U.S. Pharmacist



Smoking Cessation

By Staff


US Pharm. 2009;34(7):21-22. 

Fighting the Addiction to Nicotine

Anyone who has tried to quit smoking can attest to the fact that tobacco products and nicotine are addictive. When smoking a cigarette, nicotine is quickly delivered through the lungs into the blood stream and carried to the brain, giving the user a pleasant feeling. As a result of both the physical and psychological addiction caused by nicotine, the smoking habit is tough to break. 

The number one reason people quit smoking is to improve their health and avoid future health problems. Tobacco smoke contains many cancer-causing chemicals. In addition to cancer, smoking also causes heart diseases such as heart attack and stroke, and lung diseases such as bronchitis and emphysema. Smoking is also dangerous for pregnant women and their babies. 

The benefits of smoking cessation are many, including a rapid normalization of blood pressure and heart rate, improvement in breathing and blood circulation, and better lung function. Over the long term, smoking cessation means a much lower chance of developing many of the cancers caused by smoking. This includes cancer of the lungs, throat, kidney, bladder, and pancreas, among others. People who stop smoking will live years longer than those who continue to smoke, regardless of their age when they stop. 

Although quitting is not easy, there are many proven programs to help smokers reach this goal. Most smoking cessation programs use a combination of education, self-help, and group meetings, as well as nicotine replacement products or drugs such as bupropion and varenicline to help relieve the symptoms of nicotine withdrawal. The success rates differ among smoking cessation programs, but the success of any program depends on the smoker and his or her commitment to quit. Smoking cessation is the most important single step smokers can take to improve their health and lengthen their lives. 

Nicotine Replacement Therapy

Smoking is a complicated addiction that is very difficult for most people to break. There are two parts to the addiction and therefore two parts to smoking cessation—the physical withdrawal from nicotine and the psychological withdrawal from the act of smoking itself. 

Health Risks of Smoking

The commonly cited reason for quitting smoking is to reverse current health problems and avoid future health risks. Tobacco smoke contains thousands of chemicals, including heavy metals and carcinogens. Smoking causes three significant types of disease: cancer, heart disease, and lung disease. Researchers have confirmed that smoking causes not only lung cancer, but cancer of the mouth, throat, voice box, esophagus, stomach, kidney, bladder, pancreas, and cervix. Heart diseases linked to smoking include heart attack, stroke, and other circulatory problems. Emphysema, chronic bronchitis, and pneumonia can also result from smoking. Other health problems caused by smoking include osteoporosis, macular degeneration, cataracts, and pregnancy complications (e.g., premature birth, low birth weight). 

Even when smokers are aware of all the benefits of quitting, the physical and psychological addiction to nicotine along with the act of smoking itself present a serious challenge. Physical withdrawal from nicotine is more significant in people who smoke one pack of cigarettes or more each day. The primary symptoms of nicotine withdrawal include depression, difficulty concentrating, increased appetite, weight gain, irritability, restlessness, and difficulty sleeping. 

Treatments to Ease Withdrawal Symptoms

Most people who smoke at least 10 cigarettes a day will benefit from nicotine replacement to ease the symptoms of nicotine withdrawal. There are many forms of nicotine used in replacement therapy, including chewing gum, lozenges, skin patches, nasal sprays, and inhalers. They vary in cost, how quickly they act, and how long they last, and each has side effects specific to the dosage form. The nicotine skin patch, chewing gum, and lozenge are available without a prescription, while nicotine nasal spray and oral inhaler require a prescription. Smokers with asthma or allergies are not good candidates for nicotine nasal spray or inhalers. Nicotine skin patches are not the best choice for smokers with skin problems or latex allergies. Acidic beverages such as coffee or orange juice interfere with the action of nicotine chewing gum and lozenges, so they should not be used together. Sometimes a combination of nicotine products can be used more effectively than a single product, such as adding a short-acting nicotine gum to a longer-acting nicotine skin patch. 

Two prescription medications approved for use in smoking cessation are bupropion (Zyban) and varenicline (Chantix). Bupropion is an antidepressant that helps ease nicotine withdrawal symptoms and can be used with nicotine replacement products. It can cause adverse effects such as dry mouth and dizziness, and should not be used in people with seizure disorders or eating disorders. Varenicline works to ease nicotine withdrawal symptoms while blocking the effects of nicotine. Its common side effects include nausea, bloating, constipation, and difficulty sleeping. Using varenicline with nicotine replacement products worsens these side effects. Pregnant women or smokers with kidney disease should not use varenicline. 

All medications used in smoking cessation programs can cause side effects, but often switching to another drug or lowering the dose can eliminate the problem. Since no single form of nicotine replacement has proven to work better than another, it is a good idea to choose a form that fits the pattern of withdrawal symptoms of an individual smoker. Your pharmacist can answer any questions you may have about prescription or OTC medications you may be taking for smoking cessation. 

To comment on this article, contact rdavidson@jobson.com.


U.S. Pharmacist is a monthly journal dedicated to providing the nation's pharmacists with up-to-date, authoritative, peer-reviewed clinical articles relevant to contemporary pharmacy practice in a variety of settings, including community pharmacy, hospitals, managed care systems, ambulatory care clinics, home care organizations, long-term care facilities, industry and academia. The publication is also useful to pharmacy technicians, students, other health professionals and individuals interested in health management. Pharmacists licensed in the U.S. can earn Continuing Education credits through Postgraduate Healthcare Education, LLC, accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

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