ARTICLE ON NICOTINE
ADDICTION- QUITTING FOR GOOD
TAKEN FROM JOURNAL
VOL.44-No .06.JUNE 2012
By Saugandha Das,
Manen patel and H.G Shivakumar
• Nicotine is a colourless, toxic alkaloid
made up of carbon,hydrogen and nitrogen.
• The primary reason why nicotine use has
turned into worldwide concern is because
of its ability to induce a state of euphoria
in the brain of the smoker thus leading to
• When a person smokes and inhales
nicotine,the active substances are
absorbed through alveoli into the lungs
• Chemical reactions in the nerve endings
and reaction time.
• Neurotransmitters called dopamine and
later endorphins are released in the brain
producing feelings of pleasure and
• As an addictive drug, nicotine has two very
potent issues –it is a stimulant as well as
Tobacco addiction is the leading preventable
cause of death in the U.S
And is the second leading cause of death in the
The WHO estimates that there are 1.3 billion
smokers worldwide today and
contributes to approximately 5 million deaths
With the present smoking trends,tobacco will kill
10 million people people each year by 2020.
• Non smokers exposed to environmental
tobacco smoke have a significantly higher
risk of developing cancers and pulmonary
• Children exposed to second hand smoke
develop a variety of respiratory disorders
TIME PHYSIOLOGICAL EFFECT
20 minutes Heart rate returns to normal
12 hours Carbon monoxide level in the blood
returns to normal
2 weeks to 3
Heart attack risks begins to drop
and lung function improves
1 year Risk of coronary heart disease is
half that of someone who smokes
10 years Risk of developing several types of
cancer is decreased
15 years Risk of coronary heart disease is
the same as a non smoker.
PHYSIOLOGICAL CHANGES AFTER
A PERSON QUITS SMOKING
SYMPTOMS OF NICOTINE ADDICTION
1 Tolerance to nicotine with decreased effect and
increasing dose to obtain same effect
2 Withdrawal symptoms after cessation
3 Smoking more than usual
4 Persistent desire to smoke despite efforts to
5 Extensive time spent smoking or purchasing
6 Postponing work,social or recreational events
in order to smoke
7 Continuing to smoke despite health hazards.
PHYSICAL STATUS EXAMINATION
1. Physical effects of nicotine use include
increased heart rate,accelerated blood
pressure and weight loss
2. Physical effects of nicotine withdrawal and
smoking cessation include weight gain due to
increase in appetite,decreased heart rate,and
improvement in the senses of taste and smell
Patient commonly discloses the odour of
smoke,tarstained teeth and premature skin
Symptoms of nicotine toxicity,otherwise known
as acute nicotine poisoning,include
pain,diarrhoea and cold sweat
Mental status examination
1. Nicotine may enhance an
individual’s level of alertness
2. Tobacco abuse and dependence
may stimulate a frantic,almost
3. The speech may also be
accelerated in line with the
4. Tobacco use can contribute to
irritability often soothened by a
dose of nicotine.
i Nicotine replacement therapy
1. Nicotine transdermal patch systems
2. Nicotine nasal spray
3. Nicotine delivery through the oral
Common adverse events common to
NRT products include dizziness,nausea
ii Non-nicotine therapies (medications)
METHODS TO QUIT NICOTINE ADDICTION
iii Novel therapies
1. Anti smoking vaccine(Nic VAX)
2. Green smoke electronic
iv Behavioral Treatments
ix Motivational Therapies
NICOTINE REPLACEMENT THERAPY
Nicotine was the first pharmacological agent approved by the Food
and Drug Administration FDA for use in smoking cessation
Nicotine replacement therapy (NRT) worksby making it easier to
abstain from tobacco by partially replacing the nicotine previously
obtained from tobacco.
TRANSDERMAL NICOTINE PATCHES
Nicotine patches deliver nicotine through skin at a relatively
Smokers who use more than 10 ciggarettes per day should use
21mg/d patch for the first 6 weeks,move to the 14 mg/d strength
for 2 weeks and then use the 7mg dose for the final 2 weeks.
Marketed products are NicoDerm,Nicotrol and Habitrol
They are marketed as individualised prescription medication.The
nasal spray delivers nicotine more rapidly than other NRTs.
Used as multidose bottles with pumps which deliver 0.5 mg of
nicotine per 50mcL squirt.Most patients are started with 1 or 2
doses per hour which may be increased to 40 doses per day.
Orally administered products
Nicotine gum is a chewing gum formulation containing
Users are instructed to use a piece of gum every 1-2 hours for
the first 6 weeks,then to reduce use gradually.
1)Acidic beverages interfere with buccal absoption of nicotine hence
Should avoid acidic beverages eg soda,coffee,beer) for 15 mts before
and during chewing gum.
2)Nicotine gum chewing may cause jaw soreness.therefore the smoker
should chew the gum to release nicotine,and then move the gum b/w
the cheek and gum for a minute or so.
Nicotine containing lozenges are available as 2mg and 4 mg
Nicotine inhalers are currently marketed as prescription medication in the US.
Each inhaler catridge contains 10 mg nicotine, of which 4mg can be delivered
and 2mg is absorbed.
A vaporizer is a device used to release the active ingredients of plant
material,commonly cannabis or tobacco.Rather than burning the herb,
which produces numerous harmful by-products, a vaporizer heats the
material,ideally to 180C (356F),so that the active compounds
contained in the plant melt and convert into an aromatic vapour.
The product is designed to be held under the tongue, where the
nicotine in the tablet is absorbed sublingually.
The drug bupropion was introduced by Glaxo-Smithkline under the
Dose-300mg/d,given as 150 mg bid.
Adverse effects-Drymouth and insomnia,a very small risk of seizure
It was developed as a nicotine receptor partial agonist.
Common side effects-difficulty in sleeping and abnormal
Nortriptyline is used as a second generation tricyclic
antidepressant marketed as the hydrochloride salt under the
trade name Sensoval,Pamelor,Norpress,Allegron.
ADR-Fast heart rate,blurred vision,urinary retention,dry mouth.
Cytisine possesses a structure and mechanism of action that
are similar to those of nicotine,but it has much lower toxicity.
ANTI SMOKING VACCINE ( Nic VAX)
Nic VAX developed by Nabi Biopharmaceuticals is a nicotine conjugate
vaccine intended to reduce or eliminate physical addiction to nicotine and is
presently in clinical trials.
GREEN SMOKE ELECTRONIC CIGARETTE
Green smoke e cigarette do not burn any tobacco,but rather,when you inhale
from an e cigarette,containing nicotine,propylene glycol and a scent that
stimulates the flavour of tobacco.
Self help books and websites can provide a no of ways to motivate
smokers to quit smoking.One well known example is calculating the
Some people have been able to find the motivation to quit just by
calculating how much money they will save after they quit.
SOME OTHER HERBAL TREATMENTS
• MUCUS CLEAR
• CRAVE-RX DROPS
Cigarette manufacturers are the only manufacturers of
any product anywhere in the world are allowed to sell
something with known high levels of
carcinogens.Overcoming nicotine dependence is difficult
and takes commitment,support and time.Even longtime
smokers can reverse much of the damage smoking has
done to the body by quitting nicotine dependence plus
taking healthy lifestyle steps.
Quitting the smoke can keep the glow of life alive.
• Centres for disease control and prevention,Annual Smoking-
Attributable mortality,years of potential life lost,and economic costs-
• http//www.quit-smoking-stop.com/nicotine addiction.html
• Nabibiopharmaceuticals,key facts about smoking nicotine addiction
and cigarette smoking-a growing global health challenge