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Smoking Cessation

Now that we conquered the diet and exercise New Year’s resolutions, lets tackle the next big goal of smoking cessation. My favorite quote is from Mark Twain:

“Quitting smoking is easy. I’ve done it a thousand times” -Mark Twain

  • n 2014, an estimated 16.8% (40.0 million) U.S. adults were current cigarette smokers. Of these, 76.8% (30.7 million) smoked every day, and 23.2% (9.3 million) smoked some days. 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.

Nicotine’s effect on the body:

  • Nicotine stimulates the CNS meso-limbic dopamine system, which is believed to be the neuronal mechanism underlying the reinforcement and reward experienced with smoking.
  • 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 exacerbate underlying psychiatric disorders.


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



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)



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, etc.) are all equally effective in helping patients kick the habit.
  • Use a patch for continuous relief from cravings…and the gum, spray, or inhaler for breakthrough urges if needed.
  • Don’t prescribe nicotine replacements with Varenicline (Chantix). The combo causes more nausea and probably won’t work any better.

Next week we can focus on the prescription drug therapy for smoking cessation.

Have a great day on the bench!

Pete Kreckel     Thompson Pharmacy Broad Avenue