Medication 

NRT_combo.gifStop-smoking medication is recommended for all smokers who are dependent on nicotine (about 80% of smokers).

You are likely to be addicted if you answer yes to any of the following:

  • Do you smoke within 30 minutes of waking up?

  • Do you smoke at least ten cigarettes a day?

  • Do you get cravings or withdrawal symptoms when you try to quit?

Medications work mainly by reducing cravings and withdrawal symptoms after you quit. Withdrawal symptoms include irritability, frustration, feeling angry, sleep problems, depressed mood, feeling anxious, difficulty in concentrating and restlessness. Medication does not usually stop all withdrawal symptoms.

Medications approximately double your chances of quitting successfully. They help with the physical addiction to nicotine while you learn to break the habit.  

 

Nicotine Replacement Therapy (NRT)

gum__patch_therapy.jpg

NRT is the most common medication used by Australian smokers. It is available in 2 main forms:

All can be purchased over-the-counter, however nicotine patches are available on a doctor’s prescription at a substantial cost saving.

NRT is safe

Nicotine replacements generally work more slowly, and the amount of nicotine in the bloodstream is less than that from smoking. That makes nicotine medications much safer and much less addictive than cigarettes.

Nicotine is the main cause of addiction to smoking but has few significant health effects. 

 

Most of the health effects of smoking are due to the tars and carbon monoxide generated by burning the tobacco. In particular:

  • Nicotine does not cause heart attacks

  • Nicotine does not cause cancer

  • Nicotine does not cause lung damage

  • Smoking while using NRT is safe

  • The risk of addiction to NRT is very low. In any case, long term use of NRT is much safer than smoking

 

NRT is always safer than smoking. NRT does not kill, it saves lives!

 

Golden rules for using NRT 

1. Use sufficient nicotine

It is vital to take enough NRT to relieve cravings and withdrawal symptoms. Some people metabolise nicotine faster and need larger doses to get the same effect. Standard doses of NRT provide about half the nicotine your body receives on average when smoking.

Nicotine lozenge and gum are available as 4mg or 2mg pieces (or 1.5mg in the case of the minilozenges). Be sure to use the 4mg product if you smoke within 30 minutes of waking.

The recommended doses are:

  • Patch. Most smokers need the full strength patch (21mg patch/24 hours or 15mg patch/16 hours). Only light smokers (<10 cigarettes per day) or underweight (<45kg) smokers should start with a lower strength patch.

  • Mouth spray: Up to 64 sprays per day

  • Nicotine lozenges: 9-15 pieces per day.

  • Minilozenges: 1.5mg mini lozenges: 9-20 pieces per day. 4mg mini lozenges: 9-15 pieces per day

  • Nicotine gum. 2mg gum: 8-20 pieces. 4mg gum: 4-10 pieces.

  • Inhalator: 3-6 cartridges per day

 

Don’t be afraid to increase the dose if you still have cravings or withdrawal symptoms. If in doubt, have more rather than less.

2. Take the full course of NRT

A full course of NRT is at least 8-12 weeks. Many smokers get overconfident early in the treatment, but don’t realise they are doing well because of the treatment. Stopping medication too early often leads to relapse.

Also, it takes time to break the smoking habit and NRT keeps you comfortable while you unlearn many years of smoking behaviour.

Long term use of NRT (months or years) may increase success rates further and is much safer than continuing to smoke.

3. Start the nicotine patch 2 weeks before quitting

Starting the patch 2 weeks before Quit Day is twice as effective as starting it on the day you quit. Smoking while using the patch is safe.

4. Continue the patch after a lapse

Do not remove the patch if you have a slip-up as it helps prevent you from going back to regular smoking. Using the patch while smoking is safe.

5. Use quick-acting forms of NRT to treat cravings

Oral forms of NRT (mouth spray, lozenge, gum and inhalator) are effective in relieving cravings, for example when triggered by stress, coffee or alcohol. Ideally, they should be used in anticipation of a craving whenever possible. Nicotine mouth spray gives the fastest relief of cravings.

After quitting, it is a good idea to carry some quick acting NRT to relieve cravings, as they can continue to occur for months or years.

6. Use NRT correctly

The incorrect use of NRT makes it less effective and causes more side-effects. It is important to follow the instructions carefully (see below). Do not drink or eat immediately before and while using oral NRT as this reduces the absorption of nicotine in the mouth.

View this video for instructions on using the various nicotine replacement products.

Combination therapy

The best results from NRT are from combining a nicotine patch for a steady, slow dose of nicotine with a quick-acting form of NRT (mouth spray, gum, lozenge or inhalator) for breakthrough cravings.

Combinations work better than single forms of treatment and are recommended for most smokers. They are safe and are usually well tolerated.

Nicotine patch

nicotine_patch.jpg

Nicotine patches are the most popular form of NRT. A patch is applied to the skin daily and delivers a steady dose of nicotine through the day.

Nicotine absorption from the patch is slow and it takes several hours for the patch to have its full effect. Patches are not so helpful for immediate cravings so are usually combined with a faster acting form of NRT, such as the mouth spray, lozenge, gum or inhalator. Sometimes multiple patches are required to relieve cravings and withdrawal symptoms.

There are two types of nicotine patch. Twenty-four hour patches are usually applied on rising and removed the next morning. They help to protect against early morning cravings and may give better craving relief overall. They can be taken off at bedtime if sleep is disturbed. The 16 hour patch that is applied in the morning and removed at bedtime.

Smokers of 10 or more cigarettes per day normally start on a full strength patch (21mg for the 24 hour patches and 15mg for the 16 hour patches). Sometimes 2 or even 3 patches are required to relieve cravings or withdrawal symptoms.

Correct use of nicotine patches

Nicotine patches work best if started 2 weeks before Quit Day. Apply the patch each morning to clean, dry, hairless skin on the upper arm, chest or back. Use a different location each day to avoid skin irritation.

Sometimes patches are applied at bedtime. The nicotine level builds up overnight and gives good protection against morning cravings. However, the higher nicotine levels at night can disturb sleep.

Click here to see a video on correct use.

Duration of use

Patches are used for 12 weeks but can be continued for longer if needed. They can be stopped abruptly or you can gradually taper the dose of nicotine over several weeks, by using weaker strength patches.

Long-term addiction to the nicotine patches is very uncommon. However, continuing to use nicotine patches is much safer than returning to smoking.

Side effects

Patches can cause skin irritation, redness, itch and rash. This is usually mild, but can be treated with 1% hydrocortisone cream if troublesome. It is important to rotate the application site each day to reduce irritation.

Insomnia and vivid dreams can also occur, but tend to improve with time. However, if severe, you can remove the patch at bedtime or a couple of hours before retiring.

Other possible, but uncommon side effects of the nicotine patch include dizziness, racing heartbeat, headache, nausea, vomiting and muscle aches.

Cost

With a doctor’s prescription, you can receive one course of subsidised patches per 12 month period. The cost is $5.80 per script for pensioners and Health care card holders and $35.40 for others.

Patches can also be purchased over-the-counter, without a prescription, for the full retail price. However, this is still cheaper than smoking!

Download the package inserts

Nicabate 24 hour patch 

Nicotinell 24 hour patch 

Nicorette 16 hour patch 
 

Nicotine gum 

Nicotine_gum_3.jpgNicotine gum delivers nicotine to the mouth where it is absorbed into the body through the lining of the cheek.

Nicotine gum is available in two strengths: 2mg and 4mg. If you smoke within 30 minutes of waking you should begin treatment with the 4mg dose.

Correct use of nicotine gum

Nicotine gum requires a special chewing technique, called the ‘bite and park’ method. Place one piece in the mouth and chew slowly until you feel a tingling or peppery taste, usually after about 10 chews. Park the gum between your cheek and gums until the tingling goes (usually about a minute). Then chew again slowly until the tingling returns. Repeat this cycle for 30 minutes or until the peppery taste fades and then dispose of the gum.

The nicotine from the gum takes about 30 minutes for the full effect to kick in. It is best used on a regular basis, for example one piece hourly. It can also be used 15 minutes before entering a situation where you may be tempted (e.g. being with other smokers).

It is important not to eat or drink while the gum is in the mouth or for 10 minutes before as this interferes with the absorption of the nicotine into the lining of the mouth.

Click here to see a video on correct use.

Dosage

The recommended dose is 9-15 pieces of gum per day. If in doubt, it is best to use more rather than fewer pieces.

Duration of treatment

A full course of treatment is 12 weeks. Tapering the amount of gum chewed helps users to stop using it.

Some people choose to continue the gum long-term to provide ongoing support. This is much safer than going back to smoking.

Side-effects

Hiccups and nausea can occur if the gum is chewed too rapidly and excessive nicotine is swallowed. Vigorous chewing can also cause jaw discomfort. Some other possible side-effects of the gum include bad taste, throat irritation and a racing heartbeat. Nicotine gum also sticks to dentures and is not suitable for denture wearers.

Cost

Nicotine gum is available over-the-counter without a prescription. The recommended retail price of Nicabate 2mg or 4mg gum is $9.99 for a 24-pack and $28.49 for a 96-pack.

Download the package inserts

Package inserts provide detailed, approved information from the manufacturer.

Nicabate gum 

Nicotinell gum 

Nicorette gum 

 

Nicabate_lozenges.png

Nicotine Lozenges

Like the gum, nicotine lozenges are held in the mouth and release nicotine as they dissolve. Nicotine is absorbed through the lining of the mouth. The lozenges are more discreet than the gum and can be used inconspicuously in public.

The lozenge is available in 2 strengths, 2mg and 4mg. Smokers who have their first cigarette within 30 minutes of waking should take the 4mg lozenge. There is also a popular minilozenge, which is available in 1.5mg and 4mg strengths.

Figure: Nicabate lonzenges and 
Nicabate mini lozenges.

Correct use

Allow the lozenge to dissolve in mouth moving it from side to side from time to time. Try not to swallow saliva excessively. The minilozenges take about 10-15 minutes to dissolve and the regular lozenges take 20-30 minutes. Do not chew or swallow the lozenge.

Like the nicotine gum, the lozenge takes about 30 minutes for the full effect to kick in. It is best used on a regular basis, for example one piece hourly. It can also be used 15 minutes before entering a situation where you may be tempted (e.g. being with other smokers).

Do not eat or drink while the lozenge is in the mouth as this reduces the absorption of nicotine into the bloodstream.

Click here to see a video on correct use. 

Dosage

The recommended daily dosages are:

  • Minilozenges. 1.5mg mini lozenges: 9-20 pieces; 4mg mini lozenges: 9-15 pieces
  • Lozenges: 2mg & 4mg lozenges: 9-15 pieces

If in doubt, it is always better to use more rather than less pieces.

Duration of treatment

A 12 week course is recommended.

Side-effects

Lozenges can cause nausea, hiccups, heartburn and flatulence if sucked too quickly or swallowed. Try to make them last longer if this is occurring. Other side-effects include insomnia, dizziness, headache, cough, sore throat.

Cost

The current recommended retail prices are:

Lozenge: 36-pack $19.99; 72-pack $33.99

Mini-lozenge: 20-pack #11.95; 60-pack $30.99.

Download the package inserts

Package inserts provide detailed, approved information from the manufacturer.

Nicabate lozenges 

Nicabate minilozenges

 

Nicotine Mouth Spray

Nicorette-QuickMist.jpg

Nicotine from the mouth spray (Nicorette QuickMist) is sprayed directly into the mouth and is absorbed much more rapidly than other forms of NRT. It starts to relieve cravings after one minute and delivers its maximum effect in about 10 minutes.

Correct use

Spray under the tongue or onto the inside of the cheek, being careful to avoid the lips and eyes. Do not inhale while spraying and do not swallow for a few seconds after spraying.

Use the mouth spray when cigarettes would normally be smoked or for quick relief if cravings occur.

Click here to see a video on correct use.

Figure: Nicorette QuickMist 

Dosage

The recommended dose is 1-2 sprays every 30-60 minutes, up to a maximum of 4 sprays per hour or 64 sprays per day.

Duration of treatment

A course of 12 weeks is recommended. The number of sprays can be gradually reduced towards the end of treatment.

Side-effects

spray.png

Side-effects from the mouth spray include irritation of the mouth and throat, increased saliva, nausea, dyspepsia, headache and hiccups.

Cost

The recommended retail price is $39.95 for a single pump spray (150 sprays) and $59.95 for a double pack.

Download the package inserts

Package inserts provide detailed, approved information from the manufacturer.

Nicorette QuickMist (waiting for CMI)

Figure: Spray directly into the mouth every 30-60 minutes

Nicotine Inhalor

Nicorette_Inhalator.jpgThe nicotine inhaler (Nicorette Inhalator) is a hollow plastic tube with a replaceable nicotine cartridge inside. It is good for people who like to handle a cigarette. When you puff on the inhalator, a nicotine vapour goes into your mouth and is absorbed through the lining of the mouth.
 

Nicorette_inhaler.gif 

Figure above: A replaceable nicotine cartridge sits inside a hollow pipe.

Figure on the right: Nicorette Inhalator 

Correct use

Take shallow puffs from the inhalator into the mouth, not deep breaths into the lungs. Take a puff approximately every 2 seconds or alternatively take 4 puffs every minute. Continue for up to 20-30 minutes until the peppery taste fades, indicate that the cartridge is empty.

Since the amount of nicotine from a puff of the inhalator is much less than that of a cigarette, about 8-10 times as many puffs compared to that when smoking a cigarette should be used.

Click here to see a video on correct use.

Dosage

Use 3-6 cartridges per day initially, increasing if needed.

Duration of treatment

A 12 week treatment course is recommended. The number of puffs can be gradually reduced towards the end of treatment.

Side-effects

Side-effects include cough, irritation of mouth and throat, abdominal discomfort, nausea, hiccups and vomiting. Breathing or puffing on the inhaler too deeply will make you cough more.

Cost

The recommended retail price of a starter pack containing a mouthpiece + 4 cartridges is $9.99. A pack of 42-cartridges is $39.99.

Download the package inserts

Package inserts provide detailed, approved information from the manufacturer.

Nicorette Inhalator (waiting for CMI)

 

Champix

champix.jpgChampix (varenicline) is a medication specifically designed to help smokers quit. Champix is the single most effective medication for quitting smoking and more than doubles the chance of quitting successfully compared to sugar pills.

Champix works in the brain by reducing cravings and withdrawal symptoms after quitting. It also reduces the enjoyment of a cigarette if you are tempted to smoke. It is not addictive or habit forming

How to take Champix

The first (Initiation) pack contains both 0.5mg (white) tablets and 1mg (blue) tablets and lasts a month. The second pack has only 1mg tablets and lasts 2 months (56 tablets). Swallow the tablet whole with a meal.

Gradually increase the dose over the first week to help your body get used to it as follows:

Champix_dose.png 

Quitting cigarettes is usually advised in the second week (days 8-14) however it can be delayed for up to several weeks if you are not ready. Champix can be safely taken while still smoking.

Take Champix for the full 12 week course to get the best results. A second 12-week course is optional and can help to prevent relapse.

Side effects

Side effects are usually mild.

  • Nausea. Up to 30% of people get nausea from Champix. Nausea is usually mild-moderate and tends to settle over time. It can be reduced by increasing the dose more slowly, taking the tablet with food or reducing the dose.
  • Insomnia, abnormal dreams
  • Drowsiness
  • Headache; constipation; dizziness; flatulence
  • Mood or behaviour changes. Some people have reported feeling depressed, agitated or even suicidal when taking Champix. It is not known if Champix causes these symptoms and they can be caused by stopping smoking itself. It is recommended to monitor your mood or behaviour while on Champix. A relative or friend may notice these changes first and should report them promptly. 
 

Warnings

  • Take care when driving or operating machinery until you know how Champix affects you
  • Do not take if pregnant or breastfeeding

Notify me

  • Persistent or severe nausea
  • Any unusual change in your mood or behaviour or if you have any thoughts of harming yourself.
  • New or worsening symptoms of cardiovascular disease e.g. chest pain, shortness of breath, pain in the legs when walking
  • An allergic reaction, such as a rash, swelling of the face or wheeze
  


Availability and cost

Champix is available by prescription on the Pharmaceutical Benefits Scheme at a subsidised rate. The cost for pensioners and Health Care Card Holders is $5.40 per month. You can only get one subsidised course in a 12 month period.

Click here to download a detailed product information sheet. [Champix CMI 11_12]

 

Zyban SR

Zyban.jpgZyban was originally developed as an antidepressant, but was found to be effective in helping smokers quit, whether they are depressed or not. Like the other stop-smoking medication, it relieves cravings and withdrawal symptoms and approximately doubles quit rates.

Zyban works in the brain to increase hormone levels in the reward centre. It is not addictive or habit forming.

How to take Zyban

Start Zyban while you are smoking. For the first 3 days, take one tablet each morning. From day 4, take 1 tablet twice daily. Try to stop smoking in the second week.

It is important not to exceed the recommended dose of Zyban as excessive doses can cause seizures (see below).The tablets should be swallowed whole and not crushed or chewed.

Zyban can be combined with quick-acting forms of nicotine replacement therapy, however the evidence for the effectiveness of this combination is controversial.

A full course of Zyban is 8 weeks, after which the tablets are stopped abruptly.

Side-effects

Zyban is usually well tolerated, but the following side-effects can occur: Insomnia, headache, dry mouth, nausea, dizziness and anxiety.

About 1 in 1,000 people taking Zyban experience a seizure.

Zyban should not be used in people who are at risk of seizure, including those with:                                                        

  • A history of past or current seizures
  • Brain tumour
  • Excessive alcohol or sedative use
  • Bulimia or anorexia nervosa
  • Past head injury

It should also not be taken in pregnancy or while breastfeeding.
 

 

Zyban also interacts with a number of medications, such as other antidepressant and antipsychotic drugs, medicines for epilepsy and certain heart and blood pressure drugs. Make sure you notify your doctor about your current medication before starting Zyban.

Availability and cost

Zyban is available by prescription on the Pharmaceutical Benefits Scheme at a subsidised rate. The cost for pensioners and Health Care Card Holders is $5.40 per month. You can only get one subsidised course in a 12 month period.

Click here to download a detailed product information sheet.

 


 

Last Modified: 04-02-2013