Nicotine Addiction

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What they do: provides nicotine without smoking

How they work: This helps to lessen the body's craving for nicotine and to reduce withdrawal symptoms. Replacement products come in several forms: gum, patch, nasal spray, inhaler and lozenge

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 Gum.

Availability: Nicotine gum, patch and lozenges can be bought

Research: A meta-analysis of nicotine replacement therapy products indicates that they are an effective intervention in achieving sustained smoking abstinence.
Moore D, Aveyard P, Connock M, et al. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ. 2009 Apr 2;338:b1024.

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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.

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*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.

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FDA 101: Smoking Cessation Products
A good discussion of the different smoking cessation products available, differentiating between products that contain nicotine and products that do not.

Updated May 23, 2018