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Understanding withdrawal symptoms
Nicotine is the substance that causes addiction. Once a smoker refrains from smoking, he/she may therefore experience short-term discomfort when the nicotine inside his/her body starts to metabolise out of the body. These symptoms are called "withdrawal symptoms". Common withdrawal symptoms include:
- Dizziness, headache
- Tiredness, poor concentration
- Dry mouth and throat, cough
- Hunger, increased appetite, etc.
The level of withdrawal symptoms experienced by quitters vary from person to person. Some people may even experience no symptoms at all. These symptoms usually reach a peak of intensity in the first week after smoking cessation and then gradually decline in 2-3 weeks.
It is important that quitters should uphold their determination as well as perseverance during this period. They should also lead a healthy lifestyle (e.g. adequate sleep, regular exercises and a balanced diet), or medications for quitting smoking when necessary.
Drugs for quitting smoking
Studies show that medications for quitting smoking help alleviate withdrawal symptoms and hence increase the success rate effectively. The commonest medication for smoking cessation can be broadly divided into two categories: those of nicotine replacement therapy and those of non-nicotine replacement therapy.
Nicotine Replacement Therapy (NRT)
Nicotine replacement therapy (NRT) is an effective and safe aid for smoking cessation. It is available in different types and formulae at dispensaries or pharmacies with registered pharmacists.
Commonly used NRT include nicotine gum, nicotine patch, nicotine inhaler and nicotine lozenge.
Points to note:
- Notwithstanding the effectiveness of NRT, smokers must keep their determination and perseverance for quitting successfully.
- Acidic beverages such as soft drink, coffee and fruit juice will affect the absorption of nicotine. Apart from water, do not eat or drink 15 minutes before and after using nicotine gum, inhaler and lozenge.
- Patients with severe angina, serious cardiac arrhythmias or individuals suffering from acute myocardial event in the recent two weeks should consult their doctors before using NRT.
- Although NRT has a lower nicotine content than cigarette, pregnant or breastfeeding women should consult their doctors before using NRT.
 Nicotine Gum
Nicotine gum is available in different dosages and the daily dosage should not exceed 15 pieces. The optimal duration of use for most people is about 12 weeks.
Chewing nicotine gum is different from chewing ordinary gum. The nicotine gum should be chewed slowly until a strong taste released and then park it intermittently between the cheeks for absorption, and then repeat the process until the gum becomes tasteless. Incorrect chewing may not only affect the absorption of nicotine but also cause side effects such as sore mouth and throat, hiccups and stomachache.
 Nicotine Patch
Nicotine Patch is available in different dosages and the optimal duration of use for most people is about 8 weeks.
Apply one patch per day to clean and dry skin on the chest, back, upper arms, hips, etc. Keep it at all times including swimming and showering. Change the location daily to avoid skin irritation.
Gently press the patch onto the site you have chosen for around 10 seconds. Do not peel it off to check whether it is fixed or not.
 Nicotine Inhaler
A nicotine inhaler consists of a plastic suction tube and a nicotine-containing cartridge. The daily dosage should not exceed 12 cartridges per day and the optimal duration of use for most people is about 12 weeks. As the size and shape of the inhaler resemble a cigarette, this may help quitters to focus on changing the behaviors which associate with tobacco use.
There are two methods for using nicotine inhaler: frequent and shallow inhalation or one deep inhalation. Each cartridge can last for about 20 minutes. In the beginning, user may experience mouth and throat irritation. The side effects would subside as the body get used to it.
 Nicotine Lozenge
Nicotine lozenge is available in different dosages and the daily dosage should not exceed 15 pieces. The optimal duration of use for most people is about 12 weeks.
The nicotine lozenge should be placed in mouth and moved at intervals from one side of the mouth to the other, until it dissolves. The lozenge should not be chewed or swallowed whole.
Non-nicotine Replacement Therapy
Bupropion
Bupropion is a drug developed to treat depression but it has also been used to help people quit smoking. Bupropion contains no nicotine and its active ingredient, amfebutamone, helps in reducing the craving on nicotine and thus the withdrawal symptoms.
Quitters should consult their doctors for using bupropion and a treatment course should be started one week ahead the quit day. A whole treatment course usually takes about 8 to 12 weeks to complete.
Points to note:
- Bupropion is contraindicated in individuals who have history of seizure disorder, significant head trauma, brain tumour, usage of monoamine oxidase inhibitor (MAOI) in the past 14 days as well as adolescents or children under 18 years old and pregnant or breastfeeding women.
- Common side effects include dry mouth, insomnia, headache, dizziness, nausea and allergy.
Varenicline
Varenicline is a drug for smoking cessation that contains no nicotine. It works at the same receptor in the brain as nicotine to help relieve the craving and withdrawal symptoms while at the same time blocking the reinforcing effects of nicotine.
Quitters should consult their doctors for using varenicline and a treatment course should be started one week ahead the quit day. A whole treatment course usually takes 12 weeks to complete.
Points to note:
- Varenicline is not recommended for use in patients with end stage renal diseases and children under 18 years old.
- Common side effects include nausea, sleep disturbance, constipation, flatulence, vomiting and headache.
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