This document provides information on tobacco cessation advice and nicotine replacement therapy. It notes that patients who smoke more than 20 cigarettes per day and have their first cigarette within 30 minutes of waking are heavily dependent on nicotine and require specialized support. It outlines reasons to quit smoking such as health benefits and discusses focusing cessation assistance on setting a quit date, past experiences, identifying potential problems, and using support systems and nicotine replacement therapy or Zyban. Nicotine replacement therapy can help with cravings by providing low doses of nicotine without other harmful chemicals and comes in various forms such as gum, patches, and inhalers to accommodate different needs. Special precautions for nicotine replacement therapy include using it cautiously for some

1. Tobacco cessationadvice
 Are you a smoker?
 How manycigarettesdoyousmoke eachday?
 How soonafterwakingupin the morningdoyou have yourfirstcigarette?
 Have you evertriedtostop smoking?
 Are you interestedinstoppingnow?
Patientswhoreportsmokingmore than20 cigarettesperdayand whohave theirfirstcigarette within
30 minutesof wakingupinthe morningare likelytobe heavilydependentuponnicotine andwill
require more specialisedandintensivesupport.
Reasonsforquittingsmoking
• Reduce riskof halitosis
• Improve appearance — lessstainingonteeth,betterskintexture
• Save money
• Feel betterandmore energetic
• Breakdependence ontobacco
• Reducedriskof cancersand heartdisease
• Betterperiodontalhealth— greaterchance of retainingteethforlife
• Reducedriskof oral cancers
• Improvedsuccesswithsurgical treatments
Assistance forthose wishingtoquitshouldfocusonthe followingpoints:
 Negotiate aquitdate — smokersneedtime toprepare
 Reviewpastexperiencesof quitting — identifywhathelpedandhinderedprogressinthe past
 Identifyanypotential problemsaheadandplanhow these canbe dealtwith
 Stressthe importance of enlistingthe supportof friends,familyandcolleagues — their
assistance isessential
 Explore the value of usingnicotine replacementtherapyandBupropion(Zyban)
 Give detailsof telephone supportlineswhichcanprovide ongoingsupportandencouragement
Bupropion(Zyban),althoughoriginallydevelopedasananti-depressantinthe US hasnow beenlicensed
as a pharmaceutical treatmentfortobaccodependence.
Nicotine replacementtherapy(NRT)
 can helppeople cope betterwiththeircravingsfornicotine,particularlymoderatesmokers.
 The use of NRT doublesapersonscessationsuccessrate.
 A range of NRT productsare available includingpatches,gums,nasal sprays,inhalatorsand
microtabs.
 NRT worksby providinglowdosesof nicotine;withoutthe otherharmful chemicalspresentin
tobacco smoke,tothe brainin orderto replace the nicotine fromcigarette smoke.
 This approachaimsto reduce the cravingfor nicotine andease orpreventthe withdrawal
symptomsassociatedwithstoppingsmoking.
What are the typesof NRT available?
Nicotine replacementproductcomesinseveral formsandstrengthstoaccommodate the different
needsandlevel of nicotineaddictionof the smokers.Beloware the 5 differenttypesof nicotine
productsavailable inthe market:
1. Nicotine gum
2. Nicotine inhaler
3. Nicotine lozenge
4. Nicotine nasal spray*
5. Nicotine patch
*Not available inMalaysia
 These nicotine productsare designedwithdifferentnicotinedeliverymechanismintermof
pace andsite of absorption.
 The nicotine gum,inhaler,lozengeandnasal spraydelivernicotine tothe brainmore quickly
comparedto patch,but lessrapidlythansmokingcigarettes.
 Nicotine isabsorbedthroughthe buccal mucosamembrane fromthe gum, lozenge andinhaler,
where asthroughthe nasal mucosamembrane forthe nasal spray.
 In contrast,nicotine patchesdelivernicotine doseslowlyandpassivelywhichiswhyitisusually
usedwithcombinationof otherNRTproducts.

2. What are the special precautions?
CardiovascularDiseases –NRT isnot an independentriskfactorforacute myocardial events.
NRT shouldbe usedwithcautionamongparticularcardiovascularpatientgroupswhichinclude
those inthe immediate (within2weeks) ppostmyocardial infarctionperiod,thosewithserious
arrhythmias,andthose withunstable anginapectoris.
Pregnancy – Pregnantsmokersshouldbe encouragedtoquitwithoutmedication.NRThasyet
to be shownbeingeffective fortreatingtobaccodependence inpregnantsmokersandhasnot
beenevaluatedinbreastfeedingpatients.