expert Opinion in Pharmacotherapy.  2001 Aug. (11): 1799-812.

2012 Warning issued from the FDA: In a large, meta-analysis of clinical trials that compared patients who received the smoking cessation drug Chantix (varenicline) to patients who received a placebo (an inactive treatment), a higher occurrence of major adverse cardiovascular events (cardiovascular-related death, nonfatal heart attack, and nonfatal stroke) was seen in patients using Chantix compared to placebo. These events were uncommon in both the Chantix and placebo groups, and the increased risk was not statistically significant, which means it is uncertain whether the excess risk for the Chantix group was due to the drug or due to chance.

Some people have had changes in behavior, hostility, agitation, depressed mood, and thoughts of suicide while taking varenicline. The role of varenicline in causing these mood changes is not clear.  If you experience any of the following symptoms, stop taking varenicline and call your doctor immediately: suicidal thoughts or actions; new or worsening depression, anxiety, or panic attacks; agitation; restlessness; angry or violent behavior; acting dangerously; excited mood (mania); abnormal thoughts or sensations; hallucinations; feeling that people are against you; feeling confused; or any other sudden or unusual changes in behavior, thinking, or mood.

Patients taking Chantix should contact their health care professional if they experience new or worsening symptoms of cardiovascular disease, such as chest pain, shortness of breath, calf pain when walking, or sudden onset of weakness, numbness, or difficulty speaking. Patients should also contact their health care professional if they have any questions or concerns about Chantix.

For more information on this medication: www.nlm.nih.gov/medlineplus/druginfo/meds/a606024.html

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FDA 101: Smoking Cessation Products
(www.fda.gov/ForConsumers/ConsumerUpdates/ucm198176.htm)
A good discussion of the different smoking cessation products available, differentiating between products that contain nicotine and products that do not.
 

Updated September 24, 2019