Stop Smoking with Nicotine Replacement Therapy (NRT) from Chemist.net

Chemist.net has put together some information about Nicotine Replacement Therapy (NRT) to help you along the journey to giving up smoking.With the start of Stoptober just a day away, Chemist.net has put together some information about Nicotine Replacement Therapy (NRT) to help you along the journey to giving up smoking.

Nicotine is seen as being the addictive component of cigarette smoke. NRT provides the body with doses of nicotine that would otherwise have been provided by cigarette smoke. NRT is available as nasal sprays, lozenges, inhalers, sub-lingual tablets (tablets that dissolve under the tongue), gums, and patches. You can use a single product, or a combination. NRT basically helps prevent some of the withdrawal symptoms you may experience when trying to quit smoking, especially for the first 12 weeks after quitting smoking.

Smoking while using Nicotine Replacement Therapy (NRT)

It is not advised to carry on smoking while using Nicotine Replacement Therapy as smoking while using NRT products can make you feel dizzy, raise the pulse rate and cause heart “pounding”.

However there are some NRT products that are available to use specifically to reduce the number of cigarettes being smoked:

These are the only NRT products that are able to be used while cutting down on the number of cigarettes being smoked.

It is better to use Nicotine Replacement Therapy products than to carry on smoking, because NRT is considered to be safe to use by most patient groups. If you are pregnant, using NRT products may increase the chance of having a birth defect.

NRT studies

It is not suggested that one NRT product is better than another, but there are differences:

  • The stronger gum (4mg vs 2mg) has shown to be more effective at getting heavy smokers to stop smoking.
  • Higher dose patches have also shown to be slightly more effective than low dose patches for the heavy smokers group. The patches may be worn only when awake (16 hour patches), or all the time (24 hour patches) but both types have shown to work equally well.
  • In a study, heavy smokers have shown to produce better results when using the nasal spray, and the less heavy smokers have shown to produce better results using the patches.
  • Some studies seem to suggest the use of two types of NRT better aids the process of smoke cessation, than the use of just one NRT. For example, use a 16 hour patch while awake, and if any cravings occur, use a 2mg or 4mg gum.

Nicotine Replacement Therapy Side Effects

  • NRT gums: Have been known to cause dental problems, jaw pain, upset stomach and hiccups. The gum is just meant to be held in the mouth and chewed only about twice a minute. If chewed too fast, too much nicotine is released causing an upset stomach. Hiccups and jaw ache are a result of chewing too much.
  • NRT inhalers and sprays: Have been known to irritate the mouth or nose. These effects are considered to be common (A high proportion of users have experienced the effects of runny nose and irritated mouth during the first two days of use).
  • NRT patches: Are known to cause mild skin rashes- using the patch on a different site every day will prevent such a side effect. The patches can keep the user awake at night- if this occurs, you can take the patch off at night, or just use the 16 hour patches when awake.

Which Nicotine Replacement Therapy Should I Use?

    1. Nicotine Replacement Therapy Gums: These are available as 2mg or 4mg and in different flavours and allow you to have easy control of cravings – simply chew a piece of gum whenever you crave a cigarette.
      • If you smoke less than 20 cigarettes a day: Use the 2mg gum and keep using this strength until you have stopped smoking.
      • If you smoke more than 20 cigarettes a day: Use the 4mg gum. Depending on how much you usually smoke per day, you may use 8-12 pieces of gum a day (maximum of 15 pieces a day).

      Chew gum slowly until taste becomes strong (less than a minute). Rest gum between gum and cheek. Chew gum again when taste has faded.

    2. Nicotine Replacement Therapy Inhalator: These keeps your hands busy, so are ideal for those who miss the physical action of holding & smoking a cigarette. They may also be useful in areas where you are not allowed to smoke, for example at work or on a plane. Inhalators should be used whenever the urge to smoke is felt or to prevent cravings in situations where these are likely to occur. Smokers aiming to reduce cigarettes should use the Inhalator as needed to prolong smoke free intervals and with the intention to reduce smoking as much as possible. As soon as they are ready they should aim to quit smoking completely. For smokers unable or unwilling to quit they can swap some cigarettes with the inhalator as a safer option to smoking. Initially replace all cigarettes with inhalator Gradually reduce inhalator cartridges until stopping completely. Max. daily dose: 12 cartridges.
    3. Nicotine Replacement Therapy Lozenges: Lozenges can be used as a safer alternative to smoking and may be useful in areas where it is not permitted to smoke, for example at work or on a plane. Lozenges are suitable for smokers who smoke 20 or fewer cigarettes per day and should be used whenever you feel the urge to smoke or to prevent cravings in situations where these are likely to occur. Smokers aiming to reduce cigarettes should take the lozenge, as needed, between smoking episodes to prolong smoke-free intervals and with the intention to reduce smoking as much as possible. As soon as they are ready smokers should aim to quit smoking completely. Most smokers require 8 to 12 lozenges per day and you must not exceed 15 lozenges in one day. One lozenge should be placed in the mouth and allowed to dissolve. Periodically, the lozenge should be moved from one side of the mouth to the other, and repeated, until the lozenge is completely dissolved. Do not chew or swallow the lozenge and do not eat or drink while a lozenge is in the mouth.
    4. Nicotine Replacement Therapy Patches: People who like the patch find it very practical – simply put one on in the morning and forget about it for the rest of the day. This may be useful in areas where they are not permitted to smoke, for example at work, or on a plane. Always apply to a clean, dry, hairless area of the skin on the front or side of the chest, upper arm or hip. Don’t apply to the same spot two days running
      • 16 hour patches for those who smoke over 10 cigarettes a day: A typical 12 week program will start with the 25mg patches, to be applied daily in the morning and removed at night before bed. As the cravings during the day reduce, the strength of the patches may be reduced to the 15mg patches, again applied daily in the same routine. Depending upon the cravings, you may then step down (once you feel stabilized on the 15mg patch) to the 10mg patch daily, Or you may step up to the 25mg strength once again if the cravings have got the better of you. Once stabilised on the 10mg patches, it’s up to you when you want to step down further by removing the need for NRT patches. All the while when using the patches, you may use other NRT products such as the gum or inhalators to control cravings or urges.
      • 16 hour patches for those who smoke less than 10 cigarettes a day: A typical 12 week program will start with the 15mg patches, to be applied daily in the morning and removed at night before bed. As the cravings during the day reduce, the strength of the patches may be reduced to the 10mg patches. If the cravings increase upon stepping down to the 10mg patches, move back to 15mg patches daily, until you have stabilized and try stepping down to the 10mg patches daily. Once stabilized on the 10mg patches it’s up to you when you want to step down further by removing the need for NRT patches. All the while when using the patches, you may use other NRT products such as the gum or inhalators to control cravings or urges.
      • 24 hour patches: For 6 weeks, start with the 21mg Patch if you smoke 10 or more cigarettes a day. (Go straight to 14mg if you smoke less). For a further 2 weeks, change to the 14mg Patch. (Alternatively start with 14mg for 6 weeks if you are a light smoker). Finally, move onto the 7mg Patch for 2 weeks.

      Following the step-down programme will let you gradually wean yourself off nicotine so you can quit for good.

    5. Nicotine Replacement Therapy sub-lingual/Microtab (dissolves under the tongue): Microtabs a suitable for smokers who wants a discreet and flexible form of NRT. It’s recommended for smokers that want to stop abruptly, or cut down and then stop. It is recommended that the tablets are used for at least 12 weeks. For smokers who smoke 20 or less cigarettes per day, start with one Microtab each hour. If you smoke more than 20 cigarettes per day, start with two Microtabs each hour, placed under the tongue at the same time. The maximum dose is 40 Microtabs per day. After 12 weeks you should aim to reduce the number of Microtabs used each day. Use beyond nine months is not recommended.
    6. Nicotine Replacement Therapy Nasal Sprays: Nasal sprays provide rapid relief for those heavily-dependent smokers who smoke over 20 cigarettes a day and often light up within 20 minutes of waking and need fast acting relief from strong cravings. It is recommended for smokers that want to stop abruptly straight away.12 week programme:
      • 8 weeks: Use as required. No more than two sprays to each nostril every hour for a maximum of 16 hours
      • 2 weeks: Reduce usage by half
      • 2 weeks: Reduce usage to zero
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