Please take one minute to answer 3 questions on smoking cessation websites
 
 
Fonctioning
  • 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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Lozenges

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.
"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.

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.

"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. http://www.cochrane.org/cochrane/revabstr/ab000146.htm

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Links

http://www.lungusa.org/tobacco/replacement_factsheet99.html

http://www.jr2.ox.ac.uk/bandolier/band86/b86-3.html

http://www.patient.co.uk/showdoc.asp?doc=23069088

http://www.ash.org.uk/html/cessation/Smoking%20reduction/NRT051229.pdf

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E. Laszlo und T.Grolimund