Quit smoking in Puerto Rico: a doctor's help by video

According to the CDC, quitting smoking lowers the risk of early death and can add as much as 10 years to your life expectancy. The earlier you quit the more you gain, but it helps at any age.

Quitting also helps control conditions the doctor treats by video, such as asthma, bronchitis, high blood pressure and high cholesterol.

Here is what happens in your body:

You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico, in English or Spanish. Visits are private and are not recorded.

Varenicline is a prescription pill to help you quit smoking. Chantix is its original US brand name; in other countries it is sold as Champix, and generic varenicline is also available. It acts on the same brain receptors as nicotine: it eases cravings and makes smoking less satisfying.

Under its FDA label:

• You start it one week before your quit date, or you start it and quit between day 8 and day 35.
• The dose goes up gradually during the first week.
• It is taken after eating, with a full glass of water.
• Treatment lasts 12 weeks; if you have quit by then, 12 more weeks are recommended to help you stay quit.
• If you cannot quit all at once, there is a gradual plan: you cut down step by step until you quit by week 12, then continue for 12 more weeks.

Common side effects: nausea (the most common), vivid or strange dreams, constipation, gas and vomiting. Nausea is usually mild and tends to ease; if it bothers you, the doctor may lower the dose.

Kidneys: if your kidneys work very poorly, the label calls for a lower dose. That is why the doctor asks about your kidneys and may order a creatinine test.

Label precautions: varenicline can increase the effects of alcohol, so cut back on alcohol until you know how it affects you. Be careful driving or using machinery at first. Seizures have been reported, so the doctor asks whether you have ever had one. The label does not recommend it for patients 16 or younger, because it was not shown to work at that age.

In December 2016, the FDA removed the boxed warning (its strongest warning) about mood and behavior effects from the Chantix label. It did so after a large trial, the EAGLES study, of about 8,000 adults with and without a history of mental health conditions, found that risk lower than previously thought.

The label still asks you to watch for changes: if you notice agitation, depressed mood, changes in behavior that are not usual for you, or thoughts of harming yourself, stop taking it and tell your doctor right away. If you live with depression or anxiety, tell the doctor: she also offers mental health care by video and takes your history into account when choosing a treatment.

Bupropion is another FDA-approved prescription pill for quitting smoking; it is started before your quit date. Read our guide to bupropion (Wellbutrin) for how it is used and who should not take it.

Nicotine replacement therapy gives you nicotine in doses that step down over time, without the toxic chemicals in cigarette smoke. It eases withdrawal symptoms while you change your habits.

• Over the counter: the nicotine patch, nicotine gum and nicotine lozenges. The FDA approves them for sale to people 18 and older.
• By prescription: the nicotine inhaler and nicotine nasal spray.

Combining works better. According to the US Preventive Services Task Force (USPSTF, 2021), using a long-acting patch together with short-acting gum or lozenges for cravings works better than a single form. The doctor helps you choose the dose based on how much you smoke.

Pregnancy and under 18: talk with the doctor before using patches, gum or any other quit-smoking medicine. In pregnancy, counseling is the recommended first step.

Most e-cigarettes (vapes) contain nicotine, which is highly addictive. According to the CDC, no tobacco product, including e-cigarettes, is safe, especially for children, teens and young adults: nicotine can harm the parts of the developing teen brain that control attention, learning, mood and impulse control. The FDA has not approved any e-cigarette to help people quit smoking.

Quitting vaping uses the same tools: a quit date, a plan for cravings, support and, if appropriate, nicotine replacement therapy. For teens with moderate or severe nicotine dependence, the American Academy of Pediatrics (AAP) says clinicians may consider nicotine replacement therapy together with support; people under 18 need a prescription for it.

The doctor sees patients of all ages. In Puerto Rico the age of majority is 21: if the patient is under 21, a parent or legal guardian stays on camera for the whole visit.

Puerto Rico's Department of Health runs the ¡Déjalo Ya! quitline (Línea de Cesación de Fumar): confidential phone counseling at no cost for people 18 and older who live in Puerto Rico. Call 1-877-335-2567.

The national line 1-800-QUIT-NOW (1-800-784-8669) and the Spanish-language line 1-855-DÉJELO-YA (1-855-335-3569) also connect you with a quit coach. Phone coaching and a visit with the doctor work well together: you can use both.

If you have decided to quit smoking or vaping, start with a video visit from anywhere in Puerto Rico. Book an evaluation; the doctor decides whether a treatment is right for you. Every day, any time (Puerto Rico time).