From the Guidelines
Nicotine withdrawal symptoms can be effectively managed with a combination of medication and behavioral strategies, and the most recent evidence recommends a minimum of 12 weeks of combination NRT or varenicline for the initial quit attempt, as stated in the 2016 NCCN clinical practice guidelines in oncology 1. To manage nicotine withdrawal symptoms, the following strategies are recommended:
- Medications: FDA-approved medications include nicotine replacement therapy (NRT) in various forms (patches, gum, lozenges, inhalers, or nasal spray), varenicline (Chantix) starting at 0.5mg once daily for 3 days, then 0.5mg twice daily for 4 days, then 1mg twice daily for 12-24 weeks, or bupropion (Zyban) at 150mg daily for 3 days, then 150mg twice daily for 7-12 weeks.
- Behavioral strategies: Complementary strategies include staying hydrated, exercising regularly, practicing relaxation techniques, avoiding triggers, and seeking social support. The withdrawal symptoms occur because the brain has adapted to regular nicotine exposure, and when nicotine is removed, the brain must readjust to functioning without it. Some key points to consider:
- Nicotine withdrawal symptoms typically peak within 1-2 weeks of quitting and then subside, as noted in the 2016 NCCN clinical practice guidelines in oncology 1.
- Combination NRT offers the greatest potential benefits for smokers, with a Cochrane network meta-analysis showing that combination NRT is superior to single forms of NRT, as reported in the 2016 NCCN clinical practice guidelines in oncology 1.
- Varenicline is a first-in-class nicotine acetylcholine receptor partial agonist that can provide some nicotine effects and block the effects of nicotine from cigarettes, as approved by the FDA and reported in the 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1.
From the FDA Drug Label
When you try to quit smoking, with or without bupropion you may have symptoms that may be due to nicotine withdrawal, including: • urge to smoke • feeling anxious • depressed mood • difficulty concentrating • trouble sleeping • restlessness • irritability • decreased heart rate • frustration • increased appetite • anger • weight gain
Nicotine withdrawal symptoms may include:
- Urge to smoke
- Feeling anxious
- Depressed mood
- Difficulty concentrating
- Trouble sleeping
- Restlessness
- Irritability
- Decreased heart rate
- Frustration
- Increased appetite
- Anger
- Weight gain 2
From the Research
Nicotine Withdrawal Symptoms
- Nicotine replacement therapy (NRT) aims to temporarily replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence 3, 4.
- The symptoms of nicotine withdrawal that many patients find distressing can be overcome by NRT, which is regarded as first-line therapy 5.
- Higher dependence appears to lead to greater withdrawal, which appears to drive greater use of NRT 6.
Effectiveness of NRT
- All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking 3, 4.
- NRTs increase the rate of quitting by 50 to 70%, regardless of setting 3, and by 50% to 60% according to another study 4.
- The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual 3, 4.
Types of NRT
- The pooled risk ratios for each type of NRT were:
- Combining a nicotine patch with a rapid delivery form of NRT was more effective than a single type of NRT 3.