From the Guidelines
Nicotine withdrawal symptoms typically peak within 1–2 weeks of quitting and can be managed with a minimum of 12 weeks of combination nicotine replacement therapy (NRT) or varenicline, as recommended by the NCCN clinical practice guidelines in oncology 1.
Managing Nicotine Withdrawal Symptoms
To manage these symptoms, medications like nicotine replacement therapy (patches, gum, lozenges, inhalers, or nasal spray), bupropion (Zyban), or varenicline (Chantix) can be effective.
- Nicotine patches typically start at 21mg for heavy smokers, decreasing gradually over 8-12 weeks.
- Combination NRT, such as a nicotine patch plus short-acting NRT (gum, lozenge, inhaler, or nasal spray), may be used to promote continued cessation.
Causes of Nicotine Withdrawal Symptoms
These symptoms occur because nicotine affects brain chemistry by releasing dopamine, creating pleasure and dependence.
- When nicotine is removed, the brain must readjust, causing withdrawal symptoms.
Importance of Behavioral Support
Combining medication with behavioral support significantly increases the chances of successfully quitting.
- Staying hydrated, exercising regularly, and avoiding triggers can also help manage withdrawal symptoms during this challenging period.
Monitoring and Follow-up
Follow-up is recommended within 2 weeks after starting pharmacotherapy, with additional periodic follow-up during therapy and after completion of therapy 1.
- Patients who do not quit immediately may quit at some later point after withdrawal symptoms subside, and continued therapy through brief slips is encouraged.
From the Research
Withdrawal Symptoms from Nicotine
- Nicotine withdrawal symptoms can be distressing for many patients trying to quit smoking 2
- These symptoms can be overcome with the help of nicotine replacement therapy (NRT), which is regarded as first-line therapy 2
- NRT is available in different modes of administration, including inhalation and buccal or transdermal absorption 2
Treatment Options for Nicotine Withdrawal
- Pharmacologic smoking cessation aids, such as NRT, bupropion SR, and varenicline, are recommended for all smokers trying to quit, unless contraindicated 3
- Combination pharmacotherapy, including an additional form of NRT or a non-nicotine replacement therapy oral medication, may be helpful for highly nicotine-dependent smokers or those with breakthrough cravings 3
- Varenicline, a partial agonist at nicotinic alpha4beta2 receptors, has been shown to be at least as effective as bupropion for smoking cessation 4
Effectiveness of Treatment Options
- The effectiveness of NRT, bupropion, and varenicline for smoking cessation has been proven, even in patients with chronic cardiovascular disease 5
- A systematic review and multiple treatment meta-analysis found that all therapies, including high-dose NRT, combination NRT, bupropion, and varenicline, offered treatment benefits over controls, but varenicline was the only treatment demonstrating effects over other options 6
- The rate of successful smoking cessation at 1 year can range from 3% to 5% without treatment, 7% to 16% with behavioral intervention, and up to 24% with pharmacological treatment and behavioral support 3