Brief Answer: Explained below. Detailed Answer: Hi XXXXXXX Welcome to Healthcare Magic! Congratulations on deciding to quit smoking! Half the battle is won when you take a firm decision to quit. Well done! Let us now discuss what we can do to win the rest of the battle. Since you have been trying to quit for some time but finding it difficult, I shall not advise quitting abruptly and braving out the withdrawal symptoms. Let us consider the other available options. There are three main strategies you can use to quit. 1) There are medicines available which reduce the craving for nicotine and make it easier to quit. These are started before quitting and after these become effective, a quit-date is set. On the pre-appointed date, you quit. Because of the medicine's effect, it is easier to remain abstinent. After you have been abstinent for a few months, the medicines are stopped. The two medicines that are commonly used are bupropion and varenicline. Bupropion is cheaper than varenicline. Varenicline is somewhat more effective. Since it is cheaper, bupropion is used more commonly. It is available in two forms SR and XL. The SR formulations are available in the dose range of 75 mg and 150 mg and have to be taken twice daily. The common brand names are Bupron SR and Zupion SR. The XL preparation is available in the dose strength of 150 mg and 300 mg. There is only one brand available (Bupron XL). It can be taken just once daily. Usually bupropion is started in the dose of 150 mg per day and later hiked to 300 mg per day if required. Bupropion should not be used by people who have a history of seizure disorder. 2) You can opt to stop smoking and use other forms of nicotine replacement when you are unable to control the craving. Nicotine containing chewing gums are available for this purpose. After a few days, you can reduce the number of chewing gums that you are taking per day and gradually taper it off. These save you from the harmful effects of smoke, but are still not harmless as they contain nicotine. 3) You can also try gradually reducing the number of cigarettes you smoke daily. Also try to reduce the number of puffs you take from each cigarette and throw away after just one or two puffs. Gradually your body will get used to the lower dosage of nicotine and you will be able to taper it off with only mild withdrawal symptoms. I guess you may have tried this before but found it too difficult. Let me know what method suits you more and we can discuss that in greater detail. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: Explained below. Detailed Answer: Hi XXXXXXX Many people fail to benefit from the nicotine chewing gums as they do not know the correct way of using it. If the chewing gum is chewed too fast, all the nicotine is released quickly and this causes a bitter taste in the mouth. It can even cause nausea and vomiting if the nicotine is swallowed. The nicotine gum should be used using the "chew and park" technique. You should chew the gum until it softens and produces a tingling sensation or peppery taste. The gum should then be "parked," or tucked, in between the cheek and gums. When the tingling ends the gum is chewed again until it returns, and is then re-parked in a new location. These steps are repeated until the gum is depleted of nicotine (about 30 to 60 minutes) or the craving dissipates. Do not swallow the saliva mixed with nicotine as it will irritate the stomach. Nicotine gums are meant to deliver nicotine through absorption into the blood vessels of the mouth and not through the stomach. Try using the 2 mg chewing gum. If it is not sufficient to control your craving, the 4 mg gums are also available. I expect you to need less than 10 gums per day initially. After a few days, start reducing the number of gums you use per day, taking a few weeks to stop completely. You can also try to manage your craving by: 1) Eating or drinking something when you have a strong urge to smoke 2) Distracting yourself by getting engaged in some task, making a phone call etc 3) Talking to a friend/ family member about your urge, who can then encourage you to resist the urge 4) Remembering the reasons to quit and the benefits of quitting Please let me know if you would like to know something else as well. What you are going to do is difficult but not impossible. Have faith in yourself and keep trying. Avoid being with people who are smoking and avoid the places where you used to smoke usually, if there were any such specific areas, as these act as cues to induce your craving. All the best! Dr Preeti Parakh MD Psychiatry

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