Its becoming harder and harder to be a smoker, and cigarettes are expensive.  Most places are now tobacco free, and are off limits to smokers.  Surgeons won’t operate on smokers because smoking impairs wound healing and leads to more surgical complications.  Second hand smoke causes the same diseases as smoking.  There are over 4000 toxic chemicals in cigarette smoke including arsenic and radioactive polonium.  80% of lung cancer patients are in smokers..  For many smokers the nicotine addiction keeps them from quitting.  Most patients who try to go “cold turkey” fail. There are medical options to help you quit smoking.

Nicotine replacement

Nicotine replacement treatment is free without a prescription from the State of Florida, due to a legal settlement with the tobacco industry.  If you smoke more than 1/2 pack per day you should start on the 21mg nicotine dose.  Otherwise start on the 14mg dose first.  I usually advise having a stress or “nicotine fit” medication like Nicorette gum or lozenges.  For the gum you chew until you taste it, then stop chewing and spit it out.  Lozenges are also available for as needed use.

Nicotine isn’t really a bad drug, its just incredibly addicting and dangerous in overdose.  Some people get stuck on the patches and can’t completely quit.  Stepping down the dose is one way to get off nicotine.  The health benefits of quitting are enormous.  In fact smoking 1 pack per day is the health equivalent of being 70 pounds overweight.  Most patients gain a little weight when they quit, just like they helped you to lose weight when you started.

Most smokers take in a deep puff through a cigarette.  The hand to mouth movement and breathing through a cigarette are very relaxing.  Its like a smoker’s binky.  Get a straw the width of a cigarette.  Cut the straw to the same length as a cigarette and put as much cotton in the straw as you can.  After you’ve used nicotine replacement you’ll still miss the cigarette in your mouth and the long breath.  Do this with the straw to mimic using a cigarette.

Vaping is another option to quit smoking.  You’ll get the nicotine with a solvent to breathe in.  This doesn’t get rid of your nicotine addition, you just stop smoking and vape instead.  Vaping isn’t safe, but its much safer than smoking cigarettes and there is no second hand smoke.

Medications for quitting smoking:

Chantix (varenicline) stops the cravings.  Its nearly $500 per month.  You start with a lower dose (0.5mg) then go to 1mg twice daily.  Taking it with food or water reduces side effects, especially nausea.  You start the medicine a week before your “quit date.”  If you can’t quit on the “quit date” the medication should be discontinued.  If successful, this medication can be continued for 12 weeks or longer.  Patients who have significant  mood problems, especially with psychosis, should avoid Chantix (varenicline).   It intensifies the effect of alcohol.  Can cause weight gain.

Buproprion (Wellbutrin and Zyban) is an antidepressant that works on both noradrenergic and dopaminergic receptors.  There is no weight gain.  Usually 4 weeks is sufficient, but it can be continued it the patient wants to.  Those with a seizure disorder probably shouldn’t take it.

Pamelor (nortriptyline) is another antidepressant that can help with quitting smoking.  Start on 25mg per day, increased to 75-100mg per day over the next month.  Side effects can include a dry mouth, constipation, blurred vision, difficulty urinating and sleepiness. The elderly along with those with heart disease should avoid this medication which is not FDA approved for quitting smoking.