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Clinician’s Corner: Smoking

In 2017, an estimated 14% (34.3 million) U.S. adults were current cigarette smokers. More than 16 million Americans live with a smoking-related disease. While this number is down from rates in the mid 90’s, it still presents a huge public health concern.  Smoking is responsible for about 90% of deaths due to lung cancer and COPD.

Estimates show smoking increases the risk:                source cdc.gov/tobacco

  • For coronary heart disease by 2 to 4 times
  • For stroke by 2 to 4 times
  • Of men developing lung cancer by 25 times
  • Of women developing lung cancer by 25.7 times
  • Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost.

Nicotine’s effect on the body:

  • Nicotine stimulates neurons in the brain that provide pleasure..
  • Smoking cessation is associated with a flu-like syndrome, cravings, irritability, insomnia, headache, and fatigue.
  • Nicotine withdrawal can lead to insomnia, anxiety, and depression, and worsen psychiatric disorders.
  • Blood pressure: it is recommended not to measure a patient’s blood pressure within 30 minutes after nicotine exposure (vaping, cigarettes or smokeless tobacco)
TREATMENT OPTIONS ADVANTAGES DISADVANTAGES
Bupropion

Zyban® RXonly

May be used in combination with other therapies, Insurance coverage for cost Risk of seizures, Other side effects, Prescription only
Varenicline

Chantix®

RXonly

More effective than Zyban or Nicotine Replacement

 

Expensive.  Risk of suicidality

Nightmares, Psychiatric disturbances

Counseling Highly successful, Cost effective with peer support, Availability Depression, Withdrawal side effects.
Combined Therapy Many options, adaptive to each patient, lower cost if not using medications Withdrawal side effects. Costs if using drugs.
Cold Turkey Minimal Costs, can be managed alone, One-step process Tolerating withdrawal symptoms, usually not successful if not fully committed
Nicotine Fading Inexpensive, Easy to follow

 

Patient must be highly committed to quitting
Nicotine Patch (OTC) Able to purchase OTC, Easy to apply, can be managed alone

 

Patient must be highly committed. Must not smoke while using the patch, Side effects, having to apply every 24hrs, Costs
Nicotine Gum(OTC) Inhaler(Rx)

Nasal(Rx)

 

Can be managed alone, Able to purchase OTC, Easy to use.

 

Patient must be highly committed. Must completely stop smoking while using, Side effects, Can’t use with dentures, Highly addictive, Costs

Nicotine Replacement Prescribing Information

  • Nicotine replacement products (gum, patches, lozenges) are all equally effective in helping patients kick the habit. Many insurance companies will pay for these products. Have your doctor call our pharmacy.
  • Use a patch for continuous relief from cravings and the gum, spray, or inhaler for breakthrough urges if needed, depending on the patient’s choice of dosage form.
  • Don’t prescribe nicotine replacements with Varenicline (Chantix). The combo causes more nausea and probably won’t work any better.
  • Ask your Thompson Pharmacist for help. He can educate you about treatment options.  Most of all your Thompson Pharmacist wants YOU to succeed in your efforts to stop smoking.  Go Ahead and ASK…. At Thompson Pharmacy it’s all for YOU!

Your Thompson Pharmacist will help, and YOU will experience the following benefits from quitting:

  • Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.
  • Within 2 to 5 years after quitting smoking, your risk for stroke may reduce to about that of a nonsmoker’s.
  • If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.
  • Ten years after you quit smoking, your risk for dying from lung cancer drops by half.