Nicotine replacement therapy helps

Second of three parts.

Q. I know I should quit smoking. I'm smoking a pack per day.

A. Like other addicting substances, nicotine acts on the brain's "reward center." It creates a sensation of pleasure and a craving for more nicotine. Nicotine replacement therapy can short-circuit the craving.

Start nicotine replacement therapy on the day you quit smoking. Since the average cigarette delivers 1 to 2 mg of nicotine, you can estimate how much nicotine you need. Begin with the full dose you need (heavy smokers need higher doses), then taper down. Here's a quick review of the options:

Nicotine patches - The patches deliver a steady dose of nicotine. A popular type of 24-hour patch called NicoDerm CQ comes in three strengths. A new patch is placed on clean, unbroken, hairless skin each day. Most smokers should start with the 21 mg dose, but people who weigh less than 100 pounds or smoke fewer than 10 cigarettes a day should start with the 14 mg dose. The dose can be reduced every 1 to 2 months as the nicotine addiction resolves. A 16-hour patch that is removed at bedtime can help people who get bad dreams from wearing the patch at night. Mild skin irritation is the most common side effect. Patch-users can also use short-acting nicotine products, such as nicotine gum or lozenges to suppress breakthrough craving.

Nicotine gum (Nicorette) - People who smoke more than 25 cigarettes a day should use the 4 mg per piece dose; lighter smokers should use the 2 mg per piece dose. Chew a piece of the gum whenever the smoking urge hits. Don't chew more than 30 pieces a day. Aim to wean off the gum in about 3 months. Avoid acidic beverages, such as coffee, tea, beer and soft drinks for at least 15 minutes before use. They may interfere with absorption.

Nicotine lozenges (Commit) - People who usually light up within 30 minutes of waking should use the 4 mg strength. Others who are less addicted can use the 2 mg lozenges.

A typical schedule calls for one lozenge every 1 to 2 hours for six weeks, then every 2 to 4 hours for two weeks, and then every 4 to 8 hours for the final two weeks. Avoid acidic beverages for at least 15 minutes before use. Side effects may include an unpleasant taste, nausea, indigestion or mouth tingling.

Today's column was written by Harvey B. Simon, M.D., associate professor of medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. The Medicine Cabinet is distributed by Tribune Media Services. For additional consumer health information, visit health.harvard.edu.