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Nicotine Replacement Therapy for Smoking Cessation

What is nicotine addiction?

Nicotine is a chemical that is inhaled from the burning of tobacco present in cigarettes. When you smoke, nicotine enters the bloodstream through the lungs and stimulates the brain. Most people who smoke regularly are addicted to nicotine.

 

When you plan to quit smoking and do not smoke any cigarettes, the blood levels of nicotine fall causing withdrawal symptoms such as irritability, inability to concentrate, restlessness, increased appetite, dizziness, constipation, or mood swings. These symptoms may begin within few hours after the last cigarette and can get worse if you do not have the next cigarette. If you still do not smoke, the symptoms peak by about 24 hours and then gradually reduce over 2-4 weeks.

Most smokers, begin smoking again to prevent these withdrawal symptoms and feel normal. Around two-thirds of smokers want to quit smoking but fail without assistance. The main cause for this failure to quit smoking is that nicotine addiction is strong and tough to break. Nicotine replacement therapy helps who are motivated to quit in these situations.

What is nicotine replacement therapy (NRT)?

Nicotine replacement therapy is a treatment used to help people quit smoking.

Products that supply low-doses of nicotine and do not contain any toxins found in smoke are used to cut down the cravings for nicotine and ease the symptoms of nicotine withdrawal.

In NRT, nicotine is inserted into the blood without smoking through products such as nicotine gums, patches, tablets, lozenges, sprays and inhalators.

They are available from pharmacies and other retail stores.

How does Nicotine replacement therapy work?

After you have stopped smoking, the drop in nicotine levels can cause you to have unpleasant withdrawal symptoms. Nicotine replacement therapy functions to stop or reduce the symptoms of nicotine withdrawal.

It helps you to quit smoking without developing any unpleasant withdrawal symptoms.

NRT does not make you aversive to or make you stop smoking. You will need determination to be successful in breaking the smoking habit.

How should I use nicotine replacement therapy?

  • You are more likely to quit the habit of smoking if you receive support from a medical professional or a counsellor, who specialises in addiction treatment. Also, the makers of these products have support programs that offer educational material (audio, video, online or printed materials) and telephonic counselling. The details of these programs will be mentioned on the packets of the different NRT products.
  • Based on the discussions with the health care professional, decide which is the NRT product that best suits you. NRT products come in many forms such as:
    • Gum
    • Lozenge
    • Skin patch
    • Inhaler
    • Nasal spray
    • Mouth spray
  • All of these products work well when used correctly. However, the gum and the skin patches are have shown high success rates when used rightly.
  • Decide on a date to start the therapy. Some people stop smoking at the end of one day and start NRT on the following day.
  • Use the right dose of NRT as recommended by the health care professional. You will need higher doses of NRT if you have smoked more than 18-20 cigarettes per day.
  • Use the NRT regularly and not intermittently.
  • Take the NRT for at least 8-12 weeks to increase your chances of quitting smoking in the long run.
  • The dose of NRT is usually decreased in the later part of the course and then stopped.
  • Do not combine NRT with other smoking cessation medications.

What are the nicotine replacement products available?

Nicotine Gum

  • These are in the form of chewing gum, available in two strengths – 2mg and 4 mg. Those who smoke 20 cigarettes or more and those who smoke their first cigarette within 30 minutes of waking up should use the 4 mg dose.
  • Chew the gum gently till you get a peppery taste. Then place this between the gum and the cheek and keep it there for the nicotine to get absorbed.
  • After 2-3 months, you should reduce the chewing time, cut the gum into smaller pieces or alternate the nicotine gum with sugar-free gum.
  • Gradually you stop the gum completely. The goal is to quit using the gum by 6 months.

Nicotine Patch

  • A patch is stuck on the skin and nicotine is absorbed into the blood through the skin.
  • The patches come in different strengths.
  • The manufacturers usually suggest that you gradually decrease the strength of the patch over time before stopping it completely.
  • These patches, however, release a steady dose of nicotine in blood and do not cause an alternate high and low levels of nicotine like when you smoke or chew a nicotine gum.

Nicotine tablets/lozenges

  • These are dissolved under the tongue (not swallowed) and absorbed into the bloodstream through the mouth.

Nicotine nasal spray

  • A solution of nicotine that is sprayed into the nose and gets absorbed into the bloodstream through the lining of the nose.
  • The rise of nicotine in the blood mimics the quick rise seen when you smoke cigarettes, which helps to relieve sudden cravings.
  • The adverse effects of nicotine nasal spray include nose and throat irritation sneezing, watering of eyes, and cough.

Nicotine Inhaler

  • Nicotine inhaler resembles a cigarette and nicotine cartridges are inserted into it and puffed for 20 minutes, similar to how you would smoke.
  • Nicotine rises quickly in blood, similar to the effect seen while smoking.
  • As it resembles a cigarette, it satisfies the oral urges and the hand-to-mouth movements of smoking, in those who miss it when they quit smoking.
  • The disadvantages include mouth or throat irritation and cough due to the nicotine vapour.

Nicotine mouth spray

  • This is a liquid sprayed into the mouth and causes a rapid rise in the nicotine level, similar to that seen during smoking.
  • Usually, the liquid is sprayed one or two times when there is an urge to smoke.
  • Do not use more than 2 sprays at a time, 4 sprays within an hour and more than 64 sprays in a day.
  • The disadvantages of the mouth spray include irritation of the throat and nose.

What are the side effects and risks of Nicotine Replacement Therapy?

All the different forms of NRT will have side effects that vary according to the type of NRT used.

Apart from the side effects that are specific to the type of nicotine replacement used, some general side effects are due to nicotine, especially when you use high doses. Reducing the dose can help prevent these symptoms.

The general side effects include:

  • Headaches
  • Nausea and other digestive problems
  • Problems with sleep in the initial few days (more common with patch), which later subsides.

Stopping nicotine replacement suddenly may lead to the same withdrawal symptoms seen when you quit smoking. You are less likely to have such withdrawal symptoms if you slowly reduce the dose or number of times the product is used per day.

There is a possibility in rare cases that the person becomes dependent on the nicotine replacement product.

Side effects of specific products are discussed below:

Gum

The side effects of nicotine gum can include:

  • Bad taste from the gum
  • Tingling sensation over the tongue (while chewing the gum)
  • Hiccups
  • Nausea (upset stomach) or heartburn.
  • Jaw pain due to repeated chewing.

Patch

The side-effects of the nicotine patches can include:

  • Skin rash at the site where the patch is stuck (changing the patch to a different location of your body or using an antihistamine cream, ointment, or gel may relieve some of the discomforts).
  • Sleep problems with the 24-hour patch, such as trouble getting sleep or having vivid dreams.

Lozenge

The side effects of nicotine lozenges include:

  • Hiccups
  • Heartburn
  • Stomach upset (especially if you swallow the lozenge)
  • Excessive gas (flatulence)
  • Headache.

Inhaler

The side-effects of nicotine inhalers may include:

  • Throat irritation
  • Cough
  • Stomach upset
  • Those who have asthma, allergies or sinus conditions may find it difficult to tolerate the product.

Next Steps

Reach out to your doctor who will help you in selecting the right NRT approach. You also need have a strong willingness to quit tobacco and require support from appropriate groups.

Consult a top General Physician

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References

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  • Medline Plus. Nicotine replacement therapy. Accessed at https://medlineplus.gov/ency/article/007438.htm on 25 Oct 2016.
  • NHS choices. Stop smoking treatments. Accessed at http://www.nhs.uk/Conditions/Smoking-(quitting)/Pages/Treatment.aspx#NRT on 26 Oct 2016.
  • American Cancer Society. Nicotine Replacement Therapy to Quit Smoking. Accessed at http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/nicotine-replacement-therapy on 27 Oct 2016

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