The consumption of tobacco products, whether inhaled or not, significantly increases the risk of diseases of the respiratory system, the cardiovascular system and neoplasms or cancers in various locations (lung, pharynx, esophagus, urinary bladder, etc.). .
Globally, smoking multiplies the odds of dying by two and a quarter of smokers will die prematurely, and will lose between twenty and twenty five years of life . The risks associated with exposure to environmental tobacco smoke have also been widely documented, so that legislation that also protects the non-smoking population has been widely and increasingly deployed.
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The benefits of quitting smoking are well established: former smokers, between ten and twelve years after quitting, have the same overall risk of contracting diseases as a person who has never smoked . This risk reduction is especially important during the first years after quitting, especially in relation to diseases of the heart and blood vessels. Getting the definitive smoking cessation is not easy but it is possible. If you have doubts about how you can tackle quitting, it is advisable to consult a health professional and follow their recommendations.
1. Drugs in smoking cessation
The therapeutic approach of the smoker includes a set of non-pharmacological measures, such as advice from a professional who provides information and guides the abandonment process. Other more intensive therapeutic interventions, such as individual or group psychological treatment, will be used selectively only in patients who require it due to their personal characteristics or clinical history.
Although medications alone are not enough to achieve smoking cessation, they can help decrease the desire to smoke and other symptoms of nicotine withdrawal (anxiety, nervousness, feeling of strangeness, difficulties in concentration, drowsiness or sleep problems, etc.) experienced by the smoker when he is adapting again to life without nicotine. This symptomatology of abstinence usually lasts a few weeks and has a tendency to decrease progressively.
All of the medications listed below have been shown to be helpful in helping smokers quit. There is none that can be considered more effective than the others in a general way for all smokers, and it is necessary to select the one that best suits each person.
Always read carefully the instructions for use and dosage of these drugs and talk to the nearest healthcare professional (doctor, nurse or pharmacist) if there are questions.
If the person who wants to stop smoking is pregnant, breastfeeding or has a serious medical problem, it is necessary to consult your doctor before starting any new medication.
2. First-line medications
They are considered first line because they are drugs with a higher degree of efficacy, safety and tolerability. Most smokers can use these medications when they make the first attempt to quit smoking. Only when you can not quit smoking after repeatedly using the first-line drugs does it make sense to consider trying a second-line medication.
Nicotine replacement therapy (NRT) : helps smokers quit smoking by reducing the craving for smoking that most people who quit smoking experience, mainly due to a lack of nicotine. The products of NRT provide controlled amounts of nicotine that gradually diminish over time, and thus allow the body to progressively adapt to increasingly lower levels of nicotine. The commercial names of the most used TSN presentations in our country are Nicotinell ® , Nicorette ® and Niquitin ® .
Nicotine patch Without medical prescription.
The nicotine patch is placed on the skin (clean, dry and hairless) of the forearm, shoulder or hip. This patch provides the body with a small and continuous amount of nicotine.
Instructions: for a consumption of 20 cigarettes per day: 4 weeks at high dose, 2 weeks at medium dose and 2 weeks at low dose, to allow users to reduce the amount of nicotine over time. Overall duration: 8 weeks.
Nicotine dose: it can vary (21 mg, 14 mg or 7 mg, those that take 24 hours, or 15 mg, 10 mg or 5 mg those that take 16 hours).
Most frequent adverse effects: local skin reaction, insomnia and / or sleep disturbance.
Contraindications: recent severe cardiac or vascular disease, peptic ulcer, dermatological diseases.
Nicotine gum Without medical prescription.
Nicotine gum is chewed to release nicotine that is absorbed through the mucosa inside the mouth.
deshtabac2 Instructions: the user must chew slowly and intermittently; this way it is chewed until the taste becomes intense, then it must "park" the piece between the gum and the buccal wall. When the flavor decreases, chew again and the process must be repeated until the flavor disappears (about 30 minutes). Drinking or eating (except water) should be avoided 15 minutes before or during use as it does not alter nicotine absorption .
Nicotine dose: may vary (2 mg or 4 mg). 1 piece every 1 or 2 hours. Consumption is on demand, a maximum of 30 a day, and we must reduce the amount of nicotine over time. Overall duration: 12 weeks.
Most frequent adverse effects: jaw pain, gastric irritation.
Contraindications: recent severe cardiac or vascular disease, peptic ulcer; carriers of dental prostheses, problems in the temporomandibular joint and inflammations or infections in the throat.
Nicotine tablets Without medical prescription.
The nicotine tablet looks like a hard candy and is left in the mouth to dissolve slowly, not to swallow or chew.
Instructions: the user should let the tablet dilute in the mouth until the taste becomes intense, then you must "park" the piece between the gum and the buccal wall. When the flavor decreases, it is necessary to suck again and the process must be repeated until it dissolves (about 30 minutes). Avoid drinking or eating (except water) 15 minutes before or during use to avoid disturbing nicotine absorption.
Nicotine dose: 1 mg. 1 tablet every 1 or 2 hours. Consumption is on demand. Normally it is between 8 and 12 tablets a day, a maximum of 30 a day, and you have to reduce the amount of nicotine over time. Overall duration: 12 weeks.
Most frequent adverse effects: irritation in the throat during the first days.
Contraindications: recent severe cardiac or vascular disease, peptic ulcer.
Nicotine mouth spray . BucoMist (Nicorette ® ). Without medical prescription.
It is a presentation that allows a spray (1 mg / pulsation solution) of nicotine directly to the mouthInstructions: On the first use and if it is not used for 2 days, the spray pump will be charged. Point the nozzle to a safe place and press the top of the dispenser 3 times until a fine spray appears. Once loaded, the nozzle is pointed towards the open mouth at a short distance. The button is pressed to administer a dose without touching the lips. Do not inhale to use it to prevent the entry of the drug into the respiratory tract. For optimal results, you should not swallow saliva for a few seconds.
Nicotine dosage: perform 1 or 2 sprays in situations in which you used to smoke a cigarette or in case of feeling anxiety. The maximum recommended dose is 4 sprays per hour and 64 sprays per day.
Most frequent adverse effects: throat irritation, nausea and excessive salivation.
Contraindications: recent severe cardiac or vascular disease, peptic ulcer.
Nicotine mouth inhaler With medical prescription. NOT commercialized in Spain.
The nicotine inhaler is a cartridge connected to a mouthpiece.
Instructions: it is placed in the mouth and inspired so that the vaporized nicotine reaches the back of the throat.
Dosage: each cartridge releases about 4 mg of nicotine. Normally they take between 6 and 16 cartridges a day, and you have to reduce the amount of nicotine over time. Overall duration: 12 weeks.
Most frequent adverse effects: nasal itching, discharge, throat irritation, cough.
Contraindications: recent severe cardiac or vascular disease, peptic ulcer.
Nicotine nasal spray . With medical prescription. NOT commercialized in Spain.
The nicotine nasal spray has a bottle that contains nicotine, which is inserted into the nose and sprayed the spray. It can be used for the rapid control of anxiety, especially for heavy smokers.
Instructions: it is placed on the nose and inspired so that the vaporized nicotine reaches the back of the throat.
Dosage: each inhalation equals about 0.5 mg of nicotine in each nostril (1 mg), approximately 1 or 2 doses per hour. The minimum is 8 doses per day with a maximum limitation of 40 doses per day. The amount of nicotine should be reduced over time. Overall duration: 12 weeks.
Most frequent adverse effects: nasal itching, nasal discharge, sore throat, cough.
Contraindications: recent severe cardiac or vascular disease, peptic ulcer.
Other first line medications . The following drugs, due to their indications, contraindications and adverse effects, require medical follow-up during their use.
Bupropion . Medical prescription.
Bupropion (Zyntabac ® ) helps reduce nicotine withdrawal and the need to smoke. It is not a product that contains nicotine.
Dosage: the first 6 days 150 mg a day, and then 150 mg twice a day (7 to 12 weeks).
Instructions: to stop smoking during the first week of treatment, since the desire to smoke is lost or reduced spontaneously.
Most frequent adverse effects: dry mouth or sleep disorders and / or insomnia.
Contraindicated for pregnant women, people with a history of epilepsy, eating disorders or alcohol-related, people who are in treatment (or who have been in treatment for the previous 15 days) for psychiatric disorders.
Varenicline . Medical prescription.
Varenicline (Champix ® ) relieves nicotinic withdrawal syndrome and blocks the effects of nicotine in cigarettes if the user starts smoking again. It is not a product that contains nicotine.
Dosage: 0.5 mg per day for the first three days, then 0.5 mg twice daily until the first week and then 1 mg twice daily (up to 12 weeks).
Instructions: to stop smoking during the first week of treatment, since the desire to smoke is lost or reduced spontaneously. To reduce nausea, the tablet can be taken on a full stomach.
Most frequent adverse effects: discomfort in the stomach, such as nausea, and also sleep disorders.
Contraindicated for: people with kidney problems and pregnant or breastfeeding women.
3. Second-line medications
The use of the following drugs is limited to patients who can not benefit from first-line drugs. They must be kept under strict medical control.
Nortriptyline Medical prescription.
Nortriptyline (Norfenazin ® 25 mg, Paxtibi ® ) is usually prescribed to treat depression; It has also been prescribed to help stop smoking when first-line medications do not work.
Dosage: initially 25 mg per day, and increased to 75 mg per day for approximately 12 weeks.
Most frequent adverse effects: sedation, dry mouth, blurred vision, urine retention, dizziness, hand tremor ...
Contraindicated for pregnant or breastfeeding women, people with heart problems or who take antidepressant MAOIs.
Clonidine Medical prescription.
Clonidine (Catapresan ® ) is usually prescribed to treat high blood pressure; However, clonidine can reduce nicotine withdrawal symptoms when first-line medications do not work.
Dosage: from 0.15 mg per day to 0.75 mg per day orally between 3 and 10 weeks.
Most frequent adverse effects: dry mouth, drowsiness, dizziness, sedation, constipation ...
Contraindicated for pregnant or breastfeeding women.
4. Nicotine replacement therapy: myths that must disappear
Myth : Nicotine replacement therapy (NRT) does not work.
Truth : Studies show that TSN doubles the chances of quitting. The probability of staying without smoking for more than six months is increased when a smoker uses NRT.
Myth : The nicotine in cigarettes is the same as the nicotine in the products of TSN. Am I not moving from one addiction to another?
Truth : The products are different and the likelihood of long-term addiction with TSN is very low. The amount of nicotine in TSN is lower than that found in cigarettes. In addition, this nicotine is released more slowly and, therefore, the risk of addiction is much lower.
Myth : TSN causes diseases.
Truth : The products of the TSN are much safer than the consumption of cigarettes, since they do not contain the 4,000 chemicals found in tobacco smoke.
Myth : If I use a TSN product, I can not use others.
Truth : TSN products can be used in isolation or in combination with other products. The doctor must be consulted beforehand to supervise the treatment.
Myth : The TSN is very expensive.
Truth : The average cost of a nicotine replacement therapy for 12 weeks (90 days) ranges between 235 and 268 euros. A person who smokes 20 cigarettes a day, tobacco costs about an average of about 3 euros a day. The cost for 12 weeks (90 days) is approximately 270 euros.
5. The combined therapies
Nicotine replacement therapies (NRTs) allow combinations between different presentations, and a controlled release form (such as the transdermal patch) is generally associated with a rapid release form (chewing gum or tablet), whereby the patient can obtain levels of nicotine in blood that suit the needs of the moment.
The association of TSN with bupropion has also been used and the association of TSN and varenicline is under study.
In general, combination therapy is reserved for patients who are unable to quit smoking with a single drug and / or patients with a very high degree of dependence.
6. Where can you find help?
Numerous scientific studies have shown that the personalized help of a health professional increases the chances of success in the process of quitting smoking. According to their situation and preferences, people who want to quit smoking can get help and guidance through different health devices.