Nicotine replacement therapy
- Nicotine, when inhaled with tobacco smoke, creates
a physical addiction.
- Nicotine withdrawal can result in unpleasant symptoms:
craving for cigarettes, irritability, depression, inability
to concentrate, anxiety, insomnia, headaches, weight gain,
increased appetite.
- Nicotine substitutes replace some of the nicotine that
you absorbed while smoking.
- They help reduce withdrawal symptoms and allow you
to focus on the behavioural and social aspects of smoking.
This can help make quitting easier.
- Your chances of giving up smoking are doubled when
using nicotine replacement therapy in comparison to using
a placebo.
- By giving up smoking you will avoid inhaling tar, carbon
monoxide and other toxic gases contained in cigarette
smoke.
Warning: Nicotine-based
treatments are pharmaceutical products. Read the manufacturer's
instructions carefully.
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Patch (transdermal nicotine
patches)
 Purpose
: The patch is an adhesive plaster containing
nicotine. Applied simply and discreetly once a day,
the patch diffuses controlled quantities of nicotine
through the skin. Ideal for smokers with a regular
habit.
Format :
The patch comes in 3 strengths: -15mg-10mg-5mg -
or -21mg (strong)-14mg
(medium)-7mg (light)-, depending on the brand. The
patch is applied in the morning
upon waking and must be worn for either 24 or 16
hours. Maximum nicotine levels in the blood are
reached 6 to 8 hours after the patch is first applied.
Directions
: Apply patch to a dry and smooth (hairless)
area of skin (arm, thigh, chest, hip, shoulder.)
Use a new area of skin each day, allowing a one-week
period before applying a patch to a previously used
area. Patches are waterproof, so showering or bathing
with a patch is permitted.
Duration
of Treatment : From 8 weeks to a maximum
of 3 months. If strong cravings persist, you may
increase the dosage or supplement the use of the
patch with another nicotine substitute (chewing
gum, lozenge, microtab, inhaler.) The patch is widely
available through chemists (packs of 14 pads), or
can be prescribed by a doctor.
Side Effects
: The nicotine patch does not cause serious
side effects. The following side-effects have been
observed in 1 in 5 users, particularly at the start
of treatment: reddening of the skin and temporary
irritation of surrounding area which disappear within
48 hours of the patch's removal. Rarer side effects
include: dizziness, headaches, nausea, lethargy,
insomnia, increased heart rate.
Important:
Do not cease treatment prematurely as this will
decrease your chances of success.
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Chewing-Gum
  Purpose
: Nicotine chewing gums release controlled
quantities of nicotine in the mouth. That are
absorbed directly through the mucous membrane. The
nicotine that is swallowed is not absorbed as the
liver destroys it. Maximum nicotine levels in the
blood (7-8 NG/ML) are reached
some 30 minutes after chewing begins, this
is a lot slower and a lot lower than the nicotine
levels attained through smoking (20-25 NG/ML
in about 5 minutes.).
Format:
The nicotine chewing gum is avai)lable in two strengths
-4mg for heavy smokers (more than 20 cigarettes
a day) and 2mg for moderate and light smokers. Various
brands offer a selection of flavours to choose from:
mint, lemon, fruit, or original (nicotine). It should
be noted that only half the
dosage indicated is actually absorbed. For
example, only 1mg of nicotine is absorbed by chewing
a 2mg piece of gum, the rest stays in the gum.
Directions:The
nicotine gum may be chewed either on a regular basis
throughout the day, or intermittently as the craving
arises. If craving persists, increase the dosage
or supplement the chewing gum with either a patch
or a nicotine inhaler. If you smoke less than 20
cigarettes a day, you can save money by cutting
a 4mg piece into 2 and chewing only 1/2 a piece
at a time.
IMPORTANT
For optimal results:
- Chew slowly: the flavour
will appear little by little
- After approximately 10 chews
place it between your cheek and gum and let the
nicotine be absorbed
- Wait for flavour to dissipate
- Slowly resume chewing (one
piece of gum = 30 minutes)
Chewing the gum too quickly releases
too much nicotine, produces a strong and acrid flavour,
decreases the gum's potency, and can provoke hiccups
or stomach pains.
Avoid drinking coffee or fruit
juices (acid) before and while chewing nicotine
gum because these types of drinks reduce the gum's
potency.
Duration
of treatment : From 8 weeks to a maximum
of 3 months. Nicotine chewing gum is available through
chemists, or can be prescribed by a doctor.
Side effects:
Nicotine chewing gum does not produce serious
side effects. The following side-effects have been
observed in 1 in 5 users, particularly at the start
of treatment: vertigo, headaches, nausea, heartburn,
hiccups, discomfort of the gums, inflammation of
the mouth and throat. Most side effects can be avoided
by closely following the directions given above.
Important:
Do not cease treatment prematurely as this will
decrease your chances of success.
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Micro-tablets
 Purpose:
Placed under the tongue, micro- tablets melt
slowly, releasing controlled quantities of nicotine
in the mouth. These tablets are discreet and can
be used at any time.
Format:
2mg tablets in handy dispenser.
Directions:
Place the tablet under your tongue and allow
to melt for 20 minutes. The effect varies from one
person to another. If you feel it is too strong,
spit the tablet out before it has completely melted.
Duration
of treatment : From 8 weeks to a maximum
of 3 months. Available through chemists (packs of
30) or can be prescribed by a doctor.
Side effects:
Tablets do not cause serious side effects. The following
side effects have been observed in 1 in 5 users,
especially at the start of treatment: headaches,
dizziness, nausea, insomnia, cold-like symptoms,
mouth-ulcers.
Important:
Do not cease treatment prematurely as this will
decrease your chances of success.
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 Purpose
: Lozenges are a more discrete alternative
to chewing gum.
Format :
Lozenges come in 1mg dosages (mint flavour). One
1mg lozenge is equal to one 2mg chewing gum.
Directions:
If you smoke less than 20 cigarettes a day, 8 to
12 lozenges a day is the recommended dosage. Do
not take more than 15 lozenges a day. If you smoke
more than 20 cigarettes a day, 4mg chewing gums
are recommended for the first two months; you
may then switch over to 1mg lozenges and reduce
the daily dose little by little.
Duration
of treatment : From 8 weeks to a maximum
of 3 months. Lozenges are available through chemists,
or can be prescribed by a doctor.
Side effects
: Lozenges do not produce serious side effects.
The following side effects have been observed in
1 in 5 users, particularly at the start of treatment:
headaches, dizziness, nausea, insomnia, cold-like
symptoms, mouth ulcers.
Important:
Do not cease treatment prematurely as this will
decrease your chances of success.
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Inhaler
 Purpose:
Inhalers help combat both nicotine addiction and
the behaviour associated with smoking. They reduce
the craving for cigarettes and mimic the process
of inhaling cigarette smoke.
Format:
Shaped like a cigarette holder, the inhaler is made
of 3 components : 1) a box of 42 refills. Each one
containing a sponge saturated with 10mg of nicotine
(mint flavour), of which only 5mg is absorbed by
the user; 2) A white plastic tube resembling a cigarette-holder
in which to insert the nicotine refills; 3) a convenient
case to hold the refills and the tube so that the
user can carry them around in a pocket or
purse.
Directions:
Inhale puffs of nicotine vapour, inhaling more often
than with a cigarette as each puff releases much
less nicotine than a cigarette: 10 to 20 puffs of
vapour release the same amount of nicotine as a
single cigarette puff. Maximum nicotine levels in
the blood are reached 20 minutes after starting
inhalation, far slower than when you inhale
cigarette smoke (5minutes). Use at least 6 nicotine
refills a day and a maximum of 12. You can either
breathe the nicotine vapours into your mouth and
then exhale, or inhale them deeply into the lungs.
The quantity of nicotine absorbed will be the about
the same in both cases, as it is mainy absorbed
through the mucous membrane of the mouth.
Duration
of treatment: From 8 weeks to a maximum of
3 months. Only available by doctor's prescription.
Side effects
: Inhalers do not cause serious side effects.
Minor side effects are possible but rare and consist
of headaches, nausea, heartburn. Users may also
experience mouth and throat irritations and a slight
cough.
Important:
Do not cease treatment prematurely as this will
decrease your chances of success.
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Pro & cons?
Here is what smokers
have told us about nicotine replacement therapy, and
our answers to their concerns:
| "I can quit smoking with the help
of these products. Willpower is all it takes." |
These products double
your chances of success. Put the odds on your side!
Strong motivation leads to success, however willpower
alone is often not enough. Most people need help to
overcome their addiction and its withdrawal symptoms.
Don't let pride be your downfall. |
| "These products don't work" |
Many clinical trials
have shown these products to be effective. However,
they do not guarantee success. Using these products
still requires effort on the part of the user
and a willingness to change. |
| "I am not addicted to nicotine" |
These products increase
your chances of success even if you only smoke 10-15
cigarettes a day. If you ever lit first cigarette
within one hour of waking up, smoked more than 5 cigarette
per day, or experienced discomfort the last time you
tried to quit smoking, you may well be addicted to
nicotine. |
| "I am against using medicines to
help me quit smoking" |
There is no shame
in using medicines to free yourself from a powerful
and physically addictive drug such as smoked nicotine. |
| "These products are too expensive" |
Depending on which
country you are, this may well be true (patches
cost CHF180 per month in switzerland), and most public
health systems (Medicare, etc) will not refund your
costs. However, the costs are still fa lot lower than
what an average smoker spends annually on cigarettes. |
| "I worry about the side-effects of
these products" |
These products have
few minor side-effects (see above). It is important
to note that the nicotine patch, nasal spray, tablets,
lozenges and chewing gums are not dangerous for your
health. It has been shown that these products
do not increase the risk of cardio-vascular problems,
even in patients with heart problems. |
| "My problem is not the physical addiction,
but breaking an old habit" |
It will be easier
for you to break the social and behavioural aspects
of your dependenxy if the physical addiction problem
is removed by the use of these nicotine products.
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| "There is a high risk of becoming
addicted to these products." |
Addiction depends
on the SPEED of nicotine absorption. Nicotine absorption
is fastest with cigarettes. Nicotine patches are not
addictive, whereas 80% of regular smokers are addicted
to cigarettes. Fewer than one percent of users of
nicotine gum become addicted to it. And long-term
use of nicotine gum has not been shown to be dangerous.
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FAQ (answered by Dr J.P. Humair)
"I
once tried quitting smoking with the help of nicotine
patches but failed. The withdrawal symptoms were
too severe. Is it possible to use both a nicotine
patch or a chewing gum or inhaler at the same time
?" |
Yes
it is perfectly acceptable to combine the patch
with another nicotine substitute (chewing gum, tablets,
inhaler, nasal spray). The latter is taken only
when difficult withdrawal episodes arise. Combining
treatments is also recommended for heavy smokers
(>30-40 cigs per day) and for those who find
single treatments ineffective. |
"I
tried quitting with the help of the 21mg patch and
nicotine chewing gum but failed: my craving never
went away. I smoke more than 35 filterless cigarettes
a day. Can I use two 21mg patches at the same time?" |
The
problem with patches is that tey can take 2-3 days
to achieve their full effect. In your case, a combination
of a 21mg patch with 4mg chewing gum (or nasal spray)
taken regularly at the start, say every 30-60 min,
is preferable. Generally, if withdrawal symptoms
are not reduced by an initial treatment, an increase
in the total dosage of nicotine through a fast acting
product is required.
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"Can
you tell me if using a patch at the same time as
bupropion (Zyban) is safe? After many attempts,
I am trying again and I would like to know if my
chances of success would increase by using
both together." |
It
is possible to combine bupropion (Zyban) with a
nicotine patch or any other nicotine substitute.
There have been only two studies on the effects
of combining bupropion (Zyban) and nicotine patches.
One showed a slight increase in success rates when
combining the two treatments, but the other found
no measurable effect.When all other treatments have
failed, combining patches with bupropion (Zyban)
is still recommended by some doctors. |
"I
quit smoking with help of patches. Later on I moved
from patches to 2mg nicotine chewing gum (6 per
day on average) It has now been 8 months since I
started using nicotine substitutes! Is this a risk
to my health?" |
No,
nicotine in itself is not a risk to your health.
Because it is not the cause of the numerous diseases
associated with tobacco. Furthermore, the doses
of nicotine involved in treatments are far lower
than the amounts absorbed by smoking. On the other
hand, nicotine is what causes addiction, and you
may possibly be addicted to the chewing gum. Although
this is undoubtedly better than being dependent
on cigarettes, try to reduce your chewing gum intake
by 1 piece each week. Note the times when you crave
the gum and try doing something else on these occasions.
You will find many suggestions for alternatives
behaviour on this website. |
References
Silagy C, Lancaster T, Stead L, Mant D, Fowler
G. Nicotine replacement therapy for smoking cessation (Cochrane
Review). In: The Cochrane Library, Issue 2, 2002.
Links
E. Laszlo und
T.Grolimund |
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