Nicotine Replacement Therapy

Nicotine replacement therapy (NRT) is used to wean a smoker off of cigarettes and tobacco over time. It provides lower doses of nicotine (the ingredient that smokers crave), so that cravings can be managed better and withdrawal symptoms can be reduced. By reducing withdrawal symptoms you can:

  • Improve your mood
  • Feel less irritable
  • Concentrate better
  • Crave less cigarettes

A study published by the Cochrane Library, containing 150 trials of over 50,000 people, has supported the effectiveness of NRT by discovering that smokers are more likely to quit smoking when using NRT. The study found that the rate of quitting increased by 50 to 70%. The author of the study concluded that, whilst NRT is highly beneficial when increasing the likelihood of stopping smoking, it isn't an essential piece of the quitting process.

Nicotine replacement therapy is available in many forms, including:

  • Chewing gum
  • Skin patches
  • Inhalers
  • Nasal spray
  • Mouth spray
  • Tablets / Lozenges
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How does nicotine replacement therapy work?

A course of NRT usually lasts eight to twelve weeks and works by stopping, or at least reducing the symptoms associated with a withdrawal from smoking. Nicotine replacement therapy replaces a portion of the nicotine you would usually receive from cigarettes in the bloodstream without the tar, carbon monoxide and other harmful chemicals that are present in tobacco smoke. These symptoms caused by withdrawal can be reduced and managed by lowering your dose of nicotine during the quitting process, whilst also reducing cravings. These withdrawal symptoms are linked to a smoking relapse as a result of stronger nicotine cravings during the early stages of the quitting process. Also, NRT provides an opportunity to change your smoking routine and help to ease cravings during more difficult periods of the day.

How to use nicotine replacement therapy

Listed below are the steps you should consider when using NRT:

  1. Decide which type of NRT is right for you and your requirements
  2. Choose a start date for the therapy
  3. Begin by using NRT regularly
  4. Use an appropriate dosage depending on how often you smoke (e.g. a high dose if you smoke over 18 to 20 cigarettes per day)
  5. Proceed to use NRT for 8 to 12 weeks
  6. Reduce the dose over the duration of the course before eventually stopping
Inhaler Options

Types of nicotine replacement therapy

Nicotine replacement therapy is available to buy in many different forms. Which form you choose normally comes down to personal preference and there aren't really any differences in terms of how they work.

Chewing gum

Nicotine gum can be chewed up to 15 times a day slowly, until the taste becomes strong. This releases the nicotine within the pieces of gum, which is absorbed in to the bloodstream. A fresh piece of gum can be used after an hour. Following a period of two to three months you should begin to use the gum less frequently and eventually should stop altogether. Nicotine gum can be purchased in dosages of 2mg and 4mg, with the 4mg dose being most preferable for individuals who smoke over 18 cigarettes per day. Nicotine gum is not recommended for individuals with dentures.

Skin patches

Nicotine patches are stuck to the skin, releasing nicotine through the skin and in to the bloodstream. They are quick and easy to apply and remove and are very discreet. Different patches last for varying lengths of time, for example patches that are worn only when awake last 16 hours, however 24-hour patches are also available. Whilst these patches can help with early morning cravings, they can interrupt sleep. Over time you should reduce the strength of the patches you use, although you can stop using the patches completely at any time without little effect on the quitting process. Nicotine patches can potentially cause rashes, tenderness and irritation at the site of application.

Inhalers

Nicotine inhalers work by inserting 10mg nicotine cartridges and inhaling the nicotine vapour via the mouthpiece, just as you would a cigarette. The amount you inhale should be decreased over time after using six to twelve each day for a period of eight weeks. Each cartridge should last roughly 20 to 30 minutes. This form of NRT is very popular because it helps smokers to replicate the motions associated with smoking a cigarette. It isn't recommended to use nicotine inhalers beyond 12 months.

Nasal spray

Nicotine from the spray is absorbed into the bloodstream via the nose. These sprays can relieve cravings by releasing nicotine rapidly into the system, similarly to a cigarette. Nasal sprays do come with a number of potential side effects, including nose and throat irritation, watering eyes, coughing and sneezing. Nasal sprays shouldn't be used when driving.

Mouth spray

Nicotine is absorbed via the mouth before entering the bloodstream. Mouth sprays work in a very similar way to nasal sprays by rapidly increasing nicotine levels like a cigarette. When using a mouth spray you should use only one or two sprays whenever you experience a craving. It's important that you never exceed 64 sprays within a period of 24 hours. This should be reduced after six weeks of use.

Tablets / Lozenges

These are taken orally in a regular form (4mg and 2mg doses) or in a mini form (4mg and 1.5mg doses). The tablets should be swallowed, whereas the lozenges should remain in the mouth to dissolve. Both release nicotine into the bloodstream, with lozenges working in a similar way to nicotine gum by releasing nicotine into the bloodstream via the mouth lining. This form of NRT is very easy to use, but can potentially cause a sore mouth, heart burn or nausea.

Side effects and precautions

There are a number of side effects that could potentially occur when using nicotine replacement therapy. These can include:

  • Dizziness
  • Headaches
  • Upset stomach
  • Skin irritation (from patches)
  • Irritation to the nose, eyes or throat (from nasal spray)
  • Sleep disturbances

Alongside side effects, there are a number of precautions that should be considered before you begin your course of nicotine replacement therapy. NRT should be used with caution if you have experienced or are currently experiencing any of the following:

  • Heart attack
  • Unstable angina
  • Irregular heartbeat
  • A recent stroke
  • Asthma
  • Skin diseases
  • Diabetes
  • Gastrointestinal disease
  • Lung disease