Nicotine-Replacement Therapy

Talk to your doctor about your options to make going tobacco-free as easy as possible. Some non-medication strategies include the nicotine patch, nicotine gum and nicotine oral inhalers.

Certain forms of nicotine replacement therapy are available without prescription at your local pharmacy. Some insurance plans, such as Medicaid, will cover nicotine replacement therapy like the patch and the gum, so check with your plan to see if a prescription can lower your costs.

Possible side effects of nicotine-replacement therapy include headache, dizziness, lightheadedness, drowsiness, stomach upset, nausea or flushing. Ask your doctor for additional guidance and information.

"The Patch"

Technically referred to as "nicotine transdermal patch system," you can purchase the patch at your drugstore without a prescription—though it is worth investigating whether your insurance plan covers it as prescription.

Dr. Seidman says your required dosage corresponds to your habit. You can replace a pack-a-day habit with a 21 mg patch; or replace 10 or fewer cigarettes a day with 14 mg or 7 mg patches.

Place the patch on your upper body above your waist. Most people put it on a hairless part of the upper arm. Remember to rotate it daily to help avoid rashes. If you feel the patch disturbs your sleep, just take it off before going to bed.

If you started with the 21 mg patch, taper down to 14 mg or 7 mg when you feel successful and confident. If you feel any side effects—a rash is the most common—discuss it with your doctor.

"The Gum"

Like the patch, you can purchase nicotine gum at the drugstore without a prescription. And like the patch, you may find that it is covered by insurance—look into what your plan offers.

Nicotine gum is sold in two doses, 2 mg and 4 mg. To determine which level you should buy, count each cigarette you smoke as 1 mg. If are a pack-a-day or more smoker, you will definitely want the stronger stuff—the 4 mg gum. With each piece of 2 mg gum, you absorb 1 mg of nicotine, the same as found in one cigarette. With each piece of 4 mg gum, you absorb 2 mg of nicotine, the same as found in 2 cigarettes.

You do not chew the gum like regular gum. Instead, chew it a few times until there is a peppery taste, which means the nicotine is being released. Then stop chewing and "park" it between your cheek and gums. Regular use is more effective than using it just as needed, but both are helpful.

Taper off use of the gum as you feel more successful and confident over two to three months. Acidic beverages like coffee, tea, citrus juices and sodas will inactivate nicotine being released in the mouth, so avoid them for 15 minutes before and at time of using the gum.

The most common side effect is nausea, usually caused by incorrect chewing. Discuss any side effects with your doctor.

Nicotine Oral Inhaler

This nicotine-replacement therapy, available by prescription only, is a thin plastic tube that pulls apart to make room for nicotine-filled cartridges. One advantage to the oral inhaler is that you can puff on the inhaler and experience the ritual hand-to-mouth feel of a cigarette when you get the urge to smoke.

Each cartridge is labeled with 10 mg of nicotine but only delivers 4 mg, and the person only absorbs 2 mg per cartridge. That means a pack-a-day smoker needs to use 10 cartridges a day. Each cartridge gives 80 puffs during a period of 20–30 minutes. Ten cartridges add up to about 800 puffs per day—enough to keep even a big smoker busy and distracted.

Frequent puffing gives the best results. Acidic beverages like coffee, tea, citrus juices and sodas inactivate nicotine being released in the mouth, so avoid them for 15 minutes before and while using the inhaler. Taper off use as you feel successful and confident after two to three months. Cold air can decrease nicotine delivery.

The most common side effects are mild mouth and throat irritation and coughing. Discuss potential side effects with your doctor.

Prescription Medication—Bupropion

Bupropion—also known as Zyban and Wellbutrin—is available by prescription only. For Bupropion, the best dose for smoking cessation is 300 mg per day. Plan to start taking Bupropion seven to 10 days before you plan to stop smoking. It can be good to start with 100 mg or 150 mg tablets and then increase to 300 mg. If you use 150 mg tablets, these must be taken eight hours apart—such as at 10 a.m. and 6 p.m.

This drug can be combined with nicotine replacement therapy—the patch, the gum—to good effect. For example: 21 mg patches replace a pack a day; 14 mg or 7 mg patches replace about 10 or fewer cigarettes a day.

Your dose of nicotine and Bupropion will reevaluated frequently for the first 14 days and then monthly. It is usual to continue both for at least three months.

The American Cancer Society says Bupropion "should not be taken if you have ever had seizures, heavy alcohol use, serious head injury, bipolar (manic-depressive) illness, anorexia or bulimia (eating disorders)."

Possible side effects of prescription medications can include agitation, dry mouth, insomnia, headache/migraine, nausea/vomiting, constipation, and tremor. Ask your doctor for additional guidance and information.

Prescription Medication—Chantix

This drug—also referred to as Varenicline—is available by prescription only. It should be taken with food and started one week prior to your target quit date.

A typical dosage is 0.5 mg once daily for three days; then 0.5 mg twice daily for four days. On the target quit date, take 1 mg twice daily for 11 weeks.

If you're not smoking at the end of 12 weeks, you may continue at 1 mg twice daily for an additional 12 weeks. You may stop treatment abruptly; there is no need to taper off.

Possible side effects include nausea, vivid dreams, constipation, flatulence, and vomiting. In November 2007, the label was updated to include a warning advising healthcare providers and patients to be aware of the potential for neuropsychiatric symptoms including changes in behavior, agitation, depressed mood, suicidal ideation and suicidal behavior in patients attempting to quit smoking with varenicline.

Ask your doctor for additional guidance and information.

Important Non-Replacement Therapy

Don't forget that there are other therapies that are just important to your success as whatever you are doing to replace nicotine— patches, gum or inhalers—or medication.

• Phone or e-mail your buddy daily to discuss your overall progress and when you walked that day.
• Keep up your daily 30 minutes of walking, but do not increase your physical activities by more than 10 percent a week.

After the six month program is over—that's how long you will need to keep in close contact with your buddy and healthcare professional support team—you still have more to do.

First, help someone else. Second, keep your buddy's contact information close by so you can use it if you get an increase in cravings. And third, keep your nicotine patch, gum or inhaler with you at all times to use when you get the urge to smoke.