Nicotine Replacement Therapy

The most important thing for quitting smoking is determination. Those who truly want to kick that habit will find that willpower plays a vital part in persisting through to the end and becoming tobacco-free. However, not everyone can do it ‘cold turkey’ so to speak – giving up cigarettes without substituting them for a replacement.

This is because all smokers are nicotine addicts. Nicotine addiction is as strong as heroin, cocaine, or alcohol addiction because a smoker’s body has become accustomed to its effects. Once you quit, cravings go into overdrive – dopamine and adrenaline floods that usually occurred due to nicotine stimulation cease to happen.

That’s why most smokers who are going through the cessation process feel anxious, restless, and depressed and why they crave a cigarette. If you’re one of those smokers who can’t rely on their willpower to push through the cravings, you will want to consider NRT – Nicotine Replacement Therapy.

Nicotine replacement therapy is an umbrella term for various ways of delivering nicotine into your organism while you are quitting smoking:

  • Nicotine patch
  • Nicotine gum
  • Nicotine nasal spray
  • Nicotine inhalers
  • Nicotine lozenges

types of nicotine replacement therapyStudies show that NTR works – cessation success rate is increased by 50 to 70% if smokers opt for one of the nicotine replacement therapies that are currently available.

Guide to Starting Nicotine Replacement Therapy

  1. Consult with your doctor. Not everyone is a candidate for nicotine replacement therapy (pregnant women, young adults) and your GP will be able to give you advice on what might work best in your particular case and suggest alternatives to NTR.
  2. Use NTR regularly – On and off usage decrease its effectiveness.
  3. Plan on 8-12 weeks and up to 6 months usage period and gradually decrease the dose during the later stages of the treatment.
  4. Check with your doctor on whether it is safe to combine NTR with other types of treatment, such as bupropion or varenicline.

Nicotine Patch

Nicotine patches deliver nicotine through the skin and different strengths and brands are available on the market. The delivery is measured and you can choose between a 16-hour patch and a 24-hour patch with nicotine strengths varying from 5 – 22 mg.

Most smokers are advised to start with a 24-hour patch (15-22mg strength), especially if they smoked more than one pack of cigarettes daily. 24-hour patches deliver nicotine while you sleep and successfully combat early morning withdrawal symptoms.

Apply the patch below the neck and above the waist – forearm or chest work the best – and make sure your skin is clean. Men might need to shave the area so that the patch can stick better. Patches are FDA approved and the recommended use length is 3-6 months, with gradual decreases in the later months.

Nicotine patch side effects:

  • Problems sleeping
  • Elevated heartbeat
  • Skin irritation
  • Nausea
  • Headache
  • Dizziness

Side effects are common and no one experiences all of them. Try experimenting with different brands of patches and different strengths. If they persist, consult your doctor and consider switching to a different nicotine replacement therapy.

Nicotine Gum

The gum is a fast-acting NRT method. It releases nicotine into your system while you’re chewing on it and the nicotine is absorbed through the mucous membranes in your mouth. They come in two different strengths – 2 mg and 4 mg. If you smoked over a pack of cigarettes a day you will want to start with 4 mg.

Chew the gum until you get a slight peppery taste in your mouth then tuck it away to the side, behind your teeth and pressing on your cheek. Repeat the process for 30 minutes and then dispose of the gum. Don’t drink or eat 15 minutes before you use the gum and abstain from drinking while using it as it decreases the effectiveness.

It’s recommended that you use no more than 20 gums during one day, depending on their strength. One gum in one hour is common but you can use more, especially to fight the onset of nicotine cravings. Recommended usage period is 8 to 12 weeks with the maximum being 6 months. In the later weeks, try reducing the number of gums you use as it’s not uncommon for people to substitute cigarette addiction with nicotine gum dependency.

Nicotine gum side effects:

  • Nausea
  • Jaw discomfort
  • Throat irritation
  • Mouth sores
  • Elevated heartbeat
  • Hiccups

Most of these side-effects are caused by improper use of the gum – chewing too fast or swallowing it.  Racing heartbeat might suggest that you’re using too large a dose of nicotine and continuing withdrawal symptoms are a sign that the dose is too small. Consult your doctor if the side-effects persist.

Nicotine Lozenge

Nicotine lozenges are a type of pastille and are similar to nicotine gums in that they come in two different strengths, 2 and 4 mg, and are an oral nicotine delivery system. You shouldn’t swallow the lozenges as nicotine is absorbed through the mucous membranes in the mouth.

Suck on lozenges until they are completely dissolved – don’t bite on them. Recommended dosage is 1 lozenge every 1 – 2 hours for up to 12 weeks. If you still feel the need to continue using them after that period, make sure you consult with your doctor. You’re not supposed to mix lozenges with other NTRs or continue smoking while using them

Nicotine lozenge side effects:

  • Heartburn
  • Nausea
  • Hiccups
  • Trouble sleeping
  • Coughing
  • Gas
  • Headache

Limit your use of lozenges to 20 per day, maximum, and try to taper down in later weeks so it’s easier for you to completely quit them after the 12 weeks have passed.

Nicotine Nasal Spray

Nicotine nasal spray is only available on prescription. It delivers nicotine through your nasal blood vessels and works very fast to suppress the cravings. Although it’s FDA-approved for up to 6 months of use, make sure you’re adhering to doctor’s orders and use it only as long as you absolutely need to. It’s quite easy to get dependent on the nicotine nasal spray and prolong your nicotine addiction that way.

Nicotine nasal spray side effects:

There are side-effects to nasal spray that will last for up to 2 weeks and they are common.

  • Headaches
  • Nasal irritation
  • Sneezing
  • Runny nose
  • Sore throat
  • Coughing
  • Watery eyes

In an event that those side-effects persist, contact your doctor. Also, consult with a specialist before using nicotine nasal spray if you asthma, nasal polyps, sinus problems, or allergies.

Nicotine Inhaler

The nicotine inhaler is also a nicotine replacement therapy available only on prescription. The cartridge delivers pure nicotine vapor straight to your mouth where it’s absorbed through the mucous membrane and enters the bloodstream.

It’s FDA-approved for use for up to 6 months and the recommended daily dosage is 4 – 20 cartridges. Nicotine inhalers are the most expensive form of NRT and should be considered only by heavy smokers or those allergic to or unable to use other types of NRTs.

Nicotine inhaler side effects:

  • Mouth irritation
  • Throat irritation
  • Upset stomach

Inhalers are most like cigarettes and some smokers find the similarity helpful during the cessation period. Still, make sure you consult with your doctor if you have any pre-existing conditions you are worried about, such as asthma or lung problems.

Quit Smoking Medication

Drug therapy has proved successful in aiding the cessation attempts of heavy smokers – those who smoke more than a pack a day or can’t start their day without a cigarette.

You will need to consult your doctor about all such medication because it’s not readily available and can be obtained only on prescription.

None of these contain nicotine and they’re not a form of nicotine replacement therapy but they can:

  • Help you manage withdrawal symptoms
  • Help with cravings
  • Keep you from relapsing

Varenicline (Chantix)

Varenicline is a craving suppressant that works by interfering with neurotransmitters nicotine targets, essentially depriving smokers of pleasures they associate with nicotine. It also works to lessen the withdrawal symptoms and is proved to help with the cessation effort and relapse incidents.

It’s advised that you start Varenicline treatment 1 – 2 weeks before quitting. The dose will gradually increase during the first two weeks.

  • First three days – 1 0.5 mg pill once a day
  • Following four days – 1 0.5 mg pill twice a day
  • Week 2 and up to 12 weeks – 1 1 mg pill in the morning and 1 in the evening

Varenicline is not prescribed to pregnant women and can be used for up to 24 weeks. Consult with your doctor if you require an additional Varenicline treatment.

Varenicline (Chantix) side-effects include:

  • Trouble sleeping
  • Nausea
  • Headache
  • Vomiting
  • Altered taste
  • Gas

Bupropion (Zyban)

Bupropion has been used as an antidepressant for years but it’s also helpful during smoking cessation. It works on the same principle as Varenicline, by interfering with neuro-receptors responsible for nicotine cravings. Usual doctor recommendation is to start using it 1 – 2 weeks before cessation, in order to give your body a chance to accumulate levels of the drug needed to combat craving onset. The recommended dose should

It’s not recommended for people who have experienced seizures, cirrhosis, or serious head injury or to those with bulimia, alcoholism, or other mental disorders.

Rarely, Bupropion will cause severe mood swings, depression, anxiety attacks, or suicidal thoughts. If that happens, seek medical assistance right away.

Bupropion (Zyban) side-effects include:

  • Trouble sleeping
  • Nightmares
  • Dry mouth
  • Agitation
  • Nausea
  • Headaches
  • Tiredness
  • Indigestion
  • Irritability

Aside from common side effects, Bupropion causes drug interactions so make sure you tell your doctor about everything you are taking – prescription or otherwise.

Other medicines for smoking cessation are in the works but have not been FDA approved for that purpose just yet. These include Clonidine, Nortriptyline, naltrexone, cytosine, and more and although they are showing promising results in the preliminary testing, more research is still needed.

Scientists are also developing anti-smoking vaccines that would be delivered as a series of shots. The research is showing some results but further testing is necessary before the vaccine is deemed safe for use on humans.

Combining Medication and NRTs

Combining these two methods can be an effective course of treatment for those who are suffering from a serious nicotine addiction. However, interactions can occur so this is only advisable under direct medical supervision. Bupropion yields better results than Varenicline when combined with nicotine replacement therapy and using both Varenicline and Bupropion at the same time does not increase the success rate of quitting smoking nor does it show any substantial benefits.