Nicotine replacement therapy for quitting tobacco

Nicotine gum and lozenges release nicotine slowly into the mouth.

Nicotine patches stick to your skin and slowly release nicotine through the skin into your bloodstream.

The nicotine inhaler has a holder that contains nicotine. The inhaler delivers a puff of nicotine vapor into your mouth and throat.

You can buy nicotine gum, patches, and lozenges without a prescription. You do need a prescription to buy nicotine inhalers.

Note: Nonprescription nicotine replacement therapy products cannot be sold legally to people younger than age 18. A doctor may prescribe one of these products if a person younger than 18 is dependent on nicotine.

Nicotine replacement therapy (NRT) helps reduce nicotine withdrawal and craving by supplying your body with nicotine. It contains about one-third to one-half the amount of nicotine found in most cigarettes.

People become dependent on the nicotine in cigarettes because it increases the levels of certain chemicals, such as dopamine and norepinephrine, in their brains. When people quit smoking, the levels of those chemicals drop, and their bodies react by having nicotine withdrawal symptoms such as grouchiness and hunger. Nicotine from medicines increases the levels of dopamine and norepinephrine just like nicotine from cigarettes does. Chemical levels in the brain are kept level so withdrawal symptoms are reduced.

When you inhale tobacco smoke, the nicotine in the smoke moves quickly from your lungs into your bloodstream. The nicotine in replacement products takes much longer to get into your system. This is why nicotine replacement medications are much less likely to cause dependence on nicotine than are cigarettes and other tobacco products.

Nicotine replacement therapy is safe when used properly. Nicotine by itself is not nearly as harmful as smoking. Tars, carbon monoxide, and other toxic chemicals in tobacco cause harmful effects, not the nicotine.

Nicotine replacement therapy is useful for most people who are trying to quit smoking.

Nicotine replacement therapy may not be right for you if you are pregnant or have heart disease.

• Pregnancy. Using nicotine replacement products during pregnancy has been linked to low birth weight . But smoking is more dangerous to you and your baby than nicotine replacement is.¹ If you are pregnant or planning to become pregnant and want to stop smoking, talk to your doctor before you decide how to do it. During pregnancy, most doctors will recommend that you try other means to stop before they will suggest a nicotine replacement product.
• Heart disease. Nicotine replacement therapy has been shown to be safe in most people with heart disease. But if you recently had a heart attack or if you have serious heart problems, such as an irregular or rapid heartbeat (arrhythmia) or chest pain (angina), consult your doctor before you use nicotine replacement products.

Doctors do not often recommend nicotine replacement therapy for people younger than 18, largely because the products have been tested only on adults. The side effects of nicotine replacement therapy for young people are unknown.

Using some form of nicotine replacement therapy doubles your chances of quitting smoking.² All forms of nicotine replacement products appear to be about equally effective when used properly.

Combining the use of the nicotine patch with another form of nicotine replacement therapy or bupropion may increase your chances of success. Talk to your doctor before you combine NRTs.

Your chances of quitting are best when you combine nicotine replacement therapy with a complete smoking cessation program that includes setting a quit date, having a plan in place for dealing with smoking triggers, and getting support from a doctor, counselor, or support group.

Since all NRTs appear to work equally well, many smokers choose a treatment based on how easy it is to use and what possible side effects it may cause. All forms of nicotine replacement have side effects, but the types of side effects differ across NRTs. Very few people (less than 5%) have to stop using a nicotine replacement product because of side effects.

Stopping nicotine replacement therapy abruptly may cause some of the same withdrawal symptoms that occur when you stop smoking cigarettes. You are less likely to have withdrawal symptoms if you gradually decrease the dose or number of uses of the specific therapy per day.

It is possible for a person to become dependent on a nicotine replacement product, although this is rare.

Gum

Side effects of nicotine gum may include:

• A bad taste from the gum. A mint and a citrus flavor are available, and most people find they taste much better.
• A tingling feeling on the tongue while chewing the gum.
• Hiccups.
• Upset stomach (nausea) or heartburn. This is sometimes caused by improper use, such as chewing the gum without "parking" it between your cheek and gum.
• Jaw pain caused by chewing. Nicotine gum is not recommended for people who have problems with the jaw joint (temporomandibular, or TM, disorders).

Lozenge

Side effects of nicotine lozenges may include:

• Upset stomach, especially if you swallow the lozenge.
• Hiccups.
• Heartburn.
• Headache.
• Excessive gas (flatulence).

Patch

Side effects of nicotine patches may include:

• A skin rash at the location of the patch. This may be a reaction either to the sticky backing on the patch or to the nicotine. People with sensitive skin or allergies to adhesive should not use the patch. Moving the patch to a different part of your body or using a nonprescription antihistamine cream, ointment, or gel (such as Benadryl) may relieve some of the discomfort.
• Sleep problems when using a 24-hour patch, such as having trouble sleeping or having especially vivid dreams. This is because your brain isn't used to getting nicotine when you are sleeping. Removing the patch after 8 p.m. may help decrease this side effect. If the sleep problem is a nicotine withdrawal symptom, not a side effect, removing the patch may not help. Talk with your doctor if you have sleep problems.

Inhaler

Side effects of nicotine inhalers may include:

• A cough.
• A scratchy throat.
• An upset stomach.

The nicotine inhaler may not be a good choice if you have a breathing problem, such as asthma, allergies, or a sinus condition.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Do not continue to smoke while you are using nicotine replacement therapy. You may overdose on nicotine if you smoke regularly and use nicotine replacement products at the same time. An overdose of nicotine can cause headaches, nausea, confusion, and vomiting. If you think you have overdosed, call your doctor right away.

Regardless of the method you use to quit smoking, you may cough more or start coughing for the first week after you quit. This is not a symptom of withdrawal from nicotine—it is the result of your body trying to clear your lungs. This happens whether you use nicotine replacement therapy or not.

With nicotine gum, lozenges, and the inhaler, not taking enough is a common cause of relapse. Avoid drinking beverages, especially acidic beverages (such as coffee, juices, and soda pop) for 15 minutes before and after you use these products. Your body may not absorb the nicotine well because of the acid in these drinks.

Choosing a form of nicotine replacement therapy is usually a matter of personal choice. People who smoke heavily are more successful when they use the strongest forms of the product (gum or lozenge with 4 mg of nicotine or patches with 21 mg or more nicotine in each patch).²

You will begin using a nicotine replacement product on your quit date, not before as with other forms of treatment.

If you find you cannot continue to use one form of nicotine replacement because of its side effects, stop using that form and try a different one. Remember, using nicotine replacement products doubles your chances of quitting smoking.

Long-term use of nicotine gum has not been found to be harmful.

Nicotine replacement therapy will reduce most but not all of the nicotine withdrawal and other symptoms associated with quitting smoking.

By the time you finish nicotine replacement therapy, you will have greatly decreased your dependence on nicotine. You also will have started to get used to not smoking at the usual times. This will take longer for people who have smoked for many years and may mean using nicotine replacement products for several weeks or months. Stopping nicotine replacement therapy too early is a common cause of relapse. When you finally reduce your nicotine intake to zero, you still may have some symptoms of nicotine withdrawal. But these symptoms won't last. Using nicotine replacement products makes symptoms less severe.

Talk to your doctor before you use two forms of nicotine replacement (such as a nicotine patch and nicotine gum) at the same time.

Using bupropion and nicotine replacement products together may work well for some people who smoke, but it should be tried only under a doctor's care. Your doctor may recommend bupropion alone instead of using two medicines.

Nicotine nasal spray (Nicotrol) is not widely used.

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Citations

1. Morales-Suarez-Varela MM, et al. (2006). Smoking habits, nicotine use, and congenital malformations. Obstetrics and Gynecology, 107(1): 51–57.

2. Lancaster T, et al. (2000). Effectiveness of interventions to help people stop smoking: Findings from the Cochrane Library. BMJ, 321(7257): 355–358.