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Michael C. Fiore, MD, MPH; Douglas E. Jorenby, PhD
University of Wisconsin Medical School Madison

JAMA. 1993;269(15):1940-1941.

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In Reply.

—The letters from Drs Hughes, McAfee, and Ottervanger et al, in reference to our review of transdermal nicotine, touch on a number of interesting points. Regarding Hughes' comments, we agree that gastrointestinal complaints and headaches are not core features of tobacco withdrawal; rather, these are among the range of symptoms smokers who have recently quit report (as reported in Hughes' and Hatsukami's research¹), and clinicians should be aware of them. Reports of drowsiness may well be secondary to the sleep disruption associated with smoking cessation. There is evidence that weight gain is positively associated with abstinence from smoking over the long term. However, research also shows that fear of weight gain can be a short-term precipitant of relapse.² The issue of weight gain is a serious problem that requires more scientific study, including the role that nicotine replacement therapy may play in delaying weight gain. We . . . [Full Text PDF of this Article]

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