From the Guidelines
Nicotine withdrawal typically lasts 2-4 weeks, though some symptoms can persist for months, and consists of both physical and psychological symptoms that begin within 24 hours of stopping nicotine use. The withdrawal process includes symptoms such as intense cravings, irritability, anxiety, difficulty concentrating, restlessness, increased appetite, headaches, insomnia, and depressed mood, which peak within the first 72 hours and gradually diminish over time 1. According to the review by Hughes, nicotine withdrawal symptoms usually start within 24 h from the last cigarette or reduction, last acutely for almost 3–4 days, and usually extend to 3–4 weeks 1.
Managing Withdrawal Symptoms
To manage withdrawal, medications like nicotine replacement therapy (patches, gum, lozenges), bupropion (Zyban, 150mg twice daily for 7-12 weeks), or varenicline (Chantix, 0.5-1mg twice daily for 12 weeks) can be effective, as they work by either providing controlled nicotine doses or affecting brain receptors to reduce cravings 1. Combining medication with behavioral support significantly increases success rates.
Duration and Severity of Withdrawal
The severity of withdrawal symptoms peaks within the first 1–2 weeks of quitting and then subsides, with some symptoms persisting for months or even years after quitting 1. Cigarette craving, the subjective desire, obsession or behavioral urge to smoke, usually peaks in the first week after stop smoking and then goes diminishing, lasting longer than other withdrawal symptoms.
Weight Gain and Smoking Cessation
Smoking cessation results in weight gain both in males and females, with >75% of smokers gaining weight when they become abstinent, and a mean weight gain attributable to smoking cessation of 2.8 and 3.8 kg in males and females, respectively 1.
Treatment Recommendations
A minimum of 12 weeks of combination NRT or varenicline is recommended for the initial quit attempt, with therapy possibly extended to promote continued cessation (ie, 6 months–1 year) while attempting to avoid longer periods of time if possible 1. Follow-up is recommended within 2 weeks after starting pharmacotherapy, with additional periodic follow-up during therapy and after completion of therapy.
From the Research
Nicotine Withdrawal Duration and Symptoms
- Nicotine withdrawal typically begins 4-24 hours after cessation of nicotine use, with symptoms peaking around the 3rd day and tapering off over the next 3-4 weeks 2
- The severity of withdrawal symptoms can vary depending on how nicotine is consumed, as well as individual factors such as genetic predisposition 2
- Common symptoms of nicotine withdrawal include:
- Negative affect (e.g. depression, anxiety)
- Restlessness
- Insomnia
- Increased appetite
- Craving for nicotine
Treatment Options for Nicotine Withdrawal
- Various medications have been shown to be effective in reducing nicotine withdrawal symptoms, including:
- These medications can help alleviate symptoms such as craving, negative affect, and restlessness, although their effectiveness can vary depending on the individual and the specific medication used 5, 6
- Combination therapies, such as combining NRT with other medications, may also be effective in reducing nicotine withdrawal symptoms 4