SMOKING CESSATION

Most people know that smoking can cause lung cancer, but it can also cause many other cancers and illnesses. Smoking directly causes thousands of deaths each year and contributes to many more. Cigarettes contain more than 4000 chemical compounds and at least 400 toxic substances. When you inhale, a cigarette burns at 700°C at the tip and around 60°C in the core. This heat breaks down the tobacco to produce various toxins. As a cigarette burns, the residues are concentrated towards the butt. The products that are most damaging are:
  • tar, a carcinogen (substance that causes cancer)
  • nicotine is addictive and increases cholesterol levels in your body
  • carbon monoxide reduces oxygen in the body
  • Components of the gas and particulate phases cause chronic obstructive pulmonary disorder (COPD)

Smoking causes 50 or so illnesses, 20 of which can kill, including:
  • Several types of cancer, including lung, stomach, mouth, throat etc.
  • Sudden infant death syndrome is more common in households where one or both parents smoke
  • COPD and emphysema
  • Smoking raises blood pressure, which can cause hypertension (high blood pressure) – a risk factor for heart attacks and stroke.
  • Couples who smoke are more likely to have fertility problems than couples who are non-smokers.
  • Smoking worsens asthma and counteracts asthma medication by worsening the inflammation of the airways that the medicine tries to ease.
  • The blood vessels in the eye are sensitive and can be easily damaged by smoke, causing a bloodshot appearance and itchiness.
  • Heavy smokers are twice as likely to get macular degeneration, resulting in the gradual loss of eyesight.
  • Smokers run an increased risk of cataracts.
  • Smoking increases your risk of periodontal disease, which causes swollen gums, bad breath and teeth to fall out.
  • Smoking causes an acid taste in the mouth and contributes to the development of ulcers.
  • Smoking reduces the blood supply to the skin and lowers levels of vitamin A, leading to paler skin and more wrinkles

Research has shown that smoking reduces life expectancy by seven to eight years.
It is estimated that two out of every three smokers want to give up. It is not easy to stop smoking as nicotine is addictive and changes the way the brain works, making the smoker need the nicotine (craving). Nicotine replacement therapy (NRT) aims to reduce this craving while the person gives up. The idea is to reduce the amount of nicotine going into the body over time, which weans the person off. Visit your pharmacist to find out about NRT for you. For more info on smoking cessation, visit http://www.hse.ie/eng/health/az/Q/Quitting-smoking/
TREATMENT
Nicotine: is contained in all NRT products. It is suitable for people over 18. There are a number of NRT products available, namely patches, gum, microtabs, lozenges and inhalators. Side effects are rare, but the most common is stomach upset (accidental swallowing of gum), local skin irritation (patches) and vivid dreams (associated with 24 hour patches)
Products:
Nicorette Invisipatches: are a discreet, easy-to-use, once-a-day solution to help patients deal with the cravings and withdrawal symptoms associated with quitting smoking. The semi-transparent patch helps patients to quit by delivering a continuous, controlled dose of nicotine into the body to help relieve cravings and withdrawal symptoms. The nicotine is released through your skin over 16 hours. It is absorbed quite slowly compared to smoking a cigarette so patients should be prepared to wait a little while longer for the nicotine to get into their system. It is important that patients use it properly, so make sure to read through all the instructions carefully.
Do:
  • Apply one fresh NICORETTE®INVISIPATCH™ first thing every morning
  • Remove the patch before going to bed and dispose of it safely
  • Apply the patch to a clean, dry, hairless area of skin on the front or side of your chest, upper arm or hip.
Don't:
  • Apply the patch to the same spot of skin two days running
  • Use the patch on broken or inflamed skin
  • Smoke while you are wearing the Patch.

It is important to gradually reduce the amount. Therefore if you smoke more than 20 cigarettes a day, then the 25mg patch is a good starting dose. The NICORETTE® INVISIPATCH™ is available in three strengths (25mg, 15mg & 10mg), so you can start on the highest dose and then gradually reduce your intake:
  • Start with the higher strength 25mg full strength patches for eight weeks
  • Switch to the 15mg patch for two weeks
  • Finally, lower the dose to the 10mg patches for a further 2 weeks before giving up all together

If you smoke less than 20 cigarettes a day, then you should start on the 15mg patch for 8 weeks, then cut down to the 10mg patch for 4 weeks.

NiQuitin patches are available in a clear patch which is almost invisible and very discreet. It can be applied it to the arm, back or chest. It should be applied to a clean, dry and hairless part of the skin to make sure it sticks and patients get 24 hour protection from cravings. The patches come in three different strengths (or Steps), which means they deliver different levels of nicotine to your body. Following the step down program allows patients to wean of the nicotine. NiQuitin Patches offer a continuous stream of nicotine throughout the day and are useful for patients who experience morning cravings.
  • For 6 weeks, start with the Step 1 (21mg) NiQuitin Patch if you smoke 10 or more cigarettes a day. (Go straight to Step 2 (14mg) if you smoke less).
  • For a further 2 weeks, change to the Step 2 (14mg) NiQuitin Patch.
  • Finally, move onto the Step 3 (7mg) NiQuitin Patch for 2 weeks.

Nicorette Gum: Extra Strength 4mg Gum is suitable for those who smoke more than 20 cigarettes per day. Lower Strength 2mg Gum is suitable for those who smoke 20 cigarettes a day or less.

To make sure you get the most from the gum it is important to use the correct chewing technique:
  • Chew the gum slowly until the taste becomes strong.
  • When this happens, rest the gum between your cheek and teeth.
  • Chewing the gum releases the nicotine, which is then absorbed through the lining of the mouth.
  • When the taste has faded you should chew the gum again.

Most people start by using between 10-15 pieces of nicotine gum each day. You should not use more than 15 pieces per day and should gradually reduce the number of pieces you chew.

NiQuitin and Nicorette Lozenge: allows patients to quickly tackle their cravings, as and when they happen. They let patients control when they get their nicotine. They're easy to keep, handy and discreet to use. The strength of lozenge you should use depends on you have your first cigarette of the day. If you have one within 30 minutes of waking up, you should start with the NiQuitin 4mg Lozenges/Nicorette 4mg. If you don't smoke within 30 minutes of waking, you should start with NiQuitin 1.5mg Lozenges/Nicorette 2mg. Then:
  • For Step 1, you will probably need a lozenge every one to two hours, and at least 9 lozenges a day, up to a maximum of 15.
  • After six weeks you should be ready to move on to Step 2, and need one lozenge every two to four hours.
  • Then after nine weeks, you should be down to one lozenge every four to eight hours.

Nicorette Inhaler keeps hands busy, so if patients are likely to miss the hand-to-mouth habit of smoking then this is the most suitable product. It is made up of a mouthpiece and a replaceable nicotine cartridge. When the patient draws on the mouthpiece of the nicotine inhaler, the cartridge releases nicotine which helps relieve the cravings. The patient should use between 6-12 cartridges per day for the first eight weeks. How many the patient needs depends on how many cigarettes they smoke. It is best to use the Inhaler when you need to relieve nicotine withdrawal symptoms and the cravings to smoke. Ideally for a 12-week smoking-reduction programme, the patient should use between 6-12 cartridges per day for the first eight weeks, then for the next two weeks reduce this by half. This helps reduce the body's cravings for nicotine, so over the last two weeks, they can gradually reduce the number of cartridges they use to zero.
Nicorette Quickmist is a fine spray format that starts to act in just 60 seconds to give fast relief from cigarette cravings. The nicotine is absorbed quickly into the body through the mouth lining, helping to relieve the urge to smoke. The dispenser is small and portable will fit easily in a handbag or pocket.

One spray should be used first and if the cravings do not disappear within a few minutes then a second spray can be used. If two sprays are required then future doses can be delivered as two consecutive sprays. For most smokers this means 1-2 sprays every 30minutes to 1 hour. The maximum dose is 2 sprays at a time, 4 sprays per hour and 64 sprays per day.
How to use: Point the spray nozzle towards the open mouth holding it as close as possible. Press the top of the dispenser to release one spray into the mouth avoiding the lips. For best results avoid swallowing for a few seconds after spraying.
Visit your pharmacist or doctor:
  • To discuss the best smoking cessation programme for you
  • If you are pregnant or breastfeeding
  • If you are on any medication
  • If you have previously tried to quit but failed
Helpful Tips from Mulligans Pharmacy:
  • At Mulligans Pharmacy, we understand that our customers may need treatment for symptoms of a personal or sensitive nature. Our pharmacists are always available for a discreet chat in our private consultation room at your request, or you can ask a Mulligans Pharmacist a question in confidence here.
  • If you have previously tried to quit but failed then perhaps you need guidance on an alternative NRT product as not all products suit every patient.
  • If you are suffering from nightmares with a 24 hour patch, you should either remove the patch before going to bed or switch to a 16 hour patch
  • Throw away all cigarettes, ashtrays, lighters etc. as this will help to avoid temptation
  • Clothes should be cleaned so they don't smell of smoke
  • Identify situations where smoking is most likely to occur and where possible try to avoid them
  • Keep a record of the process so you can discuss your progress with your pharmacist.We always encourage patients to pop back to the pharmacy to let us know how they are getting on
  • Reward yourself
  • For more info on smoking cessation, visit http://www.hse.ie/eng/health/az/Q/Quitting-smoking/
Shop Smoking Cessation Treatments >
Ask a Mulligans Pharmacist a question now >
The information provided is intended solely as a guide. Please seek the advice of your pharmacist to determine whether a particular service, medication, or treatment programme will be of value to you. Always check the dosage directions carefully on all medicines. Never combine medicines without consulting your doctor or pharmacist. All health facts and information contained herein should not be a substitute for medical advice. The use of this site is subject to our Terms & Conditions.