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Tobacco health risks
Tobacco health risks


Definition:

Nicotine withdrawal involves irritability, headache, and craving for cigarettes or other sources of nicotine. These symptoms occur when a nicotine-dependent individual suddenly stops smoking or using tobacco, or cuts back on the number of cigarettes or tobacco products used.

See also:



Alternative Names:

Withdrawal from nicotine



Causes, incidence, and risk factors:

Almost all people who try to quit have some form of nicotine withdrawal. Generally, people who smoked the longest or smoked a greater number of cigarettes each day are more likely to have withdrawal symptoms.

People who are regular smokers tend to have particularly strong cravings and worsening of withdrawal symptoms at certain times, places, or situations associated with smoking.



Symptoms:

How severe your symptoms are depends on how long you smoked and how many cigarettes you smoked each day. Common symptoms include:

  • An intense craving for nicotine
  • Tension
  • Irritability
  • Headaches
  • Difficulty in concentrating
  • Drowsiness and trouble sleeping
  • Increased appetite and weight gain

A milder form of nicotine withdrawal, involving some or all of these symptoms, can occur when a smoker switches from regular to low-nicotine cigarettes or significantly cuts down on the number of cigarettes smoked.

Symptoms of nicotine withdrawal can mimic, disguise, or aggravate the symptoms of other psychiatric problems, according to the American Psychiatric Association.



Signs and tests:



Treatment:

There are several strategies for treating nicotine withdrawal. Nicotine supplements can help. They come in several forms:

  • Gum
  • Inhalers
  • Nasal spray
  • Skin patch

All work well if used properly. People are more likely to use the gum and patches correctly than other forms.

Nonhabit forming prescription medications may help you quit smoking and keep you from starting again. Such medicines include:

  • Bupropion (Wellbutrin, Zyban)
  • Varenicline (Chantix)

Short-term use of the antidepressant medication bupropion (Wellbutrin, Zyban), along with a quit-smoking program, may help you quit. Using bupropion or nicotine replacement therapies alone doubles the odds of successful quitting. A combination of these methods increases success rates even more.

Varenicline (Chantrix) is a newer smoking cessation medicine. It blocks the effects of nicotine and eases withdrawal symptoms. There is some evidence that it may be more helpful in quitting smoking than buspirone.

Other medications include clonidine, antidepressants such as fluoxetine (Prozac), and buspirone (Buspar). Since nicotine itself has antidepressant effects -- and many smokers unknowingly smoke to self-medicate depression -- use of antidepressants to relieve withdrawal may be particularly helpful.

A screening test for depression may also be helpful to ensure proper treatment and increase the odds of maintaining smoking abstinence.

People trying to quit smoking often become discouraged when they don't succeed at first. Research shows that the more times you try, the more likely you are to succeed -- so don't give up! If you aren't successful the first time you try to quit, look at what occurred or what didn't work, think of new ways to quit smoking, and try again. Many attempts are often necessary to finally "beat the habit."



Support Groups:



Expectations (prognosis):

Nicotine withdrawal is short-lived and symptoms should pass in time, usually less than a week. While withdrawal is the most uncomfortable part of quitting, the real challenge is beating long-term cravings and staying away from tobacco.

Like any addiction, quitting tobacco is difficult, particularly if you are acting alone. If you join smoking cessation programs, you have a much better chance of success. Such programs are offered by hospitals, health departments, community centers, and work sites.

The best quit-smoking programs combine multiple strategies to help keep you from starting smoking again. Counseling by telephone can be as helpful and as effective as face-to-face counseling.



Complications:

The most likely complication will be a return to smoking. Weight gain due to increased eating also may occur. This is much less unhealthy than continuing to smoke, and those with concerns about weight should address them while quitting so that they do not undermine their attempts to stay away from cigarettes.

Withdrawal may also sometimes bring on a relapse of major depression, bipolar disorder, or substance abuse problems.



Calling your health care provider:

See your health care provider if you wish to stop smoking, or have already done so and are experiencing withdrawal symptoms. Your provider can help provide treatments, some of which are only available by prescription.



References:

Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2008;1:CD000146.

Croghan IT, Hurt RD, Dakhil SR, et al. Randomized comparison of a nicotine inhaler and bupropion for smoking cessation and relapse prevention. Mayo Clin Proc. 2007;82(2):186-195.

Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007;1:CD000031.

Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2006;3:CD002850.

Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ. 2008;336(7644):598-600.

Jorenby DE, Hays JT, Rigotti NA, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006;296(1):56-63.




Review Date: 6/19/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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