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Questions posted in the
The Addiction Forum have been answered by
Steven Adelman, M.D. and by Richard C. Bozian M.D. F.A.C.P. of Harvard Vanguard Medical Group.
Question Title: Scared of nicotine replacement therapyForum: The Addiction Forum
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Hello I'm a 23 year-old white female who really needs to quit smoking. I have had chest pains and palpitations for 6 years and I know that smoking is not helping this problem at all, (and in fact may be causing it). I Have MVP and possible coronary artery spasm and therefore, I'm really freaked out when I read that you shouldn't take nicotine gum or the patch if you have heart problems...(trust me-I understand the irony of the fact that I smoke). Somehow I've come to equate smoking with being healthy enough to smoke. If I can't smoke then I must be pretty bad off. Sick and twisted logic. Anyway..would the patch or gum be o.k.? If I start having palpitations with this stuff I will freak out. Thanks
_______ Dear Heather, Think of it this way: You are addicted to nicotine. There are many nicotine delivery systems available to you. Cigarette smoking is the most hazardous of them all, because it involves taking in a number of hazardous compounds above and beyond the nicotine. In addition to the carcinogens, which are nowhere to be found in the nicotine replacement therapies, cigarette smoke contains carbon monoxide, which damages your heart and cardiovascular system. None of the nicotine replacement therapies contain carbon monoxide. The alternative nicotine delivery systems (patches, gum, spray and inhaler) are MARKEDLY SAFER than tobacco smoke. People who use them as directed run lower levels of nicotine in their systems than they get from smoking. So NRT is virtually guaranteed to do less of a number on your heart than your smoking does. As a smoker, you have become an expert at administering nicotine; therefore it is unlikely that you will overdose yourself with NRT. Since you are not used to having nicotine on board at constant low levels around the clock (this is what people get from the patch), you might be better off starting off with the nicotine gum. I almost always advise people not to bother with the 2mg gum and to go right to the 4 mg gum, since the smaller dose doesn't come close to delivering the levels of nicotine which smokers are used to. However, because of your "anxiety" (which is probably more of a rationalization which buys you time smoking as opposed to anything rational or logical), you might be better off starting with the 2mg dose. As long as you limit your use of the gume to when you feel like smoking, you will be keeping your nicotine levels below what you are used to. If nicotine gum doesn't work for you, then talk to your doctor about getting a prescription about the new nicotrol inhaler, which is a good alternative to the other forms of NRT. Check out my Ask DrSteve web site, hyperlinked below, for much more about smoking cessation and NRT. Good luck! Steve Adelman, M.D. (a.k.a. DrSteve)
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