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	James L. Holly, M.D.

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Your Life Your Health - Medical Management of Smoking Cessation: How Your Doctor Can Help You Quit Smoking

Norma Duncan,MSN, APRN-BC, FP

March 07, 2002

Your Life Your Health - The Examiner

Most smokers are aware of medications, patches, inhalers, chewing gum, and even hypnosis as tools to help stop smoking. What has proved to be the best method? I will try to outline what I believe is the best way for you to quit the tobacco habit. This is not my opinion. This method has been researched by the federal government and is in their approved guidelines for health care providers who want to help their patients quit smoking. As with most successful things in life, this one requires a combination of strategies.

Is there a medicine I can take to help curb my desire for tobacco?

You will most likely be started on Zyban (Wellbutrin SR 150mg). The first 3 days should be single pill days. On the fourth day the dose should be twice a day. The second dose should be taken no later than midafternoon as this medicine can cause the patient to be wakeful. This timing can be easily adapted for shift workers. You should plan to be completely off tobacco at the end of three weeks. It's important to set the stop date before you begin the program. During this three week time period most (if not all) patients should find that the tobacco will not be as pleasing as it usually is. Many will find their use decreasing.

Who should not be on Zyban(Wellbutrin SR)? You should not be started on this drug if you have a history of seizures, have had a recent serious head injury, or have uncontrolled hypertension.

Once your blood pressure is under control (130/80 most of the time), you can begin the drug. It is good to keep a blood pressure diary to show your doctor after you begin the drug. Alert your provider (Doctor/Nurse Practitioner) if your blood pressure begins to consistently rise above the target of 130/80.

Are there additional medications I can use to help me during the nicotine withdrawal?

The day you lay the tobacco down (cold turkey) you should apply a 21mg Nicotine patch and change it daily for 6 weeks. This dose is for the long term user who knows they are very addicted to nicotine. There is a lower dose schedule for those who are not heavy smokers. At the end of the six week period you should be switched to a 14mg Nicotine patch. After 2 weeks on this patch you switch to a 7mg Nicotine patch for another twoweeks. After that no more patches.

How long do I need to take the Zyban (Wellbutrin SR)?

Plan to stay on the Zyban for an entire year. This time period has been shown to have the best long term effect for stopping the tobacco habit.

Are there other things I should try?

Other strategies that should be used with the above treatment include having partner support or the support of a group of people. Some people have a group in their work place. Daily exercise can ease tension and keep the weight down. Thirty minutes a day most days for the rest of your life should be your goal. Zyban (Wellbutrin SR) has been shown to improve satisfaction with food and may keep the tobacco user from gaining excessive weight.

Tell me about out of pocket costs and insurance coverage for this treatment?

Paying for these therapies can be expensive. Your Doctor can use the following codes for this therapy: Stress Reaction (308.9) and Tobacco Abuse (305.1). I have not personally found an insurance company that will pay for the therapy if the provider only uses Tobacco Abuse (305.1). If you have depression as well the code for depression will cover the cost of the Wellbutrin SR. The patches are about $30 a week. Most insurance companies do not pay for the patches. Keep the receipt as they are tax deductible. Most doctor's offices have coupons for these patches. One of the names brands I'm most familiar with is Nicoderm CQ. The doctor should write out a prescription for the patches for you. Here's what the doctor should write of the patch prescription:

Nicoderm CQ 21mg/24hr # 42
Nicoderm CQ 14mg/24hr # 14
Nicoderm CQ 7mg/24hr # 14

The doctor can have the nurse write the prescription out and then have the doctor review and sign it.

GlaxoSmithKline makes Wellbutrin SR and Nicoderm CQ patches. You may be eligible for a significant price cut if you apply for the "orange" card. There are income restrictions on this?no more than an annual income of $26,000 if single or $35,000 if a couple. You must be Medicare eligible with no other resources to pay for prescriptions to qualify for the "orange"card. Your doctor should have these applications in the office.

Don't underestimate the strength and persistence required to stop this habit. Use the latest methods to make yourself successful. Some get discouraged because they've failed many times. This method may give you the best chance at overcoming this powerful, expensive and health ravaging addiction. I wish you the best.

Remember, it's your life and it's your health

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