Thousands of smokers have quit for good. Tobacco has been used as a mood-altering substance for centuries, but today there are medications that can help break the cycle of addiction. Smoking stimulates the central nervous system, creating metabolic changes that create a feeling of relaxation. This pleasurable sensation is reinforced and becomes intertwined with social, leisure and work-related activities. As tolerance builds, stress increasingly triggers the urge to smoke. Overcoming physical withdrawal symptoms takes time, but the health benefits of quitting begin almost immediately.
Nicotine Replacement Therapy
The American Cancer Society (ACS) reports that most smokers quit eight to 10times and start smoking again within three months due to nicotine cravings. Nicotine replacement therapy (NRT) provides enough nicotine to stimulate the brain's release of dopamine, an endorphin that diminishes cravings. In conjunction with other quitting methods, such as attending a support group, the ACS says NRT can double the chances of remaining smoke-free. Do not smoke while using patches, gum or other forms of NRT, and set a firm goal to taper off NRT within a maximum time period of six months.
Newer Antidepressants
Antidepressant medications such as Zyban and Welbutrin (buproprion), and Chantix (varenicline tartrate), take up to two weeks to reach full effect. During this time it is okay to continue smoking. Zyban is an extended-release medicine that stimulates the release of dopamine to reduce cravings, although it contains no nicotine. Zyban and NRT can be used simultaneously. People with a history of bipolar disorder, anorexia, bulimia, alcoholism, brain injury, seizures or liver or kidney disease should talk to their doctor before taking Zyban.
Chantix also releases dopamine to reduce tobacco cravings, but it is unique in its ability to compete for and block nicotine receptor sites in the brain, blunting the pleasurable effect of smoking. In this way, the stress-relief effect of tobacco use is not reinforced and addiction is easier to break. Side effects of Zyban, Wellbutrin, and Chantix may include dry mouth, insomnia, nausea, constipation, dizziness, and blurred vision. The FDA warns there is a risk that suicidal depression could be triggered by taking these antidepressants, especially among younger patients.
Off-label Medications
The American Cancer Society lists other medications that smokers can use, under doctor's advice, to stop smoking--even though they are not FDA-approved for this purpose. Smokers who are not good candidates for newer antidepressants may want to try an older antidepressant, Nortriptyline. Started up to four weeks before smoking stops, this medicine's side effects may include drowsiness, dry mouth, trouble urinating, blurred vision, constipation, rapid heart rate, and weight gain. Nortriptyline may interact with other medications and should not be stopped abruptly.
Clonidine is a medication for hypertension that is used off-label to reduce the symptoms of opiate withdrawal and has also been prescribed for the treatment of nicotine addiction. Clonidine can be started a few days before or on the quit date. Blood pressure may need to be monitored, and side effects include dizziness, nausea, dry mouth and fatigue. Clonidine should not be used for more than one month for smoking cessation, and it is necessary to taper the dose over a few days when stopping this medication.
