Options in Nicotine Therapy

About two-thirds of smokers who try to quit on their own aren't successful, and withdrawal symptoms typically cause their relapses. By using nicotine replacement therapy (NRT) to reduce these symptoms, smokers who try to quit have a better chance of succeeding.

Nicotine is a highly addictive substance found in tobacco, according to the American Cancer Society (ACS). When smokers try to quit smoking, they experience both psychological and physical withdrawal symptoms caused by the lack of nicotine. Up to 90 percent of smokers say that the withdrawal symptoms are their only reason for not quitting, according to the National Cancer Institute (NCI).

How severe the withdrawal symptoms are depends on the nicotine levels in the blood. That level depends on the length of time between cigarettes, how deeply a person inhales, how many cigarettes are smoked each day, and the brand smoked, according to the NCI. NRT delivers nicotine to the body more slowly than does smoking, which takes only a few seconds.

Because of the difficulty in overcoming nicotine addiction, NRT is recommended for anyone trying to quit smoking, except pregnant women and those with cardiovascular disease, according to the U.S. Agency for Healthcare Research and Quality. NRT works best if it is used when a person first attempts to quit.

Combination is best

Because NRT deals with only the physical aspects of addiction, it's not intended to be used alone. Studies have shown that pairing NRT with behavior counseling can double your chance of successfully quitting smoking. 

Side Effects of NRT 

NRT may cause some of these side effects, according to NCI:

  • Skin irritation and itching

  • Dizziness

  • Racing heartbeat

  • Sleep problems

  • Headache

  • Nausea

  • Vomiting

  • Muscle aches and stiffness

Nicotine patch

Nicotine patches provide a measured dose of nicotine through the skin and can be purchased without a prescription. As the nicotine doses are lowered over a course of several weeks, the smoker is weaned off nicotine.

The 16-hour patch works well if you are a light to average smoker; it's less likely to cause side effects. But it does not deliver nicotine during the night, so it won't help you through withdrawal symptoms in the early morning, according to the NCI. The 24-hour patch provides a steady dose of nicotine around the clock, so you can avoid highs and lows.

Depending on body size, most smokers start by using a full-strength patch (15 to 22 mg of nicotine) daily for four weeks, then use a weaker patch (5 to 14 mg) for another four weeks. The Food and Drug Administration (FDA) recommends using the patch for no longer than three to five months. You should place the patch on a clean, dry area of the skin without much hair, the NCI says. The patch should go below the neck, but above the waist and rotated to different locations with each new application to avoid skin irritation. 

Nicotine gum

Nicotine gum is a fast-acting form of replacement in which nicotine is absorbed through the mouth. You can buy the gum without a prescription; it comes in 2 mg and 4 mg strengths. The gum is recommended for one to three months, with the maximum being six months.

No more than 20 pieces should be used in one day. For best results, chew the gum slowly until you note a peppery taste, then "park" it against your cheek. Alternate between chewing and parking for about 20 to 30 minutes. If the gum is initially chewed too fast, a headache can result from the rush of nicotine. 

Nicotine gum is better than the patch for people with sensitive skin. Nicotine gum also allows you to control your dose of nicotine, because you can chew it as you need it, the NCI says. One drawback is that the gum may lead to long-term dependence. Up to 20 percent of people who use the gum keep on chewing for at least a year after quitting smoking.

Possible side effects of nicotine gum include:

  • Throat irritation

  • Mouth ulcers

  • Hiccups

  • Nausea

  • Jaw discomfort

  • Racing heartbeat

Nicotine nasal spray

The nasal spray delivers nicotine quickly to the bloodstream, because it is absorbed through the nose. It is available by prescription only. Check with your health insurance carrier to see if the spray is included in your plan.

The nasal spray gives immediate relief of withdrawal symptoms and offers a sense of control over nicotine cravings. The FDA recommends that the spray be prescribed for three-month periods and that it not be used for more than six months.

Common side effects of the nasal spray, according to the NCI, include:

  • Nasal irritation (possible nose bleeds) 

  • Runny nose

  • Watery eyes

  • Sneezing

  • Throat irritation

  • Coughing

These side effects last one to two weeks. Your doctor may suggest that you use another form of NRT if you have asthma, allergies, nasal polyps, or sinus problems.

Nicotine inhalers

Nicotine inhalers are plastic tubes with nicotine cartridges inside them. When you puff on one, its cartridge provides a nicotine vapor. Unlike other types of inhalers, which deliver most of their medication to the lungs, nicotine inhalers deliver most of their nicotine vapor to the mouth. They are available only by prescription. Check with your health insurance carrier to see if the spray is included in your plan.

Common side effects of the inhaler include:

  • Coughing

  • Throat irritation

  • Upset stomach

Nicotine lozenges

The lozenge is the newest form of NRT, and comes in 2 mg and 4 mg strengths. The lozenge should be used over a 12-week period, with one lozenge every one to two hours for the first six weeks, then one lozenge every two to four hours for three weeks and finally one lozenge every four to eight hours for three weeks, according to the NCI.

You should not smoke or use other tobacco products when using the lozenge. If you feel that you need to continue to use the lozenge after 12 weeks, you should talk to your health care provider.

Possible side effects of the lozenge include:

  • Difficulty sleeping

  • Nausea

  • Hiccups

  • Coughing

  • Heartburn

  • Headache

  • Flatulence

Choosing a method

When choosing which type of NRT best suits you, think about which method best fits your lifestyle and smoking pattern.

Nicotine patches are convenient and have to be applied only once a day. With nicotine gum, lozenges and inhalers, you can control your dosage. Nicotine nasal sprays work very quickly when you need them. With nicotine inhalers, you can mimic the use of cigarettes by puffing and holding the inhaler.

NRT shouldn't be used if you continue to smoke or chew tobacco.

While many of the NRT options are available without a prescription (see above), it is always best to consult with your health care provider to see which of these options may be best for you.

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