Nicotine replacement products, including patches, gum, nasal sprays, and inhalers, can be a valuable part of your overall strategy to stop smoking. They do not work perfectly, but they are a valuable aid in reducing the symptoms of nicotine withdrawal while you learn to adjust to living without cigarettes. These products are closely regulated by the U.S. Food and Drug Administration, and they are safe and effective for most people when used as directed (see the warning on page 73). They work by delivering a safer form of nicotine (the addictive component of cigarette smoke) without any of the cancer-causing and otherwise harmful substances. They may also desensitize nicotine receptors in your brain to reduce the satisfaction from smoking.
Used properly, nicotine replacement products at least double your chances of success, and they are especially successful when used with other smoking cessation support methods, like telephone counseling or a for- malized program. You still have to change your behavior in order to kick your dependence on nicotine, but the drugs substitute for a cigarette in the meantime. They are available in several forms and can be used individually or in combination. Always talk to your doctor or other health-care provider about how to use these products safely and for maximum effect. If you experience unpleasant side effects, report them to your doctor.

Patches

If you choose to use nicotine patches, you wear a patch every day for
6 to 8 weeks. The patches are easy to use; you can put one on under your clothes and leave it there all day without any other effort on your part. The patch delivers a low dose of nicotine for 16 to 24 hours, starting
4 to 6 hours after you put the patch on. The patches are available in different doses so that you can taper off gradually. The most annoying side effect is a rash on the patch application site in some people. Other side effects include dizziness, nausea, and increased blood pressure. If you use a patch and are scheduled for an MRI (magnetic resonance imaging) procedure, tell your doctor or technician about the patch. Remove the patch at home the morning of the test, unless instructed otherwise, to prevent burns (the radiofrequency waves used in MRIs heat the patch to a dangerous degree). Do not smoke while wearing a patch; this is dangerous.

Gum

Nicotine gum delivers nicotine through the mucous membranes in your mouth. It acts on your system in 20 to 30 minutes. Starting on your quit date, you will chew 10 or 15 pieces of the gum each day for about 3 months. You will have to

WARNING!
Nicotine Replacement and
Heart Disease
If you have certain types of heart problems such as irregular heartbeat or chest pain, nicotine replacement drugs may not be right for you. Although these products are safe for most people with heart disease, your doctor will evaluate your risk. Most of the products are over-the-counter drugs; don’t start using them without checking with your doctor first.

learn the “chew-and-park” system in order for it to be effective: you chew the gum slowly until you get a distinctive taste or tingle in your mouth, and then “park” it between your gum and your cheek for a full
30 to 60 seconds. You repeat this chew-and-park cycle, without drink- ing any beverages, for about half an hour for each piece of gum. Some people get a sore jaw, hiccups, or nausea. These effects are usually mild.

Nasal Sprays

A nasal spray is a fast-acting nicotine delivery system. Starting on your quit date, you use the spray one or two times an hour, and if you get an urge to smoke, up to no more than ?ve times an hour. You generally continue using the spray for about 3 months, tapering off gradually. Some people experience nose and throat irritations, which usually disappear after the ?rst week or so of use.

Inhalers

A nicotine inhaler, available by prescription, is a plastic cylinder with a nicotine capsule inside. You place the device in your mouth and suck in nicotine vapor that is absorbed into the mucous membranes in your mouth. Some people like the inhaler because using it mimics some aspects of puf?ng on a cigarette. You need to puff on the device four or ?ve times a minute for as long as 20 minutes to deliver an effective dose of nicotine. You will use the device 6 to 16 times a day for about 3 months, and then taper off for about another 3 months. Some people get slight mouth or throat irritations.

Lozenges

The lozenge is a promising form of nicotine replacement. It is quick- acting and easy to use, because you just let it dissolve in your mouth without biting or chewing. You can use it similarly to nicotine gum.
You may use a combination of a slow-release product like the patch and one of the quick-release products like the gum, sprays, or inhalers to help you through the nicotine withdrawal process. There is no one product or combination of products that has proven to be more effective for long-term success. Talk to your doctor about how to manage your smoking cessation medications and how to bolster their effectiveness with counseling and support.

Drugs

A drug called bupropion hydrochloride, which contains no nicotine, is approved by the Food and Drug Administration for smoking cessation. It is a form of antidepressant that increases the level of a substance called dopamine in your brain, just as nicotine does. Bupropion may be appropriate for any smoker trying to quit, but it may be especially attractive to people who have tried nicotine replacement without success or who do not wish to use nicotine in any form. It may also help lessen weight gain after smoking cessation. If you use bupropion, you start about a week before your of?cial quit date and continue for 2 to 3 months. Side effects in some people include dry mouth, sleep dif?culties, and nausea, which tend to disappear over time. The drug may not be safe for people who have or have had a seizure disorder, brain injury, or eating disorders. You will need to thoroughly discuss your medical history before taking this drug (or any other); for safety’s sake do not take bupropion prescribed for someone else.
Varenicline, a relatively new drug, works to block the action of nico- tine in the body by blocking receptor sites on cell membranes. In a major research study, people who took varenicline were much more likely to give up smoking in a 12-week period than those who took a placebo (sugar pill) or bupropion. People who took varenicline in the study reported a reduced craving for nicotine and fewer other with- drawal symptoms than those taking a placebo. However, side effects of varenicline include nausea, headache, and insomnia.