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Nicotine Replacement Therapy for Quitting Smoking

Harry Mills, Ph.D.

One popular approach to smoking cessation is Nicotine Replacement Therapy, or NRT. Nicotine replacements are designed to be used in a graduated approach. The dose of NRT is reduced slowly to allow tobacco users time to develop new behaviors and to break the psychological links to their habit. Many smokers who try to quit without nicotine replacement have difficulty because they are bothered by nicotine withdrawal symptoms. According to the American Heart Association, NRT can be safe and effective in helping people to quit smoking when used as part of a comprehensive program. NRT helps control cravings while the dependence on nicotine is slowly eliminated. Additionally, NRT allows you to focus on overcoming the psychological and behavioral aspects of smoking without the added difficulties of withdrawal symptoms. By reducing the symptoms of withdrawal, NRT can double an individual’s chances of quitting successfully.

doctor talking to patientNicotine replacement comes in many forms. Nicotine patches, gum, and lozenges are available over the counter, while nicotine nasal spray and nicotine inhalers are available only by prescription. Most NRT therapies are designed to be continued for 8 to 12 weeks. Research has not found a single NRT system that is more effective than any other, and thefore, most people should choose the NRT that they feel most comfortable with.

The following is a brief outline of each type of replacement therapy, which, in combination with your smoking diary (which you will learn more about later in this article), can help you decide which NRT might be the most successful for you. Keep in mind that you should consult your doctor before you begin any of the following treatment options. People with heart or circulation diseases and pregnant women need to be especially careful when undertaking nicotine replacement therapy, and should consult with their doctors to determine whether nicotine replacement is appropriate.

Over-the-Counter Options

Nicotine gum, patches, and lozenges are readily available without a prescription at drugstores, food retailers, and mass merchandisers. All of these products come with instructions regarding their use.

Nicotine gum is designed to release nicotine slowly into your system as you chew it. Keep in mind that this type of gum is not meant to be chewed continuously. Instead, you should chew it enough to soften it when you first put it in your mouth, and then place it between your cheek and gum to allow the nicotine to make its way into your system through the blood vessels in your cheek. This method is called “parking,” and is similar to what people who use chewing tobacco do. You can continue to alternately chew and park the gum for about 30 minutes before it loses its effectiveness. Nicotine gum can be useful if you want to avoid weight gain because it will satisfy your desire to have something in your mouth, making you less likely rely on snacks to ease your cravings.

Nicotine patches resemble adhesive bandages, and are applied to a clean, hairless part of your skin between your neck and your waist, making them easy to conceal beneath your clothing. Nicotine patches are designed to be worn for up to 24 hours. These patches deliver a constant dose of nicotine to your body through your skin, and help to alleviate the symptoms of withdrawal. People who choose to use nicotine patches generally start with a higher dose and gradually switch to lower doses until they no longer need a patch. Using nicotine patches doubles the success rate of people who are motivated to quit smoking. However, if you find that you still experience nicotine cravings after using the patch for 8 weeks, chances are the patch is not the right NRT for you.

Nicotine lozenges come in the form of hard candy, and work in the same way that nicotine gum does. As the lozenge dissolves in your mouth, it releases a dose of nicotine that travels through your bloodstream to your brain. Nicotine lozenges should last up to 30 minutes in your mouth, and should always be allowed to dissolve. You should never chew a nicotine lozenge, because chewing it will release the nicotine too quickly and can cause indigestion. You should also avoiding eating or drinking anything 15 minutes before you use a lozenge and while it is in your mouth, because that will reduce its effect. The nicotine lozenge may be a good choice for you if you want to be discreet as you cut down on your nicotine intake. Because the lozenge resembles a piece of hard candy, only you will know what it is. At the same time, people who are around small children must take care to keep lozenges out of their reach.

Prescription Options

Prescription NRT options include nicotine inhalers and nasal sprays, as well as the prescription antidepressant Zyban, which has been shown to be effective in helping people to quit smoking. Many people feel most comfortable working with their doctor while attempting to quit smoking. The advantage of using a prescribed method is that your doctor can help to monitor your efforts. Because your doctor is familiar with your medical history and the different treatment options, he or she is best equipped to decide which method is right for you.

Nicotine inhalers are plastic devices that look very similar to cigarettes. Inhalers mimic the action of smoking by providing a substitute for the cigarette. Users obtain nicotine from a cartridge located inside the inhaler when they puff on the device. When you begin using these NRTs, the initial dose is four inhalers a day. The maintenance dose is four inhalers a day with gradual tapering of use. Nicotine inhalers should not be used for more than 12 weeks. If you think the nicotine inhaler may work for you, keep in mind that inhalers are the most expensive form of NRT.

Because inhalers mimic the action of smoking, they may or may not be a good idea. On one hand, inhalers can be useful for people who have difficulty giving up the behavioral actions of smoking. On the other hand, inhalers do not allow the user to eliminate this behavior. One of the most difficult things to overcome on the way to smoking cessation is the behavioral cues associated with smoking. Since a person will ideally try to eliminate the cues associated with smoking as they go through the cessation process, nicotine inhalers may not be a good option.

Another prescription NRT option are nicotine nasal sprays. These sprays come in containers similar to over-the-counter decongestant sprays, and deliver nicotine to the bloodstream faster than any of the other NRT options. For this reason, nicotine nasal spray is able to relieve cravings quickly, and is often helpful for people who have a high degree of dependence on nicotine. Two sprays, one in each nostril, is considered one dose of nicotine nasal spray. The maximum recommended dose is 40 individual doses per day.

Another type of medication that can help some people quit smoking is Zyban (bupropion), also sold as Wellbutrin. While Zyban may offer additional help to some individuals, it is NOT a nicotine replacement product, but a prescription antidepressant. Zyban can be successful in reducing the symptoms of nicotine addiction by affecting the chemicals in the brain that are related to nicotine craving. When used alone, Zyban has been shown to be somewhat better than the nicotine patch in helping people quit smoking for at least a month. When combined with nicotine replacement, significantly more smokers who used Zyban were able to stop smoking for over a month.

Regardless of which method you choose, if you do decide to use nicotine replacement therapy, remember that you should never use a form of NRT and smoke at the same time. If you smoke while wearing a nicotine patch, for example, you run the risk of introducing too much nicotine into your system, which can cause you to overdose. As with any new treatment, make sure you read the information that comes with the NRT or talk to your doctor or pharmacist to make sure you understand how to use the product safely.