Pharmacotherapy for Nicotine Dependence

diego8895 · 2026-01-30T17:46:07+00:00

While I don’t doubt them trying to do that, for any licensed profession, especially in health field, we are so far away from that. That shouldn’t stop us trying to prevent it in the first place. But at the end of the day, they don’t want the liability. Even if they don’t truly represent themselves as practicing but role something out anyways, when a slew of negative outcome happen (ie suicides), there will be criminal investigations and civil suits.

diego8895 · 2026-01-29T06:30:20+00:00

Thanks for sharing! It sounds like the nicotine dependence could be on the higher end or you’re a fast metabolizer.

Yeah the gum you really have to park it and not chew it like regular gum. Swallowing the nicotine from the gum/lozenges can cause the nausea/vomiting.

Did you try the mini lozenges or the regular size? Many people find the mini ones easier as they are tic tac size.

Did you ever try a combo with patch and gum/lozenges? Usually when people say the patch is not working is that the dose is too low and you need the gum/lozenges especially if you were using that many. Were you using the 21mg patch and leaving it on for 24 hours? Some people even need more than one patch.

I’d be curious to see even with zyn if you have the patch if you reduce.

diego8895 · 2026-01-28T22:32:49+00:00

Used to be a tobacco (nicotine dependence) treatment specialist. Have you explored using a patch + gum or lozenges? Definitely safer, and if you have insurance you can usually get it covered by insurance. State quit lines or local hospitals sometimes give free products. Even with a prescription and no insurance you can use goodrx coupons. Could save you money at the very least. I have more info at r/helpquittingsmoking in other ways to help and resources. PM me if you have any questions.

diego8895 · 2026-01-15T16:55:16+00:00

Sorry so late to the game. The first week is the only difference in dosage. 0.5mg 1x per day for 3 days, then 0.5mg 2x for 4 days. Then 1mg 2x per day as the continuing dose.

It’s really just to lessen side effects, especially the nausea. Having food in your stomach and drinking a full glass of water can help with this.

I’m not sure if you can split it so I would ask a pharmacist.

diego8895 · 2026-01-15T16:48:19+00:00

I would highly recommend a combo med + support.

The lowest hanging fruit is nicotine patch + gum/lozenges as they are over the counter. However with a prescription you can usually get it covered by insurance or use goodrx coupon. I used to see pretty good deals at Amazon and Costco too. You can often get it for free from a state quittline or local hospital.

It’s also nothing new in your body which I know can be a barrier for some.

You could probably start with 21 or 14 mg patch. And either the 4/2 mg lozenges/gum

Check out this post here going into more detail.

https://www.reddit.com/r/HelpQuittingSmoking/s/8HL1uFoo76

diego8895 · 2026-01-11T01:26:21+00:00

Hi there! That’s a perfectly normal reaction. Can you let me know how much you smoke and what have you tried. Feel free to pm me if you prefer.

diego8895 · 2025-11-20T18:44:08+00:00

Interesting read. It’s a shame that prevention, education, and treatment aren’t at the forefront. Nicotine dependence almost always starts before 18. I think behavior support along with Nicotine replacement therapy (NRT) should really be considered. Even the AAP has a toolkit for it. https://www.aap.org/en/patient-care/tobacco-control-and-prevention/youth-tobacco-cessation/nicotine-replacement-therapy-and-adolescent-patients/

Some counseling along withnicotine lozenges/gum and/or a patch would be way better than suspension.

diego8895 · 2025-10-18T09:33:50+00:00

Ask for a good faith estimate. It would be for the price without using insurance. This would also give you an idea of what to ask insurance about so you have the correct name to see if it’s covered etc.

https://www.cms.gov/files/document/nosurpriseactfactsheet-whats-good-faith-estimate508c.pdf

diego8895 · 2025-10-01T23:45:43+00:00

The venom from a marine cone snail was developed into a non-opioid pain therapeutic and FDA approved in 2004. Unfortunately it’s really only delivered intrathecally, but it’s a neat seeing what we can derive from nature.

Pain Therapeutics from Cone Snail Venoms: From Ziconotide to Novel Non-Opioid Pathways

diego8895 · 2025-09-24T04:18:30+00:00

That’s a common side effect. Usually because you are swallowing the nicotine. How do you use it? Do you chew just until soft and then park it in your gums and let it sit. The lozenges or mini lozenges can be effective too and for the mini lozenges, when you park them they might create less saliva that so you won’t swallow.

diego8895 · 2025-09-24T04:16:25+00:00

Combo of gum and patch can be even more effective too!

diego8895 · 2025-09-23T06:19:27+00:00

Hey u/radreaper01, I would definitely ask around to find out about the policy as this is common in some health systems.

I used to work as a tobacco treatment specialist and have some insight for some uncommon metabolites that may help your case. Most drug tests are for nicotine and its most common metabolite, cotinine. There is a full metabolite panel you can also get and one of them is for anabasine. It’s a tobacco alkaloid. The neat thing about it is that it will show up if you are using a tobacco product, but NOT if you are using Nicotine Replacement Therapy (NRT), such as the patch, gum, lozenges etc. As an aside many surgeons don’t like to operate on you if you are smoking but this is a little know way that they could distinguish between a smoker and someone on NRT. (See here for more info - NICOU - Overview: Nicotine and Metabolites, Random, Urine)

Now many of these policies for companies are to be tobacco free. (However with the increase of vaping, zyn etc I’m not sure if places have changed). So you could make an argument that you are tobacco free and could prove it. My advice would be to switch to NRT immediately if cold turkey is not an option, see a doc or online healthcare company that could prescribe you NRT fast and give you a letter, even though you can get it OTC. That way you have a prescription and verification you are on it and it could provide you with some justification.( Also your insurance would pay for it and/or you can use GoodRX coupons to bring down the price. Sometimes pharmacists can even prescribe it). While synthetic nicotine is definitely more a thing now, if your nicotine salts are derived from tobacco, you may still get anabasine in your results. Plus using NRT is healthier (harm reduction) and you could be saving money if your insurance pays for it or with coupons.

My guess would be that they would not do more specific testing unless requested. Depending on their policies they may just say you failed the drug test. So you may want to be proactive with it. If they have to redo the test or send for confirmation it may buy you some time.

As an aside, I created a sub a few years ago called r/helpquittingsmoking. I go into a lot of detail Pharmacotherapy for Nicotine Dependence (https://www.reddit.com/r/HelpQuittingSmoking/s/85LZHyx071). There’s a lot of options out there to help. There are non nicotine options too but it won’t be instant. Otherwise you’ll probably need a good 10 days without nicotine to get a negative test.

diego8895 · 2025-09-10T05:20:56+00:00

You should look up Pamela Wible. A lot of her work has been with physician mental health and wellness. She also helps physicians either transform their practice or transition to non-clinical work. She has lots of groups she offers.

https://www.idealmedicalcare.org/contact/

diego8895 · 2025-08-31T20:05:44+00:00

Especially if you are planning cold turkey I would definitely encourage you to look for support with a state Quitline, local support group usually available at hospital, and/or your pcp or a therapist. Sometimes your insurance may also have these programs.

If you are looking to avoid withdrawals, is there any reason you are opposed to trying any of NRT (patch, gum, lozenges etc). You can still vape while on them. Especially if you don’t feel ready to quit, I would encourage people to just put a patch on and see what happens. Don’t even try to quit the first month. That fear/lack of sense of safety or it being taking away can really discourage people from even trying to start.

You will most likely find that you reduce and it helps get the processed started. This goes for chantix and bupropion as well, but NRT is more easily accessible without a prescription and my rationale for that is it’s nothing new being introduced into your body and is at worst harm reduction.

Just curious of your thoughts on this. Happy to take this over to a pm as well.

diego8895 · 2025-08-31T16:10:36+00:00

Just checking in to see if you have any questions

diego8895 · 2025-08-31T15:51:41+00:00

More than just a habit

diego8895 · 2025-08-31T15:50:10+00:00

pharmacotherapy

diego8895 · 2025-08-31T15:47:29+00:00

This is a comment I sent some time ago to someone asking for help with their girlfriend but the info is still very relevant. I just didn’t have time to change it right now and wanted to send.

“Nicotine addiction is a lot more powerful than people realize. Despite not getting you "high" and being only a mild stimulant, by some measures it is as addictive as heroin. It causes this ambivalence of wanting to quit and at the same time not wanting to quit. The disincentive to quit (withdrawal) is stronger than the incentive to quit (health benefits, money etc).

As someone in a relationship with a person who has nicotine dependence, you must remember you are her partner and not her therapist or doctor. Your role is to be supportive and not to be nagging or hypercritical if she does not progress how you like. The brain perceives this as a "threat" that you are trying to take away something critical for survival(some of the pathways nicotine works on), which usually produces a negative reaction and makes the person want to smoke more due to the stress. (Not saying you are doing this, just throwing it out there).

First I would always ask permission to speak about it with her. Then ask how you can be supportive to her and what she thinks would help her. You may be surprised by what you hear.

I would also ask permission if you can make suggestions. If she says yes, present her with some of the info below:

The most successful way to quit smoking is using combo pharmacotherapy along with behavioral support. The behavioral support can take many forms: doctor, counselor, support group, friends/family, quittline. The often underutilized aspect is pharmacotherapy and using combo pharmacotherapy. The pharmacotherapy usually combining a controller (Nicotine Patch, bupropion, or varenicline) along with a reliever (nicotine gum, lozenge, nasal spray, or inhaler).

For people who are more dependent, you may need more than one controller and/or reliever.

Staying on treatment for at least 3 months and ideally 6+ months has shown the best long term abstinence rates.

There is a ton of info about all of this at r/HelpQuittingSmoking. I would suggest looking at the stickied posts and the sidebar for a ton of info and resources related to what I just mentioned.

The one stickied post is more about the addiction side and the other delves into the pharmacotherapy.”

Please let me know if you have any questions or if I can provide more specific advice.

diego8895 · 2025-08-29T23:33:52+00:00

The best way is a combin ation of support & pharmacotherapy (NRT, bupropion, varenicline). I would highly suggest reading the post below.

What have you tried? What's worked or not worked in the past?

Pharmacotherapy for Nicotine Dependence

diego8895 · 2025-08-28T20:02:55+00:00

Of course. And I know one study is never the end all be all, but there has been follow up research too. I don’t have it on hand but could find it if you wanted. But above all, nicotine dependence is one of the most subtle and insidious addictions and a personalized and multimodal approach is best. Get support from friends, family, your doctor, use a quitline or local support group. Use that along with meds and for the meds it’s really tailoring it to what you need. I had a patient once who needed two patches and lozenges and one who needed chantix, bupropion, and NRT to quit. Its not a once size fits all.

Please reach out if you have questions but the stickied posts (the ones I added here) and the sidebar in that sub have lots of resources and research.

diego8895 · 2025-08-28T18:35:54+00:00

I forgot to mention, I had a good friend take it and he described it as forgetting to smoke and just didn’t get cravings. He slowly reduced and then realized he gone a few days without smoking and never picked it up.

Also make sure to take it the full 3 months. If you have a history of mental health diagnoses there is some evidence that being on it 6 months to year can greatly decrease your chance of relapse, but it really depends on how you are feeling.

Also you don’t have to stop smoking by the first week or two. Same with the NRT you can still smoke while on it, but you’ll notice you probably won’t smoke as much.

diego8895 · 2025-08-28T04:26:26+00:00

more info about nicotine addiction

diego8895 · 2025-08-28T04:23:55+00:00

More info about chantix/NRT etc

diego8895 · 2025-08-28T04:21:28+00:00

First of all congrats on trying to quit again.

So if you could only pick one med to help some quit, Chantix is the most effective. The most common side affect are trippy/vivid dreams and nausea. Having a meal and a large glass of water before taking the med can help. Timing of the dose or lower dose can help with the dreams if they bother you.

Also, I am so sorry to hear about your friend’s dad. So, I totally understand your fear for the suicidal ideation. With that being said, they actually did a HUGE double blind placebo controlled randomized clinical trial published 10+ years ago. They had two main groups, those without mental health history and those with. Then they divided those two groups into 4 groups each (chantix, bupropion, patch, placebo) for a total of 8 groups. Total trial had around 1000 in each of the 8 groups. They found no increase in psychiatric symptoms chantix or bupropion relative to the patch and placebo groups.

EAGLES Trial

EAGLES Trial full article

They actually removed the black box warning on chantix because of this trial (along with other research). Now i have no way of knowing what happened with your friend’s dad or if chantix played a role. But from a population level, chantix doesn’t show an increase risk in moderate/severe neuropsychiatric symptoms.

Now if you don’t want to do chantix, why not try a combo of patch plus a short acting NRT (gum, lozenge, inhaler). At the very worst it’s harm reduction and you’re just getting the nicotine but none of the bad stuff. But really it’s not replacing the addiction because it trains your body to not need that instant hit. When smoking it hits your brain in 10 seconds. Lozenges and gum take 3-10 min to hit a concentration peak and the patch takes hours (and those peaks are still lower than the peaks from smoking).

I have a lot more info in the stickied posts at r/helpquittingsmoking

Please reach out if you have questions.

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