Nicotine replacement therapy (NRT) increases your chance of quitting smoking.
What is nicotine addiction?
Nicotine is a
drug that is inhaled from the tobacco in cigarettes. It gets into the
bloodstream and stimulates the brain. Most regular smokers are addicted
to nicotine.
If you are a regular smoker, when the blood level
of nicotine falls, you usually develop withdrawal symptoms such as
restlessness, increased appetite, inability to concentrate,
irritability, dizziness, constipation, nicotine craving, or just
feeling awful. These symptoms begin within a few hours after having the
last cigarette. If they are not relieved by the next cigarette,
withdrawal symptoms get worse. If you do not smoke any more, the
withdrawal symptoms peak after about 24 hours, and then gradually ease
over about 2-4 weeks.
So, most smokers smoke regularly to feel 'normal', and to prevent withdrawal symptoms.
About
2 in 3 smokers want to stop smoking but, without help, many fail to
succeed. The main reason why so few smokers succeed, even though they
want to stop smoking, is because nicotine addiction is strong and
difficult to break. This is where NRT can help.
What is nicotine replacement therapy (NRT)?
NRT
is a way of getting nicotine into the bloodstream without smoking.
There are nicotine gums, patches, inhalers, tablets, lozenges, and
sprays. You can buy most of these from pharmacies and other retail
outlets. They are also available on prescription.
How does NRT work?
NRT stops, or reduces,
the symptoms of nicotine withdrawal. This helps you to stop smoking,
but without having unpleasant withdrawal symptoms. NRT does not 'make'
you stop smoking. You still need determination to succeed in breaking
the smoking habit.
How do I use NRT?
- Take advice from a GP, practice nurse, pharmacist or Stop Smoking Clinic.
- Decide on which type of NRT will suit you best (see below).
- Set a date to start. Stop smoking, and start NRT straight away.
Some people prefer to stop smoking at the end of one day, and start NRT
when they wake the following day.
- Do not smoke at the same time as taking NRT.
- You should use NRT regularly at first, and not 'now and then'.
- Use an adequate dose of NRT. The higher doses are used if you smoked more than 18-20 per day.
- Use NRT for at least 8-12 weeks for the best chance of stopping smoking long-term.
- The dose of NRT is typically reduced in the later part of the course, and then stopped.
You are more likely to stop smoking if you receive counselling
or support whilst taking NRT. A doctor, nurse, pharmacist, or Stop
Smoking Clinic may give this support. Also, the manufacturers of NRT
often offer support such as telephone counselling, tapes, internet
sites, personalised written programmes, etc. The details come on the
packets of the various NRT products. It is strongly advised that you
take up any offer of support whilst going through the difficult time of
giving up smoking.
How effective is NRT?
NRT does increase the
chance of quitting smoking. Various studies have looked at this issue.
The studies compared NRT to a similar dummy (placebo) product in people
who were keen to stop smoking. The results from the studies showed
that, on average, about 17 in 100 people who took NRT stopped smoking
successfully. This compared to about 10 in 100 who took the dummy
(placebo) product rather than NRT. In other words, it increased the
rate of success by about 70%. A combination of NRT with support or
counselling may give the best chance of success.
Which form of NRT is best?
There is not much
difference in how well the different types of NRT work. Personal
preference usually determines which one to use. Below are listed some
points about each form of NRT. Please note, this is just a brief
overview. Read the manufacturer's instructions on the packet for
detailed advice on each type of NRT, or seek advice from a pharmacist,
doctor or nurse.
Nicotine gum
Two strengths are available -
2mg and 4mg. You should use the 4mg strength if you smoke 18 or more
cigarettes a day. You need about 12-15 pieces of gum per day to start
with (about one per hour). To release the nicotine, chew the gum slowly
until the taste is strong. Then rest it between the cheek and the gum
to allow absorption of nicotine into the bloodstream. Chew the gum
again when the taste fades, and rest it again when the taste is strong,
etc. Use a fresh piece of gum after about an hour.
After 2-3
months you should use the gum less and less. For example, reduce the
chewing time, cut the gum into smaller pieces, or alternate the
nicotine gum with sugar-free gum. Gradually stop the gum completely.
The
disadvantage of gum is that some people do not like the taste, or
always having something in their mouth. Gum is not suitable if you wear
dentures.
Nicotine patches
A patch that is stuck onto
the skin releases nicotine into the bloodstream. Some patches last 16
hours, which you wear only when you are awake. Other types last 24
hours, and you wear these the whole time. The 24 hour patch may disturb
sleep, but is thought to help with early morning craving for nicotine.
Patches are discreet, and easy to apply.
The patches come in
different strengths. The manufacturers normally recommend that you
gradually reduce the strength of the patch over time before stopping
completely. However, some research studies suggest that stopping
abruptly is probably just as good without the need to gradually reduce
the dose.
The disadvantage of patches is that a steady amount of
nicotine is delivered. This does not mimic the alternate high and low
levels of nicotine when you smoke, or with chewing nicotine gum. Skin
irritation beneath the patch occurs in some users.
Nicotine inhaler
This resembles a cigarette.
Nicotine cartridges are inserted into it, and inhaled in an action
similar to smoking. Each cartridge provides up to three 20 minute
sessions. You should use about 6-12 cartridges a day for eight weeks,
and then gradually reduce over four further weeks. It is particularly
suitable if you miss the hand-to-mouth movements of smoking.
Nicotine tablets / lozenges
You dissolve
these under the tongue (they are not swallowed). Nicotine is absorbed
through the mouth into the bloodstream. They are easy to use.
Nicotine nasal spray
The nicotine in the
spray is rapidly absorbed into the bloodstream from the nose. This form
of NRT most closely mimics the rapid increase in nicotine level that
you get from smoking cigarettes. This may help to relieve sudden surges
of craving. Side-effects such as nose and throat irritation, coughing,
and watering eyes occur in about 1 in 3 users. As the nasal spray may
cause sneezing and watering eyes for a short time after use, do not use
it whilst driving.
Can different methods of NRT be combined?
This
is an option, especially if you have particularly bad withdrawal
symptoms. The common combination is to use an NRT patch (which gives a
regular background level of nicotine) with gum or a nasal spray (taken
now and then to top up the level of nicotine to ease sudden cravings).
Evidence from research studies suggests that this kind of combination
provides a small but significant increase in success rates compared
with a single product. It is also thought that it is safe to combine
NRT in this way.
NRT and other diseases and situations
As a
rule, getting nicotine from NRT is much safer than from cigarettes.
(NRT does not contain the harmful chemicals that cigarettes have.) But
the following points may be relevant to some people.
-
Pregnancy.
NRT is likely to be safer than continued smoking and so its use can be
justified in pregnant women who are finding it difficult to stop
smoking. NRT products that are taken intermittently (such as gum,
lozenge, spray, inhalator) are preferred to patches. This is to
minimise the exposure of nicotine to the unborn baby. Avoid
liquorice-flavoured NRT products.
-
Breastfeeding. The amount of nicotine that gets into
breastmilk is probably similar whether the mother smokes or uses NRT.
Breastfeeding within one hour of smoking or taking an NRT product can
significantly increase the levels of nicotine in breast milk.
Therefore, NRT products that are taken intermittently are probably best
if NRT is used during breastfeeding. Avoid using the NRT for at least
one hour before breastfeeding.
-
If you are taking a theophylline medicine (used for some
lung conditions) and stop smoking, the blood level of theophylline will
increase. (The chemicals in cigarette smoke interfere with this
medicine.) It is likely that the dose you need to take will need to be
reduced, typically by about a third.
Some other points about NRT
- Apart from
causing addiction, nicotine is not thought to cause disease. The health
problems from cigarettes, such as lung and heart diseases, are due to
the tar and other chemicals in cigarettes. So, taking NRT instead of
smoking is one step towards a healthier life.
- The dose of nicotine in NRT is not as high as in cigarettes. Also,
the nicotine from smoking is absorbed quickly, and has a quicker effect
than NRT. So, NRT is not a perfect replacement. Withdrawal symptoms are
reduced with NRT, but may not go completely.
- Always read the product label before starting NRT for full instructions and cautions.
- Cost - a week's supply of NRT can vary, depending on the one you
chose. NRT is also available on prescription. However, your doctor will
follow guidelines when prescribing NRT. For example, a first
prescription should only be issued if you are committed to giving up
smoking, and further prescriptions should only be issued if you have
stayed off cigarettes.
- The risk of becoming addicted (dependent) on NRT is small. About 1
in 20 people who stop smoking with the help of NRT continue to use NRT
in the longer term.
Further help and information
Quit - a charity that helps people to stop smoking.
Quitline: 0800 00 22 00 Web: www.quit.org.uk
NHS 'Go Smokefree' Services
NHS smoking helpline 0800 169 0 169 Web: www.gosmokefree.nhs.uk
For help and advice on stopping smoking, and for details of your local NHS Stop Smoking Service.
References
© EMIS and PiP 2008 Updated: 19 May 2008
