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AMERICAN THORACIC SOCIETY SERIES ON TOBACCOPrescription Medications to
Congratulations! Making the decision to stop smoking is the most important thing you can do to improve and protect your health, as well as the health of those around you. Trying to quit on your own, sometimes called “cold turkey”, may be difficult and uncomfortable. Tobacco users are sometimes more successful in quitting if they use medications and attend a quit smoking program. Using FDA approved medications can help make your quit attempt more comfortable and more successful.
Are there medications to help me stop
vider if you would like to take the bupropion
in combination with nicotine replacement
There are several different medications to help
you stop tobacco use. Four of these medica-
What is varenicline (Chantix®)?
tions are available only with a prescription.
Varenicline is a pill you take once a day.
Two of these medications are pills (bupropion
Varenicline works by blocking the areas of
and varenicline) and two are nicotine replace-
the brain that are affected by nicotine. Start
ment products (inhalers and nasal spray). Each taking varenicline about 7-10 days before
of these medications are only approved for
quit date. Usually, you will be asked to take a
those 18 years of age and older. Below is in-
smaller dose for a few days then increase to a
formation about these four medications, how
higher dose. Varenicline is taken for 12 weeks.
they are taken and some of the possible side
If you have successfully quit at 12 weeks, you
can continue taking it for an additional 12
What is bupropion (Zyban®)?
Bupropion is a pill that you take once or twice
Although many people have quit successfully
a day. It is the same drug as the antidepres-
with varenicline, some have experienced side
. Bupropion works by making
effects with this medication such as: nausea,
smoking less desirable to you. Start taking this
vomiting and unusual, vivid or upsetting
medication about 7-10 days before
dreams. If you have kidney problems, talk to
date. Most people take bupropion for a total of
your doctor before using varenicline. People
taking varenicline should be aware that it may
Although many people have quit successfully
cause depression, agitation, suicidal thoughts
with this medication, some have experienced
and suicidal actions. People taking varenicline
side effects such as: an increase in blood pres-
should use caution when driving or operating
sure or allergic reactions. You should not take
heavy machinery until they know how this
bupropion if you have a history of seizures
or have an eating disorder (anorexia, bulimia
What are nicotine inhalers?
etc.). While most people tolerate this medi-
Nicotine inhalers are plastic mouthpieces
cation well, some have experienced depres-
with replaceable nicotine cartridges. Nicotine
sion, agitation, suicidal thoughts and suicidal
replacement products such as this contain
actions. People taking bupropion should use
the nicotine you would normally get with a
tobacco product. For best results, puff on the
machinery until they know how this drug will
mouthpiece, and do not take large inhala-
tions. Large inhalations can cause coughing
You can take other nicotine replacement prod-
and throat irritation. You can use up to 16
ucts (e.g. nicotine gum, nasal spray, etc.) along
cartridges per day when you first quit smok-
with bupropion. Consult your health care pro-
ing. Do not start using this product until you
AMERICAN THORACIC SOCIETY SERIES ON TOBACCO
Prescription Medications to Help You Stop Using Tobacco (cont.)
have quit smoking (or quit using other tobacco
■ Any quit attempt will be improved by the
products). If you smoke and also use nicotine
replacement products, you may develop seri-
■ Seek medical help immediately if you
ous side effects from an overdose of nicotine
(see below). Talk to your health care provider
before using the nicotine inhaler in combina-
■ Don’t get discouraged with any setbacks in
tion with other nicotine replacement products.
your attempts to quit. Your goal of quitting
What is nicotine nasal spray?
Nicotine nasal spray is a liquid you spray in
Tobacco Control Committee of the American
your nose. To avoid nasal irritation, do not
Thoracic Society, Patricia Folan RN, MS, Diane
inhale the spray deeply into your nose. In order to avoid the side effects of an overdose
Suzanne C Lareau RN, MS
of nicotine, do not smoke and also use nico-tine replacement products. Talk to your health
care provider before using the nasal spray in
Fiore MC, Jaen CR, Baker TB, et al. Treating To-
combination with other nicotine replacement
bacco Use and Dependence: 2008 Update.
Clinical Practice Guideline. Rockville, MD: U.S. Department
of Health and Human Services. Public Health Ser-
Which tobacco cessation medications
are the right ones for you?
FDA (Food and Drug Administration) Consumer
Sometimes combining the nicotine replace-
Health Information. Accessed June 22, 2011
ment products (such as using the patch/gum/
lozenge or nasal spray at the same time) or
U.S. Food and Drug Administration. FDA 101: Smok-
using them together with bupropion can make
ing Cessation Products. January 2010.
you more comfortable and more successful in
quitting. Talk to your health care provider who
Signs and symptoms of nicotine poison. http://
can help you decide which products are best
What are the side effects of too much
U.S. National Library of Medicine. Pub Med Health.
Medications for quitting tobacco use.
You can get too much nicotine by taking nicotine replacement products and continu-ing your tobacco use. You should seek medical help if any of the following develop as they may be a sign of an overdose of nicotine: nau-sea, vomiting, agitation, rapid breathing, fast or irregular heartbeat, or an increase in your blood pressure.
■ If you are having trouble quitting tobacco
products “cold turkey”, speak with your health care provider about other ways to help you become successful.
■ Prescription medications may help you
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LONG-TERM PSYCHOLOGICAL AND NEUROLOGICAL COMPLICATIONS OF Courtesy Clinical Professor of Psychiatry Address and Phone 100 East Sybelia Avenue, Suite 210 Abstract This report documents a long-term case of severe hexachlorocyclohexane (lindane) poisoning where, despite prompt medical treatment, the patient continued to experience neurological and psychiatric symptoms for 20 months followin