Quitting smoking can be challenging, particularly if you’ve attempted to quit cold turkey without success. Try not to be discouraged by this — there are a number of safe and effective tools you can use to make the process more manageable. Nicotine Replacement Therapy Products are the most well-researched front-line treatments used to help with smoking cessation. Here, we take a closer look at the effectiveness of Nicotine Replacement Therapy.
What Is Nicotine?
Nicotine is the main addictive substance in tobacco products. It stimulates the adrenal glands which can cause an increased heart rate, increased blood pressure, and limited blood and oxygen flow throughout the body. Nicotine also promotes the release of dopamine in the brain, which is the chemical that controls our pleasure, pain, and emotions.
Frequent use of cigarettes can lead to nicotine dependency as the body becomes accustomed to receiving hits of nicotine. As dependency increases, the intensity of withdrawal symptoms in between cigarettes increases too. Withdrawal symptoms include intense cravings, restlessness, irritability, and anxiety. These symptoms can be very unpleasant and uncomfortable, and usually only subside when the body receives that next nicotine hit.
Research shows that nicotine isn’t the direct cause of tobacco-related disease. However, the addictive quality of nicotine causes people to continually smoke tobacco, which exposes the body to a range of harmful chemicals.
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What Is Nicotine Replacement Therapy?
Nicotine Replacement Therapy (NRT) products release nicotine into the body without the other toxic chemicals found in tobacco. NRT is designed to help reduce the cravings and uncomfortable withdrawal symptoms that can cause a relapse. You don’t need to wait before starting your NRT — you can begin using NRT products as soon as you’ve had your last cigarette.
Is NRT Effective For Quitting Smoking?
NRT is extremely effective for quitting smoking. All forms of NRT therapy can increase the odds of quitting smoking by 50-60%. A study showed that combining a transdermal patch with another form of NRT, such as a lozenge or gum, increases the quit rate by 5% when compared to just one form of NRT. There were also no additional safety risks reported from taking two forms of NRT together. This combination approach is effective because while the patch works to release a steady stream of nicotine throughout the body, the other NRT product can help to alleviate any sudden breakthrough cravings.
Remember, NRT products only deal with the physical side of cigarette dependence. It can alleviate withdrawal symptoms by delivering a nicotine hit, but NRT products do not address the psychological factors that surround smoking addiction. This is why NRT is most effective when used in conjunction with counselling and behaviour therapy.
Generally, NRT is not recommended for use after 12 months. While there are no reported risks to extending NRT use beyond this stage, there are no reported benefits either. However, if you do need to continue with NRT, you can talk to your GP about ongoing treatment. The sustained use of NRT is still preferable to cigarette smoking.
There are a number of NRT products available to help you on your quitting journey. You can discuss these options with your GP to work out which treatment will be best for you.
The transdermal patch is applied to the skin. It gradually delivers nicotine through the skin over the time period in which it’s worn. There is a 24-hour and 16-hour patch, each with 3 different strength options. Your dosage will depend on how many cigarettes you smoke in a day. If you smoke fewer than 10 cigarettes you’re considered a light smoker, and if you smoke more than a pack a day you’ll be considered a heavy smoker. An average smoker will fall somewhere in between.
Over time, you will gradually decrease the dosage of your patch as your body adjusts to functioning without nicotine. Nicotine patches are safe for long-term use and extended use of a patch is preferable to smoking.
Common side effects of nicotine patches include:
- Skin irritation
- Racing heart (this may mean your dose is too high)
- Sleep issues (most often seen with the 24-hour patch)
- Muscle stiffness or aching
If you experience any bothersome symptoms, be sure to talk to your doctor. Side effects may mean your dose is too high, or you may actually be experiencing nicotine withdrawal if your dose is too low (remember, NRT products are designed to gradually wean you off nicotine).
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
- 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 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:
- Mouth irritation
- Sore throat
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
- Increased heart rate
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
- 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
- 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 are not currently an approved form of nicotine replacement therapy in Australia, so they can only be administered by a GP. When used in conjunction with advice from a trained professional, nicotine vapes are effective smoking cessation tools.
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.