Nicotine replacement products can help you manage cravings and nicotine withdrawal. These products have been demonstrated to be effective and safe for most individuals in controlled clinical trials.
The methods of nicotine replacement we may recommend for you are described below. Always check with your doctor before using any nicotine replacement product to ensure that it is safe and appropriate for you.
The nicotine patch provides a steady amount of nicotine to the body transdermally, or through the skin. Starting on your “quit date,” the patch is applied daily each morning and worn for 16 or 24 hours. You must not smoke while using the patch because your body may get too much nicotine (overdose).
A typical regimen is as follows:
- First 4-6 weeks, starting dose of 21-22 mg patch for 16/24 hours
- Next 2-4 weeks, taper to 14 mg patch for 16/24 hours
- Final phase, taper to the lowest dose, 7 mg patch, for 16/24 hours
- Total recommended duration of treatment is 6-12 weeks
Most studies indicate that abrupt cessation of the use of patches does not cause significant withdrawal symptoms; thus, tapering may not be necessary. The nicotine transdermal patch is available over the counter (NicoDerm® CQ®) as well as by prescription.
Who Should Not Use the Patch?
- More Common — Rash/itching/redness of skin where the patch is applied, insomnia (difficulty sleeping), headache
- Less Common — Nausea, upset stomach, abnormal dreams, nervousness
Nicotine gum (Nicorette®) delivers nicotine in either 2 or 4 mg doses through buccal (mouth) absorption. There is a specific 30-minute chewing regimen, which differs from the ordinary way of chewing gum in the rate of chewing and the need to “park” the gum between your cheek and gums for periods of time to maximize absorption. An acidic environment decreases absorption of nicotine, so beverages such as coffee, juice, and sodas should not be used immediately before, during, or after nicotine gum use. For those who smoke one to 24 cigarettes per day, the 2 mg gum is recommended. For those who smoke 25 or more cigarettes daily, the 4 mg gum is recommended. Scheduled dosing, e.g. one piece of 2 mg gum per hour, is considered more effective than irregular use. Nicotine gum is available over the counter and by prescription. Be sure that no one else uses the gum, and keep out of reach of children and away from pets.
Who Should Not Use Nicotine Gum?
- Pregnant or nursing women
- Anyone still smoking (risk of overdose)
- Those who are allergic to the nicotine patch
- People who have other health problems should check with their doctor before using nicotine gum
Some people develop mild side effects such as hiccups, upset stomach, or jaw ache. Most of these side effects go away if the gum is used correctly.
Nicotine Nasal Spray
Nicotine nasal spray (Nicotrol NS®) is a nicotine solution in a nasal spray bottle like those used with antihistamines. The average dose of one spray administration delivers approximately 1 mg of nicotine. Compared to nicotine gum, the spray produces a more rapid rise in blood nicotine levels, with peak levels occurring within ten minutes after dosing. Smokers are instructed to use the spray as needed up to 30 times per day for 12 weeks, including a tapering-down period.
The nasal spray is available by prescription only.
Who Should Not Use Nicotine Nasal Spray?
Major side effects are nasal and throat irritation, rhinitis, sneezing, coughing, and watering eyes, with one or more of these occurring in 75 percent of patients. The nasal spray does have dependence potential, based on findings in some studies that several patients who quit smoking continued to use the spray for long periods.
The nicotine inhaler (Nicotrol® nicotine inhalation system) consists of a plastic mouthpiece shaped like the tip of a tobacco pipe, and blister-pack cartridges, each of which delivers 4 mg of nicotine from a porous plug containing 10 mg nicotine (only 4mg of which are actually delivered). The cartridge is inserted into the mouthpiece prior to use, and the user inhales through the mouthpiece using deep inhalation or shallow puffing as needed. The nicotine is flavored with menthol. As with nicotine gum, the nicotine from the inhaler is absorbed mainly in the mouth, not in the lungs. The initial recommended dose is 6 to 16 cartridges per day for up to 12 weeks, followed by gradual reduction for the next 6 to 12 weeks, with the aim of finishing treatment by the end of six months.
The inhaler is available by prescription only.
Who Should Not Use the Nicotine Inhaler?
See guidelines for nicotine gum and nicotine nasal spray. Additionally, because nicotine is an airway irritant, those with asthma or pulmonary disease should consult their doctors before use. Other forms of nicotine replacement may be advisable for such persons.
Some people may cough, experience irritation in the nose, mouth, and throat, or have heartburn or nausea. These are usually mild and decrease within a couple of weeks.
The Nicorette Lozenge delivers nicotine in either 2 or 4 mg doses through the buccal (mouth) mucosa. The lozenge is designed to dissolve in the mouth, occasionally being moved from one side of the mouth to the other, as you would with any other lozenge. It will take approximately 20 to 30 minutes to completely dissolve. In order to maximize the absorption of nicotine, do not eat or drink 15 minutes before using the lozenge or while the lozenge is in your mouth. Using more than one lozenge at a time or continuous use (one lozenge after the other), as well as chewing or swallowing the lozenge, may cause hiccups, heartburn, nausea, or indigestion. For those who use their first cigarette more than 30 minutes after waking, the 2 mg lozenge is recommended; for those who smoke within 30 minutes after waking, the 4 mg lozenge is recommended. It is recommended to use at least nine lozenges per day during the first six weeks, but not to exceed 20 per day, or more than five lozenges in a six-hour period. The nicotine lozenge is available over the counter. Be sure that no one else uses the lozenge, and keep out of reach of children and away from pets.
Who Should Not Use the Nicotine Lozenge?
- Pregnant or nursing women
- Anyone still using tobacco products such as smoking cigarettes, cigars, chewing tobacco, and snuff
- People who have other health problems should check with their doctor before using the lozenge
A warm or tingling sensation as nicotine is released in your mouth is normal. However, stop using the lozenge and consult your physician if you experience persistent mouth problems or indigestion, severe sore throat, irregular heart beat, palpitations, nausea, dizziness, diarrhea, weakness, or a rapid heart beat.
Zyban® is a reformulation of the antidepressant Wellbutrin® (bupropion IR). Although it is unknown exactly how Zyban reduces symptoms of nicotine addiction and withdrawal, it nonetheless appears to be an effective smoking cessation method for many people.
Zyban is available by prescription only.
Who Should Not Use Zyban?
- Anyone with seizure disorders (e.g. epilepsy) or at risk of seizures
- Anyone with an eating disorder (e.g. bulimia, anorexia)
- Anyone already taking bupropion or a monoamine oxidase (MAO) inhibitor for depression
- Pregnant or nursing women
- Those who are allergic to bupropion
- More Common — Insomnia (difficulty sleeping), dry mouth, dizziness, runny nose
- Less common — Loss of concentration, nausea, constipation, dizziness, anxiety
Note: There is a chance that 1 out of every 1,000 (0.1 percent) people taking bupropion will have a seizure.
For those whose cravings have not been sufficiently managed with nicotine replacement or Zyban, there are other medications and treatment options that your heath care provider can discuss with you.