Nicotine Addiction

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Nicotine addiction is the second-leading cause of death worldwide, and the leading cause of preventable death. Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths yearly, or 1,300 deaths every day.

The physical effects of nicotine use include accelerated heart rate, increased blood pressure, and weight loss.  Nicotine may also enhance an individual’s level of alertness, although tobacco abuse and dependence may simulate a frantic, almost manic, picture. Speech may also be accelerated in line with behavior. Cessation after prolonged tobacco use can contribute to irritability, which is often soothed by a dose of nicotine.

Nicotine withdrawal symptoms may include:

• feeling irritable, angry or anxious
• having trouble thinking
• craving tobacco products
• feeling hungrier than usual

Nicotine replacement therapy

Nicotine replacement therapy (NRT) works by making it easier to abstain from tobacco by partially replacing the nicotine previously obtained from tobacco. All of the commercially available forms of NRT increase the chances of successful smoking cessation. Overall, NRT increases the quit rate by 50-70%.

Types of NRT products on the market today include the following:

• Transdermal nicotine patch
• Nicotine nasal spray
• Nicotine gum
• Nicotine lozenge
• Sublingual nicotine tablet
• Nicotine inhaler

Non-nicotine pharmacotherapy-Prescriptions

The medications bupropion and varenicline have demonstrated efficacy for smoking cessation.

Bupropion acts by alleviating some of the symptoms of nicotine withdrawal. Like NRT products, bupropion has been endorsed by the US Clinical Practice Guideline as a first-line therapy. Compared with placebo, bupropion approximately doubles smoking cessation rates, and it is equally effective for men and women.  Varenicline helps smokers quit by preventing withdrawal symptoms while moderate levels of dopamine are maintained in the brain.  Combination treatment with varenicline and bupropion may be more effective than single-drug therapy for smoking cessation in those smokers motivated to quit.