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Smoking Cessation

Smoking tobacco is the largest known cause of preventable deaths. On average people who smoke cigarettes die 10 years earlier than those who do not. About half of the people who smoke cigarettes will die of tobacco related disease. Cigarettes are very addicting because they cause dopamine release within the nucleus accumbens in the mesolimbic regions of the brain, this leads to a "reward" sensation which the smoker can also get from nicotine replacement therapies such as nicotine gum, lollipops, lozenges and patches. Quitting smoking can lead to withdrawal symptoms such as anxiety, irritability, depression, restlessness, cough, constipation, cravings, insomnia, and anger. These withdrawal symptoms are strong in the first week, but then gradually go away over the following month. Quitting may require multiple attempts as the smoker learns his or her triggers and behavioral patterns. There are a variety of smoking cessation regimens. We encourage smokers to talk to their doctor to help them quit, and also to consider a therapy such as nicotine replacement therapy, or a prescription drug therapy such as varenicline(this is a very effective treatment) as long as they are not contraindicated to taking it.

Risks of Smoking

Smoking can make current respiratory and cardiovascular conditions much worse, and can greatly increase the smokers chances of getting aneurysms, coronary heart disease, stroke, peripheral artery disease, chronic respiratory illnesses such as COPD and reduced lung function, a large variety of cancers, reduced fertility in women, infant mortality if smoking while pregnant, other adverse pregnancy outcomes, and respiratory infections such as pneumonia, bronchitis, and pharyngitis. It can also lead to osteoporosis, cataracts and other illnesses.

Important Substance Interactions With Smoking - Oral Contraceptives, Caffeine, and Prescription Medications

Cigarettes contain thousands of chemicals which include carbon monoxide, ammonia, cyanide, nicotine, and tar which contains a compound called polycyclic aromatic hydrocarbons which have been shown to cause cancerous tumors. Some of these compounds can interact with certain drugs and therefore it is important that your doctor or pharmacist is aware of your tobacco smoking. Most of the drug interactions are from actions of CYP1A2 induction, meaning that it can cause the liver to metabolize certain drugs more quickly if you are a smoker. For this reason, it is recommended to decrease your intake of caffeine right when you stop smoking in order to avoid a stronger effect of caffiene than usual, which can make withdrawal symptoms worse. Evidence clearly shows a strong increase in the risk of heart attack, blood clots, and strokes in women who use oral contraceptives and smoke cigarettes. This effect is greatest in women over age 35 who smoke more than 15 cigarettes per day, and therefore cigarette smoking should not be allowed in this group of patients.
Smoking also costs a lot of money.

Ready to quit smoking? Try:

1) Choose a quit date within the next 2 weeks. Prepare for your quit date by throwing away all ash trays and smoking paraphernalia in your home, workplace and car. Inform your friends and family that you want to quit smoking and are giving it a try. You can rearrange your house and avoid spending time in places that you typically smoke. If you can, try to limit or avoid alcohol consumption for the first few weeks, drinking alcohol can cause cravings to smoke. Try spending as little time as possible being around other people who are smoking.

2) Be prepared for cravings to occur and plan how you will deal with cravings for the first few weeks. Stressful situations and other "triggers" may cause cravings. Remember that cravings go away after the first few weeks. Effective ways to deal with cravings include: Meditation/breathing exercises, self massages, taking a short break from a stressful situation, contacting a friend who knows you are trying to quit, taking a form of nicotine replacement therapy. Using a toothpick, candy cane, or gum can also help.

3) Identify smoking "triggers". Smoking triggers are situations where you typically smoke, examples include while drinking alcohol, after a meal. while going on the porch, while driving, while talking on the phone, while sitting in a certain chair, and during stressful situations. Plan to do a replacement routine instead of smoking. For example, after a meal go for a walk or do the dishes. After cleaning your car and removing all ashtrays, chew gum and listen to music instead of smoking. If you smoke while drinking coffee, choose a different drink instead of coffee for the first few weeks. Limit your time spent in any place or situation where you usually smoke.

Plan how to respond when someone offers you a cigarette and remember, the cravings will go away with time. Think about how good it will be when you are free of smoking addiction!

Nicotine Replacement Therapy such as lozenges, gum, and patches supply the body with nicotine so that withdrawal symptoms do not occur. If they do occur, the withdrawal symptoms will be far less strong then if the user tries to quit suddenly with no replacement therapy. With nicotine replacement therapy, the patient is not ingesting any carcinogens(no cancer risk), they are only ingesting nicotine to ease withdrawal symptoms.

Do not smoke cigarettes while using the following products, smoking while using these products will increase the level of nicotine too much, resulting in adverse effects such as abdominal pain, dizziness, palpitations, nausea and vomiting.

Nicotine Replacement Therapy

Nicotine Lozenges:

Smoke first cigarette within 30 minutes of awakening:4 mg
Smoke first cigarette after 30 minutes from awakening: 2 mg
Week 1-6: 1 lozenge every 1-2 hours as needed.
Weeks 7-9: 1 lozenge ever 2-4 hours as needed.
Weeks 10-12: 1 lozenge every 4-8 hours as needed.

Nicotine Gum:

Smoke 25 or more cigarettes per day: 4 mg gum.
Smoke less than 25 cigarettes per day: 2 mg gum.

Week 1-6: 1 piece every 1-2 hours as needed.
Weeks 7-9: 1 piece ever 2-4 hours as needed.
Weeks 10-12: 1 piece every 4-8 hours as needed.

Nicotine Patches:

Nicoderm CQ patch:
Smoke more than 10 cigarettes per day: 21 mg/day for 6 weeks, then 14 mg per day for 2 weeks, then 7 mg per day for 2 weeks.
Smoke 10 or less cigarettes per day: 14 mg/day for 6 weeks, then 7 mg/day for 2 weeks.

Generic Patch:
Smoke more than 10 cigarettes per day: 21 mg/day for 4 weeks, then 14 mg per day for 2 weeks, then 7 mg per day for 2 weeks.
Smoke 10 or less cigarettes per day: 14 mg/day for 6 weeks, then 7 mg/day for 2 weeks.

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