The Effectiveness Of Nicotine Replacement Therapy

Nicotine replacement therapy (NRT) products are some of the best-researched tools for helping people quit smoking. 

They’ve helped many smokers who’ve struggled to quit cold turkey and keep slipping back into the habit. 

If you’ve tried quitting but find yourself going back, NRT products can make the process easier to handle.

Let’s dive into what these products are and how they can support you on your journey to quit smoking for good.

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What Is Nicotine?

Nicotine is the addictive chemical in tobacco that keeps you hooked. 

It stimulates your adrenal glands, which can lead to a faster heart rate, higher blood pressure, and reduced blood and oxygen flow around your body. 

Nicotine also triggers the release of dopamine, the brain’s feel-good chemical that affects your mood, pleasure, and emotions.

If you smoke regularly, your body likely depends on nicotine, as it gets used to the regular hits. 

This dependence can make withdrawal tough, causing intense cravings, irritability, anxiety, and restlessness. These symptoms often only ease when you light up again.

While nicotine itself isn’t the main health threat, its addictive nature keeps you smoking and exposes you to the thousands of harmful chemicals in cigarettes.

What Is Nicotine Replacement Therapy?

Nicotine replacement therapy (NRT) products work by giving you a bit of nicotine to ease your dependence on it, but without all the disease-causing chemicals found in cigarettes. 

NRT helps to curb cravings and ease those unpleasant withdrawal symptoms that can make you slip back into smoking.

You can start using NRT right after your last cigarette to give yourself a better chance of quitting permanently.

Is NRT Effective For Quitting Smoking?

NRT can help make your quit-smoking goal achievable, increasing your chances by 50% to 60%.

Combining a nicotine patch with something like gum or lozenges can boost your chances of quitting by an extra 5% compared to using just one, according to a study.

There’s no added safety risk when using both together. The patch provides a steady nicotine supply, while the other NRT helps with sudden cravings. 

However, take note that NRT only helps manage the physical addiction to nicotine, so it’s most effective when combined with counselling or behaviour therapy.

Professional recommendations suggest that NRT is safe to use for up to 12 months. If you need it for longer, your GP can guide you on ongoing use, which is still better than smoking anyway.

NRT Products

There’s plenty of NRT options out there to help you quit for good. If you’re unsure which one’s right for you, just have a chat with your GP. 

They can give you the best advice and help you find the right treatment to suit your needs.

Transdermal Patch

The nicotine patch is worn on your skin, gradually releasing nicotine throughout the day. 

You can choose between two options: a 24-hour or a 16-hour patch, each available in three strengths. 

Remember, your dosage will depend on how much you smoke daily:

• Light smoker – fewer than 10 cigarettes
• Heavy smoker – over a pack a day
• Average smoker – Somewhere in between

As your body adjusts, you’ll slowly reduce the patch dosage. It’s safe for long-term use and better than smoking.

Just watch out for common side effects, including:

• Skin irritation
• Dizziness
• Racing heart (dose may be too high)
• Sleep issues (with the 24-hour patch)
• Headache
• Nausea
• Muscle stiffness

If symptoms bother you, consult your doctor because you might need a different dose.

Nicotine Gum

Nicotine gum is different from regular gum, which is usually chewed consistently.

Nicotine gum is designed to be held in the mouth for about 30 minutes and chewed intermittently.

Chew the gum until you get a peppery taste or tingly feeling, and then tuck the gum up into the inside of the cheek. Only chew the gum again once the taste fades.

As with the transdermal patch, there are different dosages available to cater to all smoking dependencies. These options are also available so that you can gradually lower your nicotine intake over time.

Common side effects of nicotine gum include:

• Throat irritation
• Mouth sores
• Hiccups
• Nausea
• Jaw pain
• Bad taste in the mouth

Food and drink can interfere with the absorption of nicotine, so it’s best to avoid eating or drinking 15 minutes before and after chewing nicotine gum.

Make sure you chew no more than 24 pieces of gum in a day. Nicotine gum can be used for up to 6 months, and it’s recommended that you begin lowering your dose around the 3-month mark.

Nicotine Lozenge

Nicotine lozenges are available in two doses.

If you usually smoke your first cigarette within 30 minutes of waking up, use the stronger dose (4mg).

If you smoke your first cigarette of the day after 30 minutes of being awake, you can opt for the lower dose (2mg).

Possible side effects of the nicotine lozenge include:

• Nausea
• Hiccups
• Mouth irritation
• Sore throat
• Heartburn

You can have a maximum of 5 lozenges in 6 hours or 20 lozenges in a day.

It’s important that you only have one lozenge at a time, and that you don’t chew or bite it. The lozenge is designed to be held in the mouth and dissolved over a period of 30 minutes.

Nicotine lozenges can be used for up to 12 weeks.

Nicotine Sublingual Tablet

Sublingual medications are similar to lozenges, however, they are absorbed into the blood via tissues underneath the tongue.

The tablet is held underneath the tongue until it is dissolved. The sublingual tablet can be used for 12 weeks, after which point daily intake should be slowly reduced.

Mild side effects for the nicotine sublingual tablet include:

• Mouth ulcers
• Heartburn
• Nausea
• Dizziness
• Increased heart rate
• Hiccups

Nicotine Oral Inhaler

The nicotine oral inhaler is designed to mimic the behaviour of smoking by replicating the hand-to-mouth ritual. Smokers may prefer this method of NRT as it is the most like smoking a cigarette.

Inhalers are only available via prescription.

With a nicotine inhaler, most of the nicotine is absorbed by the mouth, stomach, and throat. Only 4% of nicotine from an inhaler will travel to the lungs.

The absorption rate for inhalers is similar to that of nicotine gum.

Side effects can include:

• Throat irritation
• Coughing
• Upset stomach

Nicotine Nasal Spray

Nicotine nasal spray requires a prescription. Nasal spray delivers nicotine through the body more rapidly as it is absorbed directly into the bloodstream through the nasal cavity.

It can help to relieve withdrawal symptoms and target cravings more quickly than other methods.

Possible side effects include:

• Runny nose
• Sneezing
• Coughing
• Throat irritation

It is recommended that you start with 1-2 nasal spray doses per hour. You shouldn’t take more than 40 doses a day.

Prescribed Nicotine Vaping

Prescribed nicotine vapes are designed to mimic the hand-to-mouth sensation of smoking in the same way as the nicotine inhaler.

However, with nicotine vapes, nicotine is delivered to the lungs. Nicotine vapes are small, battery-operated devices that heat liquid and turn it into a vapour that is inhaled. This means there’s no combustion to stimulate the release of nicotine.

It is a safer option than smoking, as nicotine vapes do not release the harmful, toxic chemicals that are found in tobacco.

Nicotine vapes can only be prescribed by a GP. 

When used in conjunction with advice from a trained professional, nicotine vapes are effective smoking cessation tools.

The latest Cochrane Review found high-certainty evidence that NVPs are more effective than NRT in helping people stop smoking.

Also keep in mind that the type of NVP you use can help or adversely affect your health. Let’s learn more about illegal and pharmacy NVPs.

Illegal NVPs

As we’ve mentioned, nicotine vapes can only be prescribed by a GP. This means you have a stop-smoking doctor overseeing your use of an NVP and monitoring your progress. 

Your prescription also ensures you have access to medically supported pharmacy NVPs.

On the other hand, you have NVP products sold and advertised almost anywhere — groceries, corner stores, and tobacconists. These are illegal NVPs, and nobody should have anything to do with them.

Illegal NVPs are dangerous because:

• You don’t know the ingredients they use in their products
• There’s no visibility on the environmental conditions they’ve been manufactured
• They’re imported without any checks on overseas sellers
• They’re typically imported under the radar like illegal drugs and substances
• They contain heavy metals and unknown potentially dangerous chemicals
• Blackmarket importers are targeting teens and young children of five years with their products.
• No consideration for the nicotine dosage they contain

On 1 March 2024, the government has banned the importation and sale of non-therapeutic NVPs outside of pharmacies.

The new regulations also ensures you have a locally insured and high-quality smoking cessation product available from your local pharmacy (who can order it in stock if they don’t have any when you called them).

Pharmacy NVPs

Pharmacies only hold stock of the best and most reliable NVPs available in the market, just like all the medicines you can find.

NVPs sold in pharmacies are made to pharmaceutical standards, complying with GMP and medical device standards.

They’re also tested for inhalation safety, ensuring that you won’t be inhaling anything dangerous as you make the product part of your quit journey.

Pharmacy-available NVPs also have chemicals and ingredients that are fully identified, tested by expert toxicologists.

They’re also medically supported by many GPs who have seen it successfully help many motivated smokers who have been failed by NRT.

Lastly, they’re locally insured. Unlike illegal NVPs, you have recourse if your device is faulty and can get an immediate replacement.

Which Product Is Right For You?

So, which form of NRT will be best for you? It’s best to talk to a GP to discuss all NRT options and come up with a tailored treatment plan. Generally, you can follow the below recommendations:

• If you’re ready to quit soon (in the next few days or weeks) – wear the transdermal patch for 2 weeks while smoking. Then, continue using the patch on its own after you’ve stopped smoking.
• If you have struggled to quit in the past or are finding it difficult to quit with one form of NRT – use both the transdermal patch and an oral NRT such as lozenges or gum.
• If you’ll be ready to quit in the next few months -– use nicotine gum or lozenges while smoking, and reduce your cigarette usage gradually.

Who Can Use NRT Products?

NRT products are safe for adults and some adolescents under 18, however, they are not recommended for children under the age of 12.

They can be used if you are pregnant, breastfeeding, or planning to become pregnant. All experts agree NRT will be safer in these circumstances than the continued use of cigarettes.

You can also use NRT products if you have stable heart disease. If you’re suffering from acute heart disease, discuss your options with your GP.

You can also use NRT products if you are suffering from mental illnesses. In this case, it is highly recommended that you also undertake counselling, to address any psychological issues that may arise as a result of quitting.

NRT can affect insulin levels, so if you have diabetes you will need to consult with your primary caregiver before starting NRT.

Take a look at our Article on Alternative Methods to Quit Smoking.

What Are The Side Effects Of NRT Products?

In addition to the product-specific side effects outlined above, the general side effects of all NRT products include a racing heart, nervousness, and headaches.

While side effects are often mild and well-tolerated, discuss any concerns or troublesome side effects with your GP.

Summary

NRT is an effective tool for quitting smoking. And, if it does fail a motivated smoker due to side effects or solely its ineffectiveness, they can turn to second-line solutions in the form of pharmacy NVPs available via prescription.

Quitting smoking is much easier and more effective with NRT and NVPs from pharmacies. There’s no doubt about it.

If you need help stopping smoking, we can help you.

Smokefree Clinic gives you access to many medically reviewed and trustworthy resources that can inform and aid you in your path to wellness, so have a look around! 

If you’re ready to get started, Smokefree can connect you to friendly Australian healthcare professionals who excel in helping patients quit smoking for good, including via the use of pharmacy NVPs.

Click here to book in with a doctor today.

Link Reference

• https://www.racgp.org.au/getattachment/c07241b0-9dc1-41bd-b25b-764389a675c9/Pharmacotherapy-for-smoking-cessation.aspx
• https://www.cochrane.org/news/latest-cochrane-review-finds-high-certainty-evidence-nicotine-e-cigarettes-are-more-effective
• https://www.bbc.com/news/health-65614078
• https://www.newshub.co.nz/home/new-zealand/2023/08/paddy-gower-on-vaping-shocking-facts-uncovered-about-the-known-and-unknown-health-risks-of-e-liquids.html
• https://www.vice.com/en/article/n7zb37/we-got-your-vapes-tested-in-a-lab-heres-what-we-found
• https://www.tga.gov.au/news/media-releases/new-regulation-vapes-starting-january-2024