Nicotine Replacement Therapy (NRT)
What are the advantages of smoking cessation and NRT?
Studies suggest that everyone can quit smoking but the tools that you use to quit could be more beneficial than others. Nicotine Replacement Therapy has been said to cause tremendous breakthroughs for some former smokers but others need not use this method of smoking cessation because of former or current problems that exist in their health. Your situation or condition can give you a special reason to quit smoking using the NRT method as your best choice:
Pregnant women/new mothers
By quitting, you protect your baby's health and your own. NRT is likely to be safer than continued smoking and so its use can be justified in pregnant women who are finding it difficult to stop smoking. NRT products that are taken intermittently (such as gum, lozenge, spray, inhaler) are preferred to patches. This is to minimize the exposure of nicotine to the unborn baby. Avoid liquorice-flavored NRT products.
Hospitalized patients
By quitting, you reduce health problems and help healing.
Heart attack patients
By quitting, you reduce your risk of a second heart attack.
Lung, head and neck cancer patients
By quitting, you reduce your chance of a second cancer. Apart from causing addiction, nicotine is not thought to cause disease. The health problems from cigarettes, such as lung and heart diseases, are due to the tar and other chemicals in cigarettes. So, taking NRT instead of smoking is one step towards a healthier life.
Parents of children and adolescents
By quitting, you protect your children and adolescents from illnesses caused by second-hand smoke.
Caution: The dose of nicotine in NRT is not as high as in cigarettes. Also, the nicotine from smoking is absorbed quickly, and has a quicker effect than NRT. So, NRT is not a perfect replacement. Withdrawal symptoms are reduced with NRT, but may not go completely.
Can using NRT really help me quit?
The proper use of one of these methods can help to double a person’s chances of quitting. NRT is not a magic solution and will not make you stop using tobacco. When combined with a smoking cessation program that includes behavior change and support, a person is more likely to be successful. The NRT can make it possible for you to be able to work on the underlying behaviors that are at the root for why you smoke. Trying to deal with your withdrawal symptoms and trying to quit at the same time can make for a difficult journey. When done with the support of others, either through a formal cessation program and counseling (either in person or telephone) or through a self-help option, your chances of quitting and preventing relapse are increased.
What are some things to consider when using NRT?
- Always read the product label before starting NRT for full instructions and cautions.
- Cost: A week’s supply of NRT can vary, depending on the one you chose. NRT is also available on prescription. However, your doctor will follow guidelines when prescribing NRT. For example, a first prescription should only be issued if you are committed to giving up smoking, and further prescriptions should only be issued if you have stayed off cigarettes.
- The risk of becoming addicted (dependent) on NRT is small. About 1 in 20 people who stop smoking with the help of NRT continue to use NRT in the longer term
Which form of NRT is best?
There is not much difference in how well the different types of NRT work. Personal preference usually determines which one to use. Read the manufacturer's instructions on the packet for detailed advice on each type of NRT, or seek advice from a pharmacist, provider, nurse, or tobacco cessation treatment specialist. The U.S. Food and Drug Administration (FDA) has approved all of the following medications to help you quit smoking. Below are a few forms of NRT that are available either over-the-counter or by prescription. The information below is meant as a guideline. Be sure to read all instructions located on the NRT packaging and follow as directed. Consult a healthcare provider if you have questions.
Click here for a chart of NRT options that list the pros, cons and comments about each of the methods.
Over-the-counter options
Nicotene Gum
Two strengths are available - 2mg and 4mg. You should use the 4mg strength if you smoke 18 or more cigarettes a day. You need about 12-15 pieces of gum per day to start with (about one per hour). To release the nicotine, chew the gum slowly until the taste is strong. Then rest it between the cheek and the gum to allow absorption of nicotine into the bloodstream. Chew the gum again when the taste fades, and rest it again when the taste is strong, etc. Use a fresh piece of gum after about an hour.
After 2-3 months you should use the gum less and less. For example, reduce the chewing time, cut the gum into smaller pieces, or alternate the nicotine gum with sugar-free gum. Gradually stop the gum completely.
The disadvantage of gum is that some people do not like the taste, or always having something in their mouth. Gum is not suitable if you wear dentures.
Nicotene Patches
A patch that is stuck onto the skin releases nicotine into the bloodstream. Some patches last 16 hours, which you wear only when you are awake. Other types last 24 hours, and you wear these the whole time. The 24 hour patch may disturb sleep, but is thought to help with early morning craving for nicotine. Patches are discreet, and easy to apply.
The patches come in different strengths. The manufacturers normally recommend that you gradually reduce the strength of the patch over time before stopping completely. However, some research studies suggest that stopping abruptly is probably just as good without the need to gradually reduce the dose.
The disadvantage of patches is that a steady amount of nicotine is delivered. This does not mimic the alternate high and low levels of nicotine when you smoke, or with chewing nicotine gum. Skin irritation beneath the patch occurs in some users.
Nicotene Tablets / Lozenges
You dissolve these under the tongue (they are not swallowed). Nicotine is absorbed through the mouth into the bloodstream. They are easy to use.
Prescription only Smoking Cessation Methods and Precautions
Nicotene Inhaler
This resembles a cigarette. Nicotine cartridges are inserted into it, and inhaled in an action similar to smoking. Each cartridge provides up to three 20 minute sessions. You should use about 6-12 cartridges a day for eight weeks, and then gradually reduce over four further weeks. It is particularly suitable if you miss the hand-to-mouth movements of smoking.
Nicotene Nasal Spray
The nicotine in the spray is rapidly absorbed into the bloodstream from the nose. This form of NRT most closely mimics the rapid increase in nicotine level that you get from smoking cigarettes. This may help to relieve sudden surges of craving. Side-effects such as nose and throat irritation, coughing, and watering eyes occur in about 1 in 3 users. As the nasal spray may cause sneezing and watering eyes for a short time after use, do not use it while you are driving.
Zyban
Bupropion Hydrochloride (Zyban) is a non-nicotine medication recognized as a smoking cessation aid. It is only available with a doctor’s prescription. It acts on the parts of the brain that are affected by nicotine.
It seems to reduce craving and withdrawal symptoms such as frustration and anxiety, difficulty concentrating, restlessness and negative mood.Some people should not take it, including people who:
- have ever had seizures
- have had head injuries
- take some anti-depressants (MAO inhibitors)
- take other medication containing bupropion
- have, or have had, eating disorders.
Caution: It is very important to discuss thoroughly and completely with your provider, your suitability to use Zyban.
Chantix
Chantix (also known as Varenicline) is a non-nicotine drug to aid with smoking cessation. It comes in tablet form and works by stimulating receptors for nicotine in the brain. This produces an effect that relieves the craving and withdrawal symptoms you can get when you stop smoking. At the same time, Chantix prevents any nicotine inhaled in tobacco smoke from having a rewarding and enjoyable effect.
Some people should not take Chantix if:
- They are allergic to any of the ingredients that Chantix contains;
- Are under 18 years of age; or
- Are pregnant, planning a pregnancy or breastfeeding.
Before being prescribed Chantix by a doctor, it is important to disclose:
- allergies to any other medicines, foods, etc;
- a history of kidney problems, haemodialysis treatment or repeated fits or convulsions;
- a history of mental illness.
Material on this page developed from the following references:
Nicotine: A Powerful Addiction: Available at: http://www.cdc.gov/. Accessed on 6/12/06.
American Cancer Society: Quitting Smoking. Prevention and Early Detection; Available at: http://www.cancer.org/. Accessed on 06/13/08.
FDA Approves Novel Medication for Smoking Cessation. Available at: http://www.fda.gov/. Accessed on 6/13/08.
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