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Nicotine replacement therapy

Alternative Names

Smoking cessation - nicotine replacement; Tobacco - nicotine replacement therapy

Information

Nicotine replacement therapy uses products that supply low doses of nicotine. These products do not contain the toxins found in smoke. The goal of therapy is to cut down on cravings for nicotine and ease the symptoms of nicotine withdrawal.

Nicotine replacement therapy is of the most help for people who smoke more than 15 cigarettes a day. It is not yet proven to help people who smoke fewer than 10 cigarettes per day.

Facts about using nicotine replacement therapy:

  • You have 10 times higher chance of quitting permanently if you do not cheat on the first day of use. The more cigarettes you smoke, the higher the dose you may need to start.
  • Adding a counseling program [01-7440]will make you more likely to quit.
  • Do not smoke while using nicotine replacement. It can cause nicotine to build up to toxic levels.
  • Nicotine replacement helps prevent weight gain while you are using it. You may still gain weight when you stop all nicotine use.
  • The dose of nicotine should be slowly decreased.

TYPES OF NICOTINE REPLACEMENT THERAPY

Nicotine supplements come in many forms:

  • Gum
  • Inhalers
  • Lozenges
  • Nasal spray
  • Skin patch

All of these work well if they are used correctly. People are more likely to use the gum and patches correctly than other forms.

Nicotine Patch

All nicotine patches are placed and used in similar ways:

  • A single patch is worn each day. It is replaced after 24 hours.
  • Place the patch on different areas above the waist and below the neck each day.
  • Put the patch on a hairless spot.
  • People who wear the patches for 24 hours will have fewer withdrawal symptoms.
  • If wearing the patch at night causes odd dreams, try sleeping without the patch.
  • People who smoke fewer than 10 cigarettes per day should start with a lower dose patch (for example, 14 mg).

Nicotine Gum or Lozenge

You can buy nicotine gum or lozenges without a prescription. Some people prefer lozenges to the patch, because they can control the nicotine dose.

Tips for using the gum:

  • If you are just starting to quit, chew 1 - 2 pieces each hour. Do not chew more than 20 pieces a day.
  • Chew the gum slowly until it develops a peppery taste. Then, tuck it between the gum and cheek and store it there. This lets the nicotine be absorbed.
  • The goal is to stop using the gum by 6 months. Using nicotine gum long-term may be safer than smoking, but research is needed to confirm this.
  • Wait at least 15 minutes after drinking coffee, tea, soft drinks, and acidic beverages before chewing a piece of gum.
  • People who smoke more than 25 cigarettes per day have better results with the 4 mg dose than with the 2 mg dose.

Nicotine Inhaler

The nicotine inhaler looks like a plastic cigarette holder. It requires a prescription in the United States.

  • Insert nicotine cartridges into the inhaler and "puff" for about 20 minutes. Do this up to 16 times a day.
  • The inhaler is quick-acting. It takes about the same time as the gum to act. It is faster than the 2 - 4 hours it takes for the patch to work.
  • The inhaler satisfies oral urges.
  • Most of the nicotine vapor does not go into the airways of the lung. Some people have mouth or throat irritation and cough with the inhaler.

It can help to use the inhaler and patch together when quitting.

Nicotine Nasal Spray

The nasal spray provides a quick dose of nicotine to satisfy a craving you are unable to ignore. Levels of nicotine peak within 5 - 10 minutes after using the spray.

  • It may be used along with the patch.
  • The spray can irritate the nose, eyes, and throat. These side effects often go away in a few days.

SIDE EFFECTS AND RISKS

All nicotine products may cause side effects. Symptoms are more likely when you use very high doses. Reducing the dose can prevent these symptoms. Side effects include:

  • Headaches
  • Nausea and other digestive problems
  • Problems getting to sleep in the first few days, most often with the patch. This problem usually passes.

SPECIAL CONCERNS

Nicotine patches are OK for use by people with heart or blood circulation problems. However, the unhealthy cholesterol levels (lower HDL levels) caused by smoking do not get better until the nicotine patch is stopped.

Nicotine replacement may not be completely safe in pregnant women. The unborn children of women who use the patch may have a faster heart rate.

Keep all nicotine products away from children.

  • The concern is greater for small children. Nicotine is a poison.
  • Call the doctor or a poison control center right away if a child has been exposed to a nicotine replacement product, even for a short time.

References

American Cancer Society. Guide to Quitting Smoking. January 17, 2013. Accessed February 4, 2013.

Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services Public Health Service, May 2008. Accessed February 4, 2013.

George TP. Nicotine and tobacco. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 31.

Hays JT, Ebbert JO, Sood A. Treating tobacco dependence in light of the 2008 US Department of Health and Human Services clinical practice guideline. Mayo Clin Proc. 2009;84:730-735.

Moore D, Aveyard P, Connock M, Wang D, Fry-Smith A, Barton P. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ. 2009;338:b1024.

Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2012 Nov 14;11:CD000146. doi: 10.1002/14651858.CD000146.pub4.


Review Date: 2/4/2013
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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