Nicotine Replacement Therapy (NRT)

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. 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 your doctor.
• 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.

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 your doctor.

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.

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.


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.

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.
• 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.