Over 30 Years of Experience
Quit Smoking
Member of the American Academy of Family Physicians | Se Habla Español
Want to Quit Smoking?
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Quit Smoking With Our Three Phase Approach
Phase 1: Select a drug that decreases the desire or craving for nicotine.
- Chantix: Although Chantix may cause side effects like sleep problems (trouble sleeping, vivid, unusual, strange, or bad dreams), gas, constipation, or nausea, for the most part it is a very safe drug to use. I recommend using a Chantix starter pack to be taken as directed and then being seen for a recheck in 28 days. Other drug treatments listed below can be used in combination with Chantix.
- Welbutrin: Another drug to consider is Welbutrin. For patients that may suffer from depression or maybe anxiety about quitting smoking, this is an excellent choice. With Welbutrin, I recommend starting at 150 mg Sustained-release one daily for three days and then one twice a day thereafter.
Phase 2: Nicotine Patches
I recommend as the second phase, two weeks into the Chantix or Welbutrin treatment, to start a nicotine patch. Although in the past I have prescribed a variety of patch doses (21mg, 14mg and 7mg), I recommend at this time that if a patient is smoking a half-pack a day or more, to start at the 21 mg dose.
These patches are worn daily (24 hours), and it is recommended that they are removed before showering or bathing, and a new patch is placed on afterwards. Patch sites need to be rotated daily.
My usual recommendation is to put a patch on the left anterior shoulder, then left anterior chest, then right anterior chest, then the right anterior shoulder, and then repeat the cycle. The goal is to get the patient to stop smoking at this point.
Phase 3: Nicotine Gum or Lozenges
If a patient cannot stop smoking after starting phase 2, I recommend for an occasional craving to start with the nicotine gum or lozenges, usually starting at a 4mg dose.
I am recommending that when the patient still has a craving, they make sure they haven't eaten or had anything to drink in the last 15 minutes, and then chew the nicotine gum until the flavor is present and a tingling is noted in your mouth, and hopefully the desire to smoke is reduced.
When this occurs, a patient should place the gum between the cheek and gum on the right or left side of their mouth, and then when the flavor wanes, re-chew it until the flavor comes back, and then place it again between the cheek and gum again. This is very similar to people who chew tobacco, and it is placed in the same area.
This is often referred to as "park and chew," and eventually, like any gum, the nicotine gum will lose its flavor. At that point, you can assume that the gum is no longer releasing enough nicotine and dispose of it. It is recommended that the patient not eat or drink for at least 15 minutes afterward.
However, summer dehydration can be a problem, and I recommend that the patient temporarily take the gum out of their month, drink water or fluids that they want to drink, and then reinsert the gum for nicotine therapy.
I would like to emphasize that the whole point of these treatments is to make it easier to quit smoking. It does not necessarily make it easy, like shutting off a light switch going from smoking to nonsmoking.
In addition, patients who follow up with their doctors monthly for anywhere from 3-6 months actually do better than patients who are just given written instructions. This is why, at Valley Family Medicine, I will probably be asking to see you monthly, and I do this to coordinate other health care during this time period as well.
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Patients wishing to quit smoking may also find it helpful to call the Wisconsin Tobacco Quit Line at 1-800-QUIT NOW (1-800-784-8669).
The Quit Line provides free one-on-one phone counseling and information, local cessation program referrals, and starter packs of quit smoking medications like nicotine gum, patches, and lozenges. It takes about 10 minutes to call and sign up.
