The Basics
Stop Smoking Aids

Nicotine Replacement Therapy
by S2H RT Staff

Nicotine Gum

Nicotine gum is one of the most popular and oldest over the counter stop smoking aids on the market. It comes without a prescription in two strengths - 2 and 4 mg's. People defined as "heavy smokers" - greater than 25-30 cigarettes per day - may benefit from higher doses of the gum. Consult a doctor or other health care professional to ensure you are placed on the right strength. Although nicotine gum is available without a prescription, the simple act of prescribing it may improve its efficacy.

Nicotine replacement therapy, like the gum, is designed to slow down the nicotine withdrawal symptoms. Clinical studies show much higher quit rates than what is seen in the real world. This is likely because those volunteering for a smoking cessation studies, might be more serious about quitting than the average person. Quit rates on this and all other nicotine replacement therapy is about double over quitting cold turkey alone.

The correct way to use nicotine gum is to chew it a few times until a tingling sensation is noticed. Once this is achieved, the gum should be kept between the cheek and gum until this sensation is no longer present, this is called "parking" the gum. Once the sensation has left, the person should begin chewing it again, until the sensation returns. People usually start out chewing between 10-15 pieces per day, but then settle down after the first week to about 5-8 pieces. The gum is typically recommended for a 3 month period.

Nicotine Lozenges

Nicotine lozenges work in the same way as the the gum. Since it does not need to be chewed, it may be easier for people to use. Much like the gum, the nicotine is absorbed in the mouth and should not be swallowed. Both can be used in combination with other stop smoking aids, but only under the direction of a doctor.The cost associated with these two forms of nicotine replacement therapy is about equal to the cost of a pack of cigarettes per day.

Nicotine Inhaler

The nicotine inhaler is much different than an inhaler used to treat asthma or COPD. In fact, the nicotine dosing takes place in the mouth and not the lungs. Each nicotine inhaler contains 10mg of nicotine. Doses may be prescribed for those people who find themselves needing to do something with their hands. But, since this is slowly absorbed in the mouth (not a true inhaler), it does not seem very effective in treating the withdrawal cravings.

Side effects seem to be limited to mild mouth and throat irritation. However, it does require a certain coordination to perform this therapy which may not be well executed by those with arthritis or other similar physical challenges. In addition, people with severe airway reactivity and chronic cough should not choose this form of nicotine replacement therapy. Results are similar to the other nicotine replacement therapies. However, it is important to realize this is available by prescription only and is the most expensive form of nicotine replacement therapy available. In addition, the nicotine inhaler is used so frequently during the day, many smokers may find it more than a little annoying.

The Nicotine Patch

The patch is another form of nicotine replacement therapy (NRT). The patch is available over the counter and is marketed under several brand names (i.e.: Nicoderm) without a prescription. It allows a steady absorption of nicotine through the skin and maintains levels of nicotine in the body which are very similar to traditional smoking. The nicotine patch may be used if a person relapsed after using another method of NRT earlier, like nicotine gum. Stop smoking success rates are very low when repeating the same nicotine replacement therapies over and over again.

Side effects are fairly mild and consist of skin irritation in roughly 40% of users, while contact dermatitis is seen about 5% of the time. These side effects may be alleviated when the skin contact point is moved around. The patch should not be used in someone with severe eczema or psoriasis.

Many people use the 24-hour patch to treat morning withdrawal symptoms, but this may cause them to have disturbing nightmares. This can be controlled by removing the patch prior to bedtime, but the morning cravings may become intense. So one has to balance the risk of dreams with the morning withdrawal symptoms. Remember, these side effects are easily managed with the right game plan.

There have been some cases of heart attacks in people who were continuing to smoke while wearing the patch. However, studies have shown there is no added risk to having a heart attack than is already present because the person is still smoking. Despite this, it is recommended that persons using this and other nicotine replacement therapies, not engage in tobacco use.Once again, to minimize the side effects and maximize its benefits, the nicotine patch should only be used in combination with other nicotine replacement therapies under the direction of a doctor.

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