Tools to Help You Stop Using Tobacco Products

BUPROPRION (Zyban)
Zyban is a medication that was originally developed to treat depression. It has been found to help some people stop using nicotine. It is believed that Zyban helps your brain produce dopamine, a chemical that helps you "feel good," in a similar way that nicotine would make you "feel good." Unlike nicotine, Zyban is not habit forming or addictive. It can help prevent you from smoking again, but while using Zyban you will also need to use other tools for the most effective results.

You should inform your doctor of the following:

• A history of seizures or convulsions, either in your family or yourself.
• A history of alcohol abuse.
• How much alcohol you drink in an average week.
• Bulimia or anorexia, current or past.
• A history of a severe head injury or brain surgery.
• If you are taking or have recently taken benzodiazepines (Valium, Xanax, Klonopin, Dalmane, Restoril, Ativan, Serax, or other medications for psychiatric or seizure problems).
• A history of bipolar (manic-depressive) illness
• Parkinson's disease being treated with medications to increase Dopamine (Sinemet, L-Dopa, etc.).
• If you are taking Tagamet (cimetadine), ulcer or anti-acid medications.
• If you are taking Propulsid, Proventil or Ventolin tablets or inhalers for asthma.

You may experience the following symptoms when you start taking Zyban. Usually these go away in the first week or two. Please call your doctor if you experience any of the side effects listed, or other problems.

Agitation and insomnia - It is recommended the evening dose be taken early in the evening to avoid the insomnia. Taking the medication with food may help. People who experience nervousness generally find that this occurs when they first start taking Zyban and the nervousness goes away gradually.

• Weight loss - Some people find that Zyban causes a decrease in appetite, which may promote weight loss.
• Headache, dry mouth, nausea, sweating, increased or irregular heartbeat.

It is also recommended that you follow the guidelines listed below while taking Zyban:

• Do not drink any beverages that contain alcohol.
• Do not take any other medications, including over-the-counter medications without letting your doctor know.
• Keep Zyban and all medications out of the reach of children and pets at all times.
• The safety of Zyban during pregnancy or while breast-feeding is unproven. You should not smoke during pregnancy. In addition, you should not use any medications during pregnancy unless they are prescribed or approved by your doctor.

SOME HINTS FOR SUCCESSFUL USE OF ZYBAN

• Take your first dose in the morning with food.
• Avoid caffeine as much as possible, as caffeine may worsen any symptoms of agitation or nervousness.
• Exercise each day - 10 to 20 minutes of walking helps to decrease cravings for nicotine and boosts your mood, making you feel better.
• Eat three balanced meals a day. Hunger can make cravings worse. Eating balanced meals can help establish healthy eating patterns and avoid weight gain.
• Eat plenty of fiber. Some people experience constipation when stopping smoking and find it helpful to increase the fiber in their diet at the time they quit. Eating celery whenever you crave a cigarette can be helpful in many ways.
• Get plenty of rest. Someone overtired is more likely to be cranky and irritable. Your body needs the time to heal as well.
• Follow the guidelines suggested by the program.

NASAL SPRAYS
Nasal sprays help reduce nicotine withdrawal symptoms. With one spray into each nostril, a total of 1 milligram of nicotine is released, allowing you the nicotine level necessary to ease your withdrawal symptoms while you are quitting. Nasal spray is absorbed through the nasal membranes. Remember, it is important not to inhale or sniff while using the spray. The nasal spray will take some getting used to. Like all prescription drugs, nasal spray may cause side effects. During the first week or so, most people experience the following side effects: hot, peppery feeling in the back of the throat or nose, sneezing, coughing, watery eyes, or a runny nose. Using the nasal spray regularly for the first week and following the instructions exactly will help you adapt to the spray.

The nasal spray is not for everyone. Patients who are pregnant or nursing, or have chronic nasal problems, heart problems, stomach ulcers, overactive thyroid, high blood pressure, allergies to drugs, diabetes requiring insulin, a kidney or liver disease, or wheezing/asthma should consult their doctor before using the spray. Also, if you are taking any prescription medication or are under a doctor's care for any condition, you should first discuss with your doctor the potential risks of this product. Because the spray contains nicotine, it is possible to become dependent on the nasal spray. Only use the spray when you are having nicotine cravings to overcome the addiction.

TRANSDERMAL NICOTINE PATCH
Nicotine patches work by getting nicotine into your bloodstream through your skin. They are designed to release the nicotine at a constant rate so that you will not experience cravings as frequently as with other methods. The goal is that you can use the patch to keep cravings at bay while you focus on the behaviors associated with nicotine use and reduce the triggers that make you want to use tobacco. Most people have a greater success rate if they gradually (slowly) reduce the strength of the patch being used over a period of weeks. The strength of the patch needs to be adjusted to your needs by assessing your use of nicotine and your general health. It is important that you do not smoke while using the patches. Some people experience unusual dreams while taking this medication. Additional side effects can be discussed during your smoking cessation counseling session.

TIPS ON USING THE TRANSDERMAL PATCHES

• Put the patch on after bathing at the same time each day. Remember to remove the old one before putting on the new patch.
• Change the place where you put the patch. You can use the diagram included to give you some suggestions.
• It is helpful to write down where you put the patch so you remember to give that site a rest for 3-5 days before putting a new one on that site.
• Write the date on the patch when you apply so you make sure that each patch is removed.
• If you find that a patch has come off, put on a new one.
• Do not take the patch off at bedtime unless you are instructed to do so by your physician.
• Read the instructions that come with your patches and follow them. If you have questions, please discuss them with your doctor or nurse.
• Do not apply the patch to a site that has been recently shaved.
• When you take the patch off, fold it placing the sticky sides together. Keep these out of reach of children and pets.
• If your skin is irritated and sore where the patch was, use a small amount of hydrocortisone cream on the site. This can be bought at any drug store without a prescription.
• If you experience other problems, contact your pharmacist or doctor.

NICORETTE (NICOTINE POLACRILEX)
Nicorette is a tool to help people stop using nicotine by giving a small dose of nicotine through the lining of the cheeks. Nicorette is not to be used like chewing gum. Guidelines for using Nicorette are as follows:

• DO NOT SMOKE OR USE OTHER NICOTINE PRODUCTS WHILE USING NICORETTE.
• Plan to use the gum on a regular basis to keep the blood levels more constant, which may help to avoid some of the cravings. One piece each hour is a place to start.
• Bite gum a few times until a tingling sensation is felt or you taste the nicotine.
• Stop biting and hold gum next to your cheek toward the front of your mouth. Do not chew Nicorette as you would chewing gum.
• When you no longer notice a tingling sensation, repeat steps 3 & 4, moving the gum to a different part of your mouth.
• Continue the process of biting and holding the gum until it becomes hard and loses its flavor. This usually takes about 30 minutes. Throw out the gum at this point.
• Do not eat or drink anything while using the gum. Any nicotine that is swallowed with saliva or washed down with liquids will not be effective and may cause an upset stomach, heartburn and/or nausea.
• Avoid acidic beverages before using the gum. If you have had coffee, cola, orange juice or other acidic liquids, rinse your mouth with water before using the gum.
• Do not swallow the gum.
• Keep the gum out of reach of children and pets at all times.

Tapering off the gum will vary for each person. Remember that Nicorette is only one tool to help you stop using nicotine and that use of a number of tools increases the chance that you will not start again. It is common to use the gum for several weeks to a few months before you are ready to stop completely.

INHALERS
The inhaler helps you control the amount of nicotine you need when the urge to smoke hits. By holding the inhaler between your fingers and puffing on it, you'll get the nicotine that your body needs, delivered in a way that can help ease your withdrawal symptoms while you are quitting. As you inhale or puff through the mouthpiece, nicotine turns into a vapor and is absorbed into your mouth and throat. What the inhaler leaves out are the harmful tars, carbon monoxide, and the smoke of a cigarette.

Use the inhaler longer and more often at first to help control cigarette cravings. Less nicotine per puff is released when you use the inhaler versus a cigarette. The inhaler uses nicotine cartridges that provide about 20 minutes of active puffing, or approximately 80 deep draws or about 300 shallow puffs. Guidelines for using the Inhaler are as follows:

Be aware that the number of inhaler cartridges varies per person, and that your doctor may adjust the number of cartridges you use during the first few weeks.

• The recommended usage is between 6 and 16 cartridges a day, with frequent continuous puffing (20 minutes).
• As your body adjusts to not smoking, your doctor will either tell you to stop using the inhaler or to slowly reduce the dose.
• Do not use more than 16 cartridges each day unless directed to do so by your doctor.
• The recommended treatment is up to three months and, if needed, a gradual reduction over the next 6-12 weeks.
• Total treatment should not exceed six months.
• Avoid using coffee, tea, soda or acidic juices 15 minutes before using the inhaler or while puffing on the inhaler.

The inhaler might not be for everybody. If you are pregnant or nursing, you are encouraged to try other methods to quit smoking, like educational or behavior changing programs, because nicotine in any form can cause harm to your unborn baby.

Also, patients with heart problems, stomach ulcers, an overactive thyroid, high blood pressure, allergies to drugs, diabetes requiring insulin, a kidney or liver disease, or wheezing/asthma should talk with their doctor first before using the inhaler. Remember, only you and your doctor can decide if the benefits of using the inhaler to stop smoking outweigh the risk of using this medicine.

CHEMICALS IN CIGARETTES
Cigarettes often contain chemicals that you would not expect to find. In fact, there are over 4000 chemicals in cigarettes, some of these include:

Chemical	Commonly found in
Acetic Acid	Vinegar
Acetone	Nail Polish Remover
Ammonia	Floor/toilet cleaner
Arsenic	Rat Poison
Butane	Cigarette lighter fluid
Cadmium	Rechargeable batteries
Carbon Monoxide	Car exhaust fumes
DDT/Deildrin	Insecticides
Ethanol	Alcohol
Formaldehyde	Preservative for bodies, tissues and fabrics
Hexamine	Barbecue lighter fluid
Methane	Swamp gas
Methanol	Rocket fuel
Napthalene	Moth balls
Nicotine	Insecticide/addictive drug
Nitrobenzene	Gasoline additive
Nitrous Oxide Phenols	Disinfectant
Stearic Acid	Candle wax
Toluene	Industrial solvent
Vinyl Chloride	Makes PVC

Known Cancer Causing Agents

• Benzo(a)pyrene
• B-Napthylamine
• Cadmium
• Crysenes
• Dibenz Acidine
• Nickel
• P.A.H.S.
• Polonium 210
• Toudine
• Urethane
• Nitrosamines
• N. Nitrosomes

Metals

• Aluminum
• Copper
• Gold
• Lead
• Magnesium
• Mercury
• Silicon
• Silver
• Titanium
• Zinc

OTHER NOTES
Stopping the use of nicotine is a process that is helped by many tools. The transdermal nicotine patch is one tool that will reduce cravings and physical withdrawal. For the best outcome, use all the tools available. These include the tips listed here: group or individual counseling, staying out of smoky environments and many other tools that can be discussed with your nicotine recovery counselor. McKinley Health Center offers counseling and medications if needed to aid you in your attempts to quit smoking. Remember, you are doing this for your health, feel good about your decision to quit and not start again!

Source
Tacoma-Pierce County Health Department, 2002.

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