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Subject: Re: Nicorette Gum
Forum: The Addiction Medicine Forum
Topic Area: Smoking
Posted by HVM - SA, M.D. on December 23, 1998 at 19:40:05:
In Reply to: Nicorette Gum posted by Pamela on December 23, 1998 at 14:20:19:
Dear Doctor:Recently I stopped smoking and am using Nicorette Gum but find it has a horrible taste and only makes me want to give IT up for cigarettes. Do you have any other suggestions for products which may help reduce my nicotine cravings? Thanks for this wonderful forum! Happy Holidays! Pamela
___You could try switching to one of the over-the-counter patches. If patch treatment does not curb the cravings, then consult your doctor about the possibility of one of the prescription products - either bupropion, the nicotine nasal spray, or the nicotine inhaler. What follows is a more detailed answer to a question similar to yours which I will be posting next week on Ask DrSteve: The Real Story About Smoking, Drinking & Getting High ( http://www.headdocs.com ). Additional info is available on that site. Bewildered by All the Choices
December 28, 1998 Dear DrSteve, I would like to know which type of pill, patch, gum, spray, inhaler
etc. you recommend to people to help them quit smoking. Bewildered by All the Choices
Dear Bewildered,
As a rule, smokers who quit with the assistance of nicotine
replacement therapy (NRT) or bupropion (a.k.a. Zyban or Wellbutrin SR)
double their chances of success when compared with those who try to
stop smoking without NRT or bupropion. So it's always advisable for
anyone who wants to be smoke-free to make use of pharmacotherapy.
This is especially true for any smoker who has tried to quit without
NRT or bupropion and failed. To the best of my knowledge, there are no published research studies
directly comparing nicotine replacement therapy (NRT) to bupropion in
smoking cessation. So deciding which of these approaches to start
with needs to be determined on a case by case basis. One advantage of NRT is that 2 of the 4 nicotine replacement products
(most nicotine patches and nicotine gum) are currently available in
the United States without a prescription. So getting your hands on
some forms of NRT is as simple as going to the store and buying a pack
of cigarettes. Another advantage of NRT is that all smokers are
exceedingly familiar with nicotine. On the other hand, bupropion is a novel and complex pharmaceutical
which most smokers have never before introduced into their systems.
One in a thousand individuals treated with 300mg per day of
sustained-release bupropion (the recommended dose for smoking
cessation) has a grand-mal seizure (convulsion) - a dangerous but
extremely serious adverse reaction. Some smokers are very turned off by the idea of using nicotine to
treat their tobacco dependence. Because of the risk of grand-mal
seizures with bupropion, for starters I tend to recommend NRT.
However, it is perfectly reasonable to start with bupropion (provided
there is no history of a seizure disorder) in people who have already
failed to respond to NRT or who find the idea of it objectionable, as
some smokers do. With regard to NRT, I prefer to start with nicotine patches. The
patch is currently the only form of NRT which does not involve
delivering nicotine on demand. Smokers who succeed in giving up
smoking by transitioning to the nicotine patch are killing 2 birds
with one stone: They are eliminating their dependence on toxic tobacco
smoke, and also giving up the practice of pulsing their systems with
nicotine whenever they crave a cigarette. I have worked with many smokers who have found it difficult to stay
smoke-free despite treatment with the strongest nicotine patch (21
mg). Sometimes they fare better with a nicotine replacement product
which, like cigarettes, delivers nicotine on demand. So they might
try nicotine gum (4 mg works significantly better for most people than
2 mg) or talk to a physician about a prescription for the nicotine
inhaler or the nasal spray. The advantage of the inhaler (see
ECSTATIC ABOUT NOT SMOKING) is that it involves a hand-to-mouth
activity similar to smoking which many smokers find comforting. The
advantage of the nasal spray is that it is the form of nicotine
replacement which gets the highest levels of nicotine into the brain,
most resembling cigarettes in that regard. Anyone who cannot stop despite the help of NRT should consult with a
physician about getting a prescription for bupropion. Those who
cannot stop despite having tried the usual recommended doses of NRT or
bupropion should not lose hope. More and more addiction medicine
experts like myself are recommending more aggressive approaches (which
should only be undertaken under the care of a qualified physician). I
sometimes use multiple forms of NRT simultaneously, combine NRT with
bupropion, or suggest NRT in doses higher than those which are
generally recommended. One of my patients is currently doing quite
well on a combination involving the patch, the inhaler, and bupropion. So, you asked a simple question and got a long and complicated answer.
Things will only get more and more complicated and bewildering as
drug companies develop new and different pharmacological strategies
for smoking cessation. I believe that anyone who stays the course and
works with a doctor who is willing to leave no stone unturned should
be able to stop smoking and to stay stopped. If you're one of those
people who has a heck of time stopping and you finally find an
approach that works, I would advise you and your doctor to take things
nice and slowly when it comes to discontinuing any successful
pharmacological treatment. Good luck! DrSteve This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. Keyword: nicotine replacement therapy, smoking cessation, bupropion
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