Nicotine replacement therapy

Nicotine replacement therapy is designed to help smokers manage withdrawal symptoms through the use of small amounts of nicotine in forms other than tobacco. Nicotine replacement products are available as gum, lozenges, patches, nasal spray and oral inhalers.

Some types of nicotine replacement therapy -- such as gum, lozenges and patches -- are available without a prescription. It's best to consult your doctor for recommendations on dosages and types of replacement therapy, however. This is especially important if you're pregnant, breastfeeding, or have any serious illnesses or chronic conditions.


Types of nicotine replacement products
Nicotine patch
The nicotine patch is a small, self-adhesive patch applied to a clean, hairless skin area, often the outer upper arm or shoulder. The patch slowly releases nicotine into the bloodstream through the outer layer of skin. This type of delivery is called transdermal, which means through the skin. Compared to smoking, transdermal nicotine offers slower absorption, smaller fluctuations in blood levels and lower blood levels of nicotine. A new patch must be applied every 24 hours, which helps maintain a relatively constant level of nicotine in the body. To avoid skin irritation, don't repeatedly apply the patches to the same spot.

Nicotine patches are often recommended because they're easy to use and well tolerated by most people. They're also considered safe for adolescents who want to quit smoking. Nicotine patches may not be appropriate if you have certain skin conditions, however. The patches are available in various doses, so you can gradually reduce the dose over time. Read the instructions carefully or consult your doctor to determine the best dose for you. The patch is typically used for four to eight weeks.

The most common side effect is itching and irritation at the site where the patch is applied. This is often related to the adhesive and may be relieved by switching to a different brand of the patch or using topical steroid creams or oral antihistamines. Other side effects may include nervousness, insomnia, headache, dizziness, and joint and muscle pain. The patch may cause abnormal heart rhythms in susceptible people, particularly if used while still smoking. As with all forms of nicotine replacement therapy, follow the instructions included with the product package or offered by your doctor.

Nicotine gum
Nicotine gum is chewed until it has a "peppery" taste and then held between your gums and cheek. The gum is available in two strengths, and you control the dose. Read the instructions carefully or consult your doctor to determine the best dose for you. The gum is intended to be used several times a day (up to 10 to 15 pieces per day, but no more than 30) to fight nicotine cravings, and then slowly tapered for up to three months.

In some cases, nicotine gum is recommended if the patch is ineffective or causes side effects. Some people simply prefer nicotine gum to other methods of nicotine replacement. The gum isn't recommended if you have peptic ulcers, and it may cause problems if you wear dentures.

Possible side effects of nicotine gum include lightheadedness, nausea, heart palpitations, mouth soreness, jaw ache, an unpleasant taste in the mouth and hiccups. As with all forms of nicotine replacement therapy, follow the instructions included with the product package or offered by your doctor.

Nicotine lozenge
Commit is an over-the-counter nicotine lozenge that's intended to be used every one to two hours for six weeks, and then slowly tapered for up to three months. Consult your doctor to determine the best dose for you.

Side effects may include indigestion and throat irritation. As with all forms of nicotine replacement therapy, follow the instructions included with the product package or offered by your doctor.

Nicotine nasal spray
The effectiveness of nicotine nasal spray is comparable or better than the patch or nicotine gum. The nicotine in nasal sprays reaches the bloodstream more quickly and begins working faster. Unlike the nicotine patch and gum, nicotine nasal spray requires a prescription. Each dose (two sprays) gives 1 milligram of nicotine, 0.5 milligram in each nostril. You begin with one or two doses an hour, with a maximum of 40 doses a day for heavy smokers. The spray can be used for three to six months, but isn't recommended for use longer than six months.

Possible side effects of nicotine nasal spray include nasal, sinus or throat irritation, watery eyes, sneezing and coughing. Headaches and dizziness may also occur. Discuss the safety of nicotine nasal spray with your doctor if you have a nasal or sinus condition, allergies or asthma. People who have heart disease, insulin-dependent diabetes or peptic ulcer disease shouldn't use the nasal spray.

Nicotine inhaler
Another option is a nicotine inhaler, which also requires a prescription. The inhaler mimics the hand/mouth ritual of the cigarette user, and nicotine is absorbed the same way as cigarettes. Each time you use the inhaler, you insert a fresh cartridge. Each cartridge contains the equivalent of 20 minutes of nicotine. The average person may use six to 16 cartridges throughout the day. Maximum use is six months.

Possible side effects may include mouth and throat irritation, swallowing difficulties, headache, nausea and respiratory problems (especially if you have a pre-existing lung condition). It may also be more addicting than the patch or gum. People who have heart disease, active ulcer disease or insulin-dependent diabetes shouldn't use the inhaler.


Indications
Nicotine replacement therapy is safe and effective. It's recommended for nearly anyone who wants to quit smoking. If you're pregnant, breastfeeding or have a serious illness or chronic condition, however, be sure to consult your doctor before starting nicotine replacement therapy. Also, if you smoke 10 to 15 cigarettes a day or less or weigh less than 100 pounds, you may need a lower starting dose of nicotine.
If your child smokes, consult his or her doctor -- some nicotine replacement products, such as nicotine nasal spray, aren't recommended for children.


Preparation
Successful smoking cessation requires a desire, readiness and commitment to quitting. Although you can buy many nicotine replacement products without a prescription, consult your doctor first. If you'd like to try nicotine nasal spray or the inhaler, you'll need a prescription.
If you take medications, the dosage may need to be adjusted when you quit smoking. Be sure to check with your doctor if you take any of the following:

acetaminophen (Tylenol, for example)
caffeine
imipramine (Tofranil or Presamine, for example)
oxazepam (Serax, for example)
propranolol (Inderal, for example)
pentazocine (Talwin, for example)
insulin
theophylline
aminophylline
Discuss possible medication interactions with your doctor or pharmacist.


Benefits
Nicotine replacement therapy can significantly increase the success rate of quitting. Nicotine replacement therapy can help nearly anyone quit smoking, including recovering alcoholics and substance abusers.

Risks
Do not smoke while using these products. It's possible to overdose on nicotine if you smoke while using nicotine replacement products. It's also important to follow package directions carefully. Medical complications from nicotine poisoning can occur from applying multiple nicotine patches, exceeding recommended doses, or using nicotine products with other medications or substances.

Considerations
Smoking is a complex addiction involving both physical and behavioral components. Quitting is different for everyone. If you have a relapse or aren't able to successfully quit smoking with the help of nicotine replacement therapy, consult your doctor. You may benefit from other medications, another delivery method or a more intensive support program.
For information on a smoking cessation program in your area, call the local chapter of the American Lung Association, American Cancer Society or American Heart Association. You may also want to contact your doctor, health plan or local hospital.

It's important to store nicotine products out of the reach of children and pets. Always dispose of them safely. Check with your health plan to learn about any special coverage or benefits for smoking cessation, including over-the-counter products such as nicotine patches or gum.


Pregnancy-specific information
Smoking during pregnancy can be harmful to your developing baby. If you're pregnant or planning to become pregnant, it's extremely important to stop smoking. Although the safety of nicotine replacement therapy during pregnancy hasn't been fully evaluated, it may be recommended if you're a heavy smoker and are having difficulty quitting. Again, consult your doctor before starting any type of nicotine replacement therapy.

Senior-specific information
It's never too late to benefit from quitting smoking. Within 24 hours, the risk of heart attack decreases. Within two weeks, circulatory and lung function improve.