Treatment
Nicotine Replacement Therapies
Non-nicotine Medicines
Different ways to stop smoking are effective for different patients. Some smokers can quit with the help of counseling, while others may need nicotine replacement therapy or non-nicotine medicines to help them quit. Since patients can improve their health in many ways by quitting smoking, medicines are often prescribed with careful monitoring to help them succeed.
Nicotine Replacement TherapiesNicotine replacement therapy may help with the withdrawal symptoms that patients experience when trying to stop smoking. Nicotine products include:
A physician should be consulted before starting any form of treatment, and the following groups should take special precautions:
- Patients who are pregnant or nursing should get advice from a health care professional before using nicotine replacement products.
- Patients who continue to smoke, chew tobacco, or use snuff should not use nicotine replacement products.
- Patients aged less than 18 years and those who have the following conditions should check with a physician before using nicotine replacement products:
- Heart disease or an irregular heartbeat.
- High blood pressure not controlled with medicine.
- Esophagitis or peptic ulcer disease.
- Diabetes treated with insulin.
- Depression or asthma treated with prescription medicines.
Non-nicotine medicines that have been studied to help people quit smoking include:
- Varenicline (also called Chantix), a drug approved by the Food and Drug Administration (FDA) for smoking cessation that acts the same way nicotine acts in the brain. This results in less craving and fewer nicotine withdrawal symptoms. In June 2011, the FDA warned that varenicline may increase the risk of cardiovascular (heart and blood vessel) adverse events in patients with cardiovascular disease. Other side effects of varenicline may include the following:
- Problems sleeping.
- Headaches.
- Abnormal dreams.
- Nausea.
- Gas.
- Upset stomach.
- Constipation.
- Feeling very tired or sleepy.
- Bupropion (also called Zyban), the only antidepressant approved by the FDA for smoking cessation.
- Fluoxetine (also called Prozac), an antidepressant shown to be effective in smoking cessation.
The FDA has directed manufacturers of bupropion and varenicline to add a boxed warning about the risk of depression, suicide, and other psychiatric events in patients who take these drugs, including:
- Psychosis.
- Hallucinations.
- Paranoia.
- Agitation.
- Anxiety.
- Panic.
- Thoughts or behaviors that are not usual for the patient.
These events have been reported in patients with or without a history of psychiatric illness. It is not known whether nicotine withdrawal is a factor in these psychiatric events. Fluoxetine has a boxed warning about an increased risk of suicide in young adults aged less than 25 years. (See the Depression and Suicide section in the PDQ summary on Pediatric Supportive Care 1.)
All patients taking these drugs, especially those with a history of psychiatric illness, should be closely monitored during smoking cessation.
The FDA advises that the important health benefits of quitting smoking should be weighed against the small but serious risk of problems with the use of these drugs.
Glossary Termsadverse event (AD-vers eh-VENT)An unexpected medical problem that happens during treatment with a drug or other therapy. Adverse events do not have to be caused by the drug or therapy, and they may be mild, moderate, or severe. Also called adverse effect.agitation (A-jih-TAY-shun) A condition in which a person is unable to relax and be still. The person may be very tense and irritable, and become easily annoyed by small things. He or she may be eager to have an argument, and be unwilling to work with caregivers to make the situation better.antidepressant (AN-tee-dee-PREH-sunt) A drug used to treat depression.anxiety (ang-ZY-eh-tee) Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.asthma (AZ-muh) A chronic disease in which the bronchial airways in the lungs become narrowed and swollen, making it difficult to breathe. Symptoms include wheezing, coughing, tightness in the chest, shortness of breath, and rapid breathing. An attack may be brought on by pet hair, dust, smoke, pollen, mold, exercise, cold air, or stress.blood vessel (blud VEH-sel) A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.bupropion (byoo-PROH-pee-ON) A substance that is used to treat depression, and to help people quit smoking. It belongs to the family of drugs called antidepressants.cardiovascular (KAR-dee-oh-VAS-kyoo-ler) Having to do with the heart and blood vessels.condition (kun-DIH-shun) In medicine, a health problem with certain characteristics or symptoms.constipation (KON-stih-PAY-shun) A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.counseling (KOWN-suh-ling) The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.depression (dee-PREH-shun) A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.diabetes mellitus (dy-uh-BEE-teez MEH-lih-tus) A disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make a large amount of urine. This disease occurs when the body does not make enough insulin or does not use it the way it should.drug (drug) Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.esophagitis (ee-SAH-fuh-JY-tis) Inflammation of the esophagus (the tube that carries food from the mouth to the stomach).fluoxetine (floo-OK-seh-teen) A drug used to treat depression. It is a type of antidepressant.Food and Drug Administration (... ad-MIH-nih-STRAY-shun) An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The Food and Drug Administration also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called FDA.hallucination (huh-LOO-sih-NAY-shun) A sight, sound, smell, taste, or touch that a person believes to be real but is not real. Hallucinations can be caused by nervous system disease, certain drugs, or mental disorders.high blood pressure (hy blud PREH-sher) A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called hypertension.insulin (IN-suh-lin) A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy.medicine (MEH-dih-sin) Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.monitor (MAH-nih-ter) In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).nausea (NAW-zee-uh) A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.nicotine (NIH-kuh-TEEN) An addictive, poisonous chemical found in tobacco. It can also be made in the laboratory. When it enters the body, nicotine causes an increased heart rate and use of oxygen by the heart, and a sense of well-being and relaxation. It is also used as an insecticide.nicotine gum (NIH-kuh-TEEN…) A chewing gum that contains a small dose of nicotine, which enters the blood by being absorbed through the lining of the mouth. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine gum.nicotine inhaler (NIH-kuh-TEEN in-HAY-ler) A device used to inhale (breathe in) small doses of nicotine through the mouth. The nicotine is absorbed through the lining of the mouth and goes into the blood. This helps stop nicotine cravings, and relieves symptoms that occur when a person is trying to quit smoking. A prescription is needed for nicotine inhalers.nicotine lozenge (NIH-kuh-TEEN LAH-zinj) A hard candy-like tablet that contains a small dose of nicotine. The nicotine is absorbed through the lining of the mouth and goes into the blood. This helps stop nicotine cravings, and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine lozenges.nicotine patch (NIH-kuh-TEEN...) A patch that sticks on the skin and contains a small dose of nicotine, which enters the blood by being absorbed through the skin. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine patches.nicotine replacement therapy (NIH-kuh-TEEN reh-PLAYS-ment THAYR-uh-pee) A type of treatment that uses special products to give small, steady doses of nicotine to help stop cravings and relieve symptoms that occur when a person is trying to quit smoking. These products include nicotine gum, nicotine inhaler, nicotine nasal spray, nicotine lozenges, and nicotine patch. They do not contain any of the other chemicals found in tobacco products.panic (PA-nik) Sudden extreme anxiety or fear that may cause irrational thoughts or actions. Panic may include rapid heart rate, flushing (a hot, red face), sweating, and trouble breathing.paranoia (PAYR-uh-noy-uh) A mental disorder in which a person has an extreme fear and distrust of others. A paranoid person may have delusions that people are trying to harm him or her.PDQ PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.peptic ulcer (PEP-tik UL-ser) A break in the lining of the lower part of the esophagus, the stomach, or the upper part of the small intestine. Peptic ulcers form when cells on the surface of the lining become inflamed and die. They are usually caused byphysician (fih-ZIH-shun) Medical doctor.pregnancy (PREG-nun-see) The condition between conception (fertilization of an egg by a sperm) and birth, during which the fertilized egg develops in the uterus. In humans, pregnancy lasts about 288 days.prescription (prih-SKRIP-shun) A doctor's order for medicine or another intervention.psychosis (sy-KOH-sis) A severe mental disorder in which a person loses the ability to recognize reality or relate to others. The person is not able to cope with the demands of everyday life. Symptoms include being paranoid, having false ideas about what is taking place or who one is, and seeing, hearing, or feeling things that are not there.side effect (side eh-FEKT) A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.stomach (STUH-muk) An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.suicide (SOO-ih-SIDE) The act of taking one's own life on purpose.symptom (SIMP-tum) An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.tobacco (tuh-BA-koh) A plant with leaves that have high levels of the addictive chemical nicotine. The leaves may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as snuff). Tobacco leaves also contain many cancer-causing chemicals, and tobacco use and exposure to secondhand tobacco smoke have been linked to many types of cancer and other diseases. The scientific name isvarenicline tartrate (vuh-REH-nih-klin TAR-trayt) A drug used to help people stop smoking by acting the same way nicotine acts in the brain. It is a type of nicotine receptor partial agonist. Also called Chantix. |
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| 1 | http://www.cancer.gov/cancertopics/pdq/supportivecare/pediatric/Patient/Page2#S ection_190 |
