Putting an end to smoking

Q. I know I should quit smoking. What can I do?

A. In addition to nicotine replacement, you can buy without a prescription, your doctor has additional tools to help you quit.

Here are some options:

Nicotine inhalers

(Nicotrol Inhaler) - Each cartridge delivers a puff of vapor containing 4 mg of nicotine through a plastic holder. The holder may help satisfy a smoker's oral urge. The average dose is 6 to 16 cartridges a day for up to

12 weeks, followed by a gradual reduction during

the next 12 weeks. Most of the nicotine is absorbed through the mouth, not the lungs. Side effects may include mouth or throat irritation and cough.

Nicotine nasal spray (Nicotrol NS) - Each spray delivers 0.5 mg of nicotine. Use one spray in each nostril when you have the urge to smoke, up to a maximum of 10 sprays an hour or 80 a day for 3 months. Side effects may include nasal irritation, sneezing, tearing and coughing. Many smokers need more than just nicotine replacement and behavioral therapy to stop smoking. Two of the drugs prescribed most often are bupropion (Wellbutrin, Zyban) and varenicline (Chantix).

Bupropion (Wellbutrin) - This antidepressant was approved for smoking cessation as Zyban. It doesn't contain nicotine and can be used in combination with nicotine replacement therapy. Start taking bupropion one to two weeks before your quit date. The dose for the first 3 days is 150 mg once a day, then 150 mg twice a day for the next 8 to 12 weeks - or longer if needed. Side effects may include dry mouth and insomnia; seizures are rare.

Varinicline (Chantix) - The newest drug approved for smoking cessation. Although experience is still limited, it appears to be the most effective quit-

smoking drug. It blocks nicotine receptors in the brain while also partially stimulating these receptors to reduce withdrawal symptoms. The usual dose is 0.5 mg once a day for the first three days, then 0.5 mg twice a day for four days, followed by the full dose of 1 mg a day for 12 weeks or longer. The dose should be lowered in patients with severe kidney disease. Nausea is common and bad dreams may occur.

Stopping smoking will take willpower and hard work, but help is available. You may gain a few pounds, go through a rough spell as your body adjusts to life without tobacco, and you may have to try several times before you finally kick the habit.

Today's column was written by Harvey B. Simon, M.D., associate professor of medicine at Harvard Medical School. For additional consumer health information, visit health.harvard.edu.