Of greater concern, 160,000 people will die of the disease in the same time period. These deaths account for 28% of all cancer deaths and comprise the leading cause of cancer death in the country today.

Cigarette smoking is the most significant risk factor for the development of the disease. It has been noted that the small but important decrease in the incidence of lung cancer (1.9% per year among men and 0.3% per year among women) can be linked to the decrease in cigarette smoking observed in the population today.

If you want to do something good for yourself or for somebody you love, help him or her to stop smoking. What you can help him/her understand is that there is NO magic pill! They will need a plan, commitment and hard work to undo all the years of smoking.

Here are some helpful tools which are at your disposal.

The first three are over the counter products (OTC). These can be purchased many places and for most people no prescription is needed.

Nicotine Patch 
The nicotine patch comes in three levels; 21mg, 14mg, and 7mg. If you smoke greater than ten cigarettes start with a 21mg nicotine patch for four to six weeks, decrease to the 14mg patch for two to four weeks, then use the 7mg patch for an additional two weeks. If you smoke ten or less cigarettes a day then begin with a 14mg patch for four to six weeks then the 7mg nicotine patch for an additional two to four weeks. The day you begin using the patch is the day you QUIT smoking. Do NOT smoke with the nicotine patch on.

The patch is good for 24 hours. At the end of a 24 hour period, take off the “used” patch and place a new patch on your other arm. This is repeated daily.

If you have difficulty with getting the patch to “stick,” use a piece of tape, coban, or pre-wrap to help it remain in place.

Other side affect from the patch include arm irritation, insomnia or vivid dreams. If you don’t care for the dreams, remove the patch about an hour before going to bed for the night. This enables the nicotine level in your blood to decrease as it did when you were smoking. Place a new nicotine patch on in the morning when you first wake up.

Nicotine Gum
The nicotine gum comes in two strengths, 4mg, and 2mg. The gum works quickly. Begin with the 4mg gum if you smoke 25 or more cigarettes; 2mg gum for less than 25 cigarettes. Maximum daily dose for the gum is 10-12 pieces/day. Gum is very coarse and may cause mouth irritations.

The proper way to use the gum is to chew it until it tingles then “park” it in between the gum and cheek in your mouth. When it no longer tingles, pop it back into mouth chew again then park. Do this until it no longer tingles.

Do not eat or drink anything except water 15 minutes prior to or after using the nicotine gum as it may not get absorbed as well through the mucosa in the mouth.

Nicotine Lozenge
The nicotine lozenge also is available in two strengths, 4mg and 2mg. It is recommended to use 10-20 lozenges a day. Begin with the 4mg lozenge if you smoke within 30 minutes of getting up. The lozenge must be sucked on and not chewed as this could cause nausea. As you begin to feel more in control, change from the 4mg lozenge to a 2mg lozenge. This may be continued for 12 weeks.

Use the 2mg lozenge if you have your first cigarette after 30 minutes from waking up. This is a guideline not an absolute. The lozenge also works quickly. Do not eat or drink anything except water 15 minutes prior to or post lozenge.

These next four items are prescription medication. You need a prescription from your primary care physician to obtain any of these products.

Nicotine Inhaler 
The nicotine inhaler is NOT like an inhaler one might use for respiratory problems. It has the appearance of the plastic end of a cigar or tiparillo. It has a nicotine cartridge which is inserted and it is puffed on. Each cartridge is good for 60-80 puffs or 20 minutes of active puffing time. This can cause mouth irritation, or hiccups if used frequently. The dose is 6-16 cartridges a day. Do not eat or drink anything within 15 minutes to maximize the effect of the medication.

Nasal Spray
The nasal spray is administered via your nose. The dose is one 0.5mg spray in each nostril one to two times per hour and should not exceed 40 applications a day. If you have reactive airways this particular product should not be used. This product may cause burning in your nasal passages and/or cause your eyes to tear.

Wellbutrin 
Wellbutrin is a known antidepressant with one of the side effects being you do not want to smoke as much. Wellbutrin is also known as bupropion (generic) or Zyban. It should be started about two weeks prior to your quit date. The dose is 150mg one time a day for three days then increase to 150mg twice a day.

If you have had seizures, closed head trauma, bulimia, anorexia, take other antidepressants or drink excessive alcohol you should discuss use of this medication with your physician before considering this option for quitting smoking. Wellbutrin may also cause a dry mouth, insomnia and decreased appetite.

Varenicline 
Varenicline is the newest product to aid in tobacco cessation. To begin this medication pick a quit date, count back seven days and that is the day you begin taking Varenicline. 

The dosage is 0.5mg for the first three days, then increase to 0.5mg two times a day for four days. The dose changes again on day eight to 1mg and is taken twice a day for as long as needed to help you quit smoking.

Varenicline must be taken with food and a glass of water. It should not be taken close to bedtime.

This medication works by blocking the nicotine receptors in the brain and clears through the kidneys. If you have kidney disease discuss use of this medication with your physician. It also may cause mood swings, vivid dreams, nausea, insomnia, suicidal thoughts.

Varenicline may not be given to airline pilots, air traffic controllers, or truck drivers due to the possible side effects.

I hope this helps clear the air on what FDA approved products are available when the desire to quit smoking reflects in your mirror.

Written by
Marie Drawbaugh
Tobacco Education and Cessation Counselor
WellSpan Health

Have you been able to quit? What worked for you? Please leave a comment below.