Nicotine replacement products
Nicotine replacement products (NRPs) are designed to assist individuals in quitting smoking by providing a controlled dose of nicotine without the harmful substances found in traditional cigarettes. These products are most effective when integrated into a comprehensive cessation program that includes education, counseling, and support. NRPs work by alleviating withdrawal symptoms as users gradually reduce their nicotine intake, facilitating a smoother transition away from smoking.
Common forms of nicotine replacement include transdermal patches, chewing gum, lozenges, nasal sprays, and inhalers, with some requiring a prescription. The Centers for Disease Control (CDC) recommends combining different types of NRPs for enhanced success rates. Users are advised against smoking while using these products due to the risk of nicotine toxicity. Some strategies, such as starting NRPs prior to the designated quit date, may increase the likelihood of successfully stopping smoking.
While the general goal is to discontinue the use of nicotine replacement products after quitting smoking, some individuals may need to use them longer than recommended. Special considerations apply for users with certain medical conditions, which may affect their suitability for specific NRPs. Overall, nicotine replacement products can be a valuable tool for those looking to overcome nicotine addiction and improve their health.
Nicotine replacement products
DEFINITION: Nicotine replacement products are used to help people stop smoking. These products work best as part of a program that also includes education, counseling, and psychological support.
How Nicotine Replacement Products Work
Nicotine replacement products provide nicotine without delivering the other harmful carcinogens found in cigarettes and help to wean a person’s body off of nicotine. The typical effects of withdrawal are minimized as one’s body adjusts to not smoking and progressively lower doses of nicotine until the use of the nicotine replacement product is stopped completely.
Nicotine patches (transdermal nicotine systems) release nicotine through the skin and into the bloodstream. Nicotine gum (nicotine polacrilex) is chewed slowly. It is then stored between the gum and cheek so that the nicotine can be absorbed through the mouth’s lining and into the bloodstream. Nicotine lozenges dissolve slowly in the mouth to release nicotine at a slow, sustained rate. Nicotine nasal spray contains small doses of nicotine that are sprayed into the nasal passages and absorbed into the bloodstream. Nicotine inhalers contain nicotine that is inhaled through the mouth and absorbed in the mouth and throat. Inhalers and nasal spray methods require a prescription in the United States. Some medications are also available by prescription, such as Varenicline (formerly Chantix) and Bupropion (Wellbutrin). Though these products do not contain nicotine, they work in the brain to reduce cravings and other side effects of quitting smoking.
With care, the Centers for Disease Control recommends these products be used in combination, such as using the patch with lozenges. This helps some people succeed and stay smoke-free.
Precautions
Smoking and using nicotine replacement products can be dangerous because nicotine can build up to toxic levels. Since the goal is to quit smoking entirely, one should not smoke while using a nicotine replacement product. Some research indicates that using nicotine replacement therapy (NRT) products one to two weeks before the actual quit day increases the chances of successfully quitting. This is called nicotine preloading, precessation, or pre-quitting NRT. People who combine several quitting strategies often have the most success.
After quitting smoking, the goal is to end the use of nicotine replacement products as well. It may be appropriate for some people to continue using nicotine replacement products longer than the recommended duration. Some people continue to use them for twelve months or longer. Weaning off the medicine is encouraged, but continuing it is preferable to smoking because cigarette smoke contains many harmful chemicals in addition to nicotine.
The presence of other conditions may affect the use of nicotine replacement products. These conditions include, but are not limited to, allergies (nasal spray only); asthma or breathing problems (with inhaler and nasal spray); type 1 diabetes; heart or blood vessel disease; high blood pressure; liver disease; overactive thyroid; stomach ulcer; and recent stroke.
Bibliography
Fiore, Michael C., et al. Treating Tobacco Use and Dependence: 2008 Update. Public Health ServiceClinical Practice Guideline. Washington, DC, US DHHS, 2008.
“Nicotine Replacement Therapy for Quitting Tobacco.” American Cancer Society, 2 Aug. 2021, www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/nicotine-replacement-therapy.html. Accessed 19 Sept. 2024.
“Nicotine Replacement Therapy.” MedlinePlus, US National Library of Medicine, NIH, 28 Feb. 2023, medlineplus.gov/ency/article/007438.htm. Accessed 19 Sept. 2024.
Piper, M. E., et al. “A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies.” Archives of General Psychiatry, vol. 66, no. 11, 2009, pp. 1253–1262.
Strandberg-Larsen, K., et al. “Use of Nicotine Replacement Therapy During Pregnancy and Stillbirth: A Cohort Study.” BJOG: International Journal of Obstetrics and Gynaecology, vol. 115, no. 11, 2008, pp. 1405–1410.