Help with the physical part of addiction
Remember, tobacco addiction is mental and physical. For most people, the best way to quit will be some combination of medicine, a method to change personal habits, and emotional support. There are medicines you can try, though they have not been studied as carefully for quitting smokeless tobacco as they have for smoking. Here are the more common medicines used for quitting tobacco.
Nicotine replacement therapy
Nicotine replacement is a way to get nicotine without the other harmful chemicals in tobacco. For smokeless tobacco users, nicotine replacement therapy (NRT) has been proven to help reduce craving and withdrawal symptoms. Lack of success in quitting is often related to withdrawal symptoms, which can be reduced with NRT. Together with counseling or other support, it can increase the number of smokeless tobacco users who quit.
The Food and Drug Administration (FDA) has approved these NRT products as effective aids for helping people to quit smoking. None of these products has been FDA-approved specifically to help people quit smokeless tobacco. Studies are still being done, but many are reporting success using these methods:
- Nicotine gum
- Nicotine patch
- Nicotine lozenges
- Nicotine inhaler
- Nicotine nasal spray
Nicotine gum, patches, and lozenges can be bought over the counter (without a prescription). Nicotine nasal spray and nasal inhalers are available only with a doctor’s prescription.
For smokeless tobacco users, certain types of NRT may help more than others. If you look at the way the tobacco is used, nicotine gum and lozenges are most like using smokeless tobacco. They also let you control your dose to help keep nicotine cravings down.
The nicotine inhaler may not be as useful for smokeless tobacco users, as it’s designed to look and feel like a cigarette. The nicotine patch gives a steady dose of nicotine, but may not help with strong cravings. Still, the patch may be more useful for people who prefer once-a-day convenience. A 2007 study compared higher-dose nicotine patches with the usual NRT doses in heavy users of smokeless tobacco. The researchers found that higher doses were more helpful in reducing withdrawal symptoms.
No matter which type of NRT you choose, make sure to follow the package instructions and don’t use any tobacco, including smokeless tobacco, when using a nicotine replacement.
NRT products are supposed to roughly match the amount of nicotine you get from NRT to the amount you typically took in through tobacco. It can be more of a challenge to get the dose right for smokeless tobacco users, since NRT products are labeled for smokers.
In general, a person who uses more than 3 cans of snuff or 3 pouches of tobacco a week is thought of as a heavy user, and would typically use the higher doses of NRT (the dose for heavy smokers). Those who use 2 to 3 cans or pouches per week would usually try the moderate doses, and those who use less than 2 would start with the lowest doses of NRT. If you have decided to try NRT, discuss your dose with your doctor before you quit tobacco.
To avoid withdrawal symptoms, you want to aim for a nicotine dose fairly close to what you got from snuff or tobacco use. You don’t want to get much more than that, because high doses of nicotine can cause harm. (See the section “Can you get too much nicotine from NRT?”) If you need more details on any of the NRT products, see our document called Guide to Quitting Smoking.
Getting the most from nicotine replacement: Nicotine replacement therapy (NRT) only helps with the physical part of withdrawal. It’s not meant to be the only thing you use to quit. NRT works best when it’s used with other quitting aids such as group sessions or counseling. NRT reduces withdrawal symptoms so you can focus on coping with the mental and emotional aspects of quitting.
If you choose to use it, NRT works best if it’s started at the same time you try to quit. Often tobacco users first try to quit on their own, and then decide to try NRT a day or more into quitting. This method does not give you the greatest chance of success, but don’t let this discourage you. There are many options available for quitting.
You should not use NRT if you plan to keep using any tobacco product. You can get too much nicotine this way.
When can I begin using nicotine replacement therapy?:You can start using nicotine replacement therapy (NRT) as soon as you throw away your tobacco. You don’t need to wait a certain length of time to put on the patch or start using the gum, lozenge, nasal spray, or inhaler. Double-check this information with the instructions on your chosen method of nicotine replacement, but in general there is no need to wait to start using NRT.
Tobacco users who are pregnant or have heart disease should talk to a doctor before using over-the-counter NRT. You may need a different type of help with quitting, and your doctor may need to see you more often if you use NRT.
Can you get too much nicotine from NRT?:It’s important to follow the package directions or your doctor’s guidance when using nicotine replacement therapy (NRT). Nicotine overdose is possible, but rare. A bit too much can cause some of the milder symptoms listed below. An overdose can cause death. Because of their small size, overdose is more of a problem with children and pets.
Nicotine absorbs through the skin, so you must use, store, and dispose of your NRT safely. Keep new NRT and any used gum or empty bottles, cartridges, patches, etc., safely away from children and pets.
It would be rare for an adult trying to quit tobacco to get a serious overdose using NRT. But with liquid forms that can absorb quickly through the skin, overdose could happen. That’s why you should not use a heat source (like a heating pad or heat lamp) on the skin under your nicotine patch — the extra blood supply could cause more nicotine to absorb. All forms of NRT can be harmful if too much is taken in.
Here are some symptoms of too much nicotine:
- Nausea and vomiting
- Belly pain
- Fast or irregular heartbeat
- Cold sweat
- Pale skin and mouth
- Tremors (shaking)
- Disturbed vision and hearing
- Dizziness or faintness (from low blood pressure)
- Breathing stops
Call Poison Control and get emergency help if you suspect an overdose. If you are taking NRT as directed and are still having mild symptoms such as headache, vomiting, diarrhea, or sweating, lower your dose and talk to your doctor.
Prescription drugs are also available to help people quit tobacco. Some can be used along with nicotine replacement therapy (NRT), and some must be started a week or more before you plan to quit. Talk to your doctor if you want to use medicine to help you quit. You will need a prescription for any of these drugs.
Varenicline: Varenicline (Chantix®) is a prescription medicine taken as a pill twice a day. It works by interfering with nicotine receptors in the brain. It lessens the physical pleasure of taking in nicotine and helps lessen the symptoms of nicotine withdrawal. It must be started at least a week before quitting.
Varenicline has been found to increase long-term (6-month) success in quitting among smokeless tobacco users. Another small study of people who were not trying to quit smokeless tobacco found that a few quit or cut down their tobacco intake while taking varenicline.
Reported side effects of varenicline have included headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence (gas), and changes in taste. People with heart disease may have a higher risk of heart attacks while taking varenicline. There have also been reports of depressed mood, thoughts of suicide, attempted suicide, and changes in behavior in people taking varenicline. People who have these problems while taking varenicline should contact their doctors right away. Reports of these side effects have been rare, but they can be serious when they do happen. Most people who take varenicline tolerate it well. It’s not completely clear if it’s safe to use along with NRT. More research is needed.
Bupropion: Bupropion (Zyban® or Wellbutrin® or Aplenzin®) is a prescription anti-depressant in an extended-release form that reduces symptoms of nicotine withdrawal. It does not contain nicotine. This drug acts on chemicals in the brain that are related to nicotine craving.
Bupropion is FDA approved as an aid in quitting smoking, but it’s not clear if it is useful for smokeless tobacco users. A 2007 study found that it helped reduce cravings and weight gain in people who were trying to quit smokeless tobacco. But in that clinical trial, the group taking bupropion had about the same success rate as the group taking placebo (sugar pills).
As of 2012, studies have not found bupropion that helpful for people trying to stop using smokeless tobacco.
Bupropion works best in smokers if they start taking it 1 or 2 weeks before their quit date. The usual dosage is one or two 150 mg tablets per day. Talk to a doctor to find out if this might be an option for you.
Bupropion can be used alone or with NRT. You should not take it if you have ever had seizures, serious head injury, bipolar (manic-depressive) illness, anorexia or bulimia (eating disorders), or problems with heavy alcohol use.
Last Medical Review: 10/18/2012
Last Revised: 10/29/2012