Nicotine replacement therapy (NRT) is often recommended for any nicotine user, particularly smokers, who want to quit the habit and end their addiction. Overcoming nicotine addiction is not an easy task as nicotine is a highly addictive substance and total cessation often produces unpleasant nicotine withdrawal symptoms. These symptoms are particularly severe in a person who is utilizing a large amount of nicotine on a daily or has been using nicotine for a prolonged period of time.
Nicotine replacement products administer nicotine into the system in controlled doses, often without the harmful effects associated with other methods of nicotine administration, like smoking or chewing tobacco. Nicotine replacement therapy should not be seen as a supplementation for nicotine usage but rather as a tool to wean the user off this addictive substance.
Types of Nicotine Replacement Products
Nicotine replacement products are available in a number of forms, all of which are equally effective if used correctly.
Nicotine Chewing Gum
Nicotine chewing gum releases nicotine as the gum is chewed. This nicotine then absorbs into the blood stream through the thin and highly vascularized lining of the mouth, particularly that of the cheek and under the tongue.
The gum may be inconvenient for a user with dentures and the taste can make it quite unappealing. Some of the side effects associated with nicotine chewing gum includes nausea, hiccups, hypersalivation and increased gastric acidity.
Nicotine Transdermal Patch
These patches are applied directly on the skin and nicotine is slowly absorbed into blood stream though the skin. Some of the side effects when using the nicotine transdermal patch include an itchy rash, dizziness, sleep disturbances and even nightmares.
Sleep associated disturbances can be reduced by using a 16 hour patch which is removed before bedtime. However, if you have morning cravings for nicotine, then a 24 hour patch is a better option.
Nicotine Nasal Spray
With this product, nicotine laden droplets are delivered into the nasal passages through a spray. The nasal lining is highly vascularized and the nicotine is quickly absorbed into the blood stream.
The nicotine nasal spray can help to reduce sudden cravings due to the rapid absorption of nicotine through the nasal passages. However, some of the the side effects on a nicotine nasal spray include, watery, red eyes, nasal irritation like nasal congestion, a runny/leaky nose, sneezing and aggravation of pre-existing upper respiratory conditions, cough, itchy throat and disturbances of smell.
Nicotine inhalers, also known as inhalators, deliver nicotine into the lungs through the mouth. Inhalers may have an added advantage over other replacement products in that to some extent it mimics the action of smoking. Some of the possible side effects associated with inhalers include coughing, gagging, itchy throat and abnormal breathing sounds when used by a person with a pre-existing respiratory disease..
* Nicotine inhalers should not be used by a person with any form of respiratory disease.
Nicotine Sublingual Tablets
These small tablets are placed under the tongue where they rapidly dissolve and are then absorbed into the blood stream. Some of the side effects include increased gastric acid, hiccups and nausea.
Similar to throat lozenges used for a sore throat, nicotine lozenges are sucked over 15 to 20 minutes. The nicotine is gradually released and absorbed into the blood stream through the lining of the mouth. The side effects of nicotine lozenges are similar to nicotine chewing gum and sublingual tablets, including increased gastric acid, hiccups, and nausea in addition to increased salivation (hypersalivation).
Dangers and Precautions of NRT
Nicotine replacement therapy (NRT) should be used with caution in the following scenarios :
NRT is usually not prescribed during pregnancy. Using nicotine through any delivery method may result in delivering a baby with a low birth weight. However, the use of NRT during pregnancy may be justified when a pregnant woman needs help to quit smoking since the dangers of tobacco smoking often outweigh the risks of NRT during pregnancy.
If NRT during pregnancy has to be considered, then intermittent doses with products like chewing gum, lozenges or inhalers may be advisable rather than a transdermal patch which delivers a steady dose.
Nicotine replacement therapy, if at all necessary in a lactating mother, should be taken at least an hour before breastfeeding to minimize the amount of nicotine in the breast milk. Gum, lozenges, a nasal spray or inhaler may therefore be the only viable options.
NRT should be used with caution in patients with cardiac problems such as a recent myocardial infarction (heart attack), arrhythmias (irregular heartbeats) or angina (chest pain).
Patients on certain chronic drugs like theophylline, which is used for asthma and other respiratory diseases, may need to reduce the dosage of their drug before commencing with NRT.
Any person below the age of 18 years should avoid NRT as the long term effects of NRT on growth and development has not as yet been ascertained.
Other NRT Information and Facts
- Most NRT products can be purchased without a prescription unless the person is below 18 years of age, but it is advisable to seek the advice of your doctor first.
- Combining two NRTs should only be done under a doctor’s guidance.
- NRT should not be stopped suddenly because it can cause the same type of nicotine withdrawal symptoms that are seen when a person quits smoking suddenly.
- Addiction to NRT is rare.
- Tea, coffee, beer and soft drinks may reduce nicotine absorption and should not be used at the same time as a NRT product.
- A person should stop smoking while on NRT as this could lead to nicotine toxicity.
- NRT should be continued for at 6 to 12 weeks after quitting smoking altogether. Recent evidence suggests that using nicotine transdermal patches for 6 months, instead of the prescribed 2 months, is more effective. (1)
- Nicotine patch works better when used longer. Medline Plus