indiacancer.org - Tobacco and Cancer

Nicotine Replacement therapy.

The nicotine patch, gum, and nasal spray are also known as nicotine replacement therapy, or nicotine substitutes. They are medicines that provide nicotine without the other harmful components of tobacco.

Nicotine substitutes treat the very difficult withdrawal symptoms and cravings that 70 to 90% of smokers say is their only reason for not giving up cigarettes. By using a nicotine substitute, a smoker's withdrawal symptoms are reduced, allowing the smoker to deal with the psychological aspects of quitting smoking.

While a large number of smokers are able to quit smoking without nicotine replacement, about two-thirds of those who attempt quitting are not successful. Lack of success is often related to the onset of withdrawal symptoms. By reducing these symptoms, smokers who want to quit have a better chance of being successful. For smokers, nicotine blood levels will vary, depending on individual smoking patterns such as the time between cigarettes, how deeply the person inhales, the number of cigarettes smoked per day, and the brand smoked. Smoking delivers nicotine to the bloodstream very quickly, within a few seconds. Nicotine replacement works more slowly, and the amount of nicotine in the bloodstream is less than that from smoking. But it offers several advantages for people trying to quit. Nicotine replacement is a cleaner form of nicotine. It avoids the thousands of poisons and tar that are found in burning tobacco. Nicotine replacement delivers a lower dose of nicotine. Nicotine replacement reduces withdrawal symptoms, allowing the smoker to focus on the psychological aspects of quitting.

Getting the most from nicotine replacement since nicotine replacement therapy deals with the physical aspects of addiction, it is not intended to be used as the only method for helping the smoker. Rather it should be combined with other smoking cessation methods that address the psychological component of smoking, such as a stop-smoking program. Studies have shown that a combined approach that pairs nicotine replacement with behavioral counseling (to change behavior) can double the number of smokers who quit smoking.

Nicotine replacement therapy is recommended in the US Agency on Health Policy and Research Clinical Practice Guideline on Smoking Cessation for all smokers except pregnant women and people with heart or Circulatory diseases.

The most effective time to start nicotine replacement is at the beginning of an attempt to quit. Often smokers attempt to quit first on their own, then decide to try a nicotine replacement. Nicotine replacement should not be used if you plan to continue to smoke or use another tobacco product.

Types of nicotine substitutes:

Nicotine patches (transdermal nicotine system) provide a measured dose of nicotine through the skin. As the nicotine doses are lowered over a course of weeks, the smoker is weaned away from nicotine. Patches can be purchased without a prescription. Several types and different strengths are available. Package inserts describe how to use the product as well as special considerations and possible side effects.

The 16-hour patch works well for light-to-average smokers and is less likely to cause side effects like skin irritations, racing heart beat, sleep problems, and headache. But it does not deliver nicotine during the night, so it is not helpful for early morning withdrawal symptoms. The 24-hour patch provides a steady dose of nicotine, avoiding peaks and troughs. It helps with early morning withdrawal. However, there may be more side effects such as disrupted sleep patterns and skin irritation.

Depending on body size, most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for four weeks, and then use a weaker patch (5-14 mg of nicotine) for another four weeks. The patch should be applied in the morning to a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist, for example, on the arm. The FDA recommends using the patch for three to five months. However, some studies have shown that using it for eight weeks or less is just as effective as using it for longer.

Side effects are related to the dose of nicotine, the brand of patch, individual skin characteristics, how long the patch is used, and how it is applied. The most common side effects are mild skin irritations such as redness and itching. Trying a different brand sometimes solves the problem. Dizziness, racing heartbeat, sleep problems, headache, nausea, vomiting, and muscle aches and stiffness are related to the dose of nicotine. Reducing the amount of nicotine will often relieve these effects. Sleep problems may be temporary and pass within 3 to 4 days. Or switching to a 16-hour patch or a lower dose patch may help. But sometimes, if side effects are too severe, it may be necessary to stop using the patch. Trying a different form of nicotine replacement is another option.

Available In India
Nicotinell Tts - Novartis
(Transdermal patches) 17.5 mg - 30 Approximate cost Rs. 2895
35 mg - 30 Rs. 3240
52.5 mg - 30 Rs. 3540

Nicotine gum (nicotine polacrilex) is a fast-acting form of replacement in which nicotine is absorbed through the mucous membrane of the mouth. It can be bought over-the-counter without a prescription. It comes in 2 mg and 4 mg strengths. For best results, follow the instructions of the package insert. Chew the gum slowly until you note a peppery taste. Then, "park" it against the cheek, chewing it and parking it off and on for about 20-30 minutes. Food and drink can affect how well the nicotine is absorbed. You should avoid acidic foods and drinks such as coffee, juices, and soft drinks for at least 15 minutes before and during gum use.

The smoker who smokes a pack or more per day, who smokes within 30 minutes of rising, or who has trouble not smoking in restricted areas, may need to start with the higher dose, 4 mg gum. No more than 20 pieces should be used in one day. Nicotine gum is usually recommended for one to three months, with the maximum being six months. Tapering the amount of gum chewed may help to stop using it.

One advantage of nicotine gum is that it allows the user to control the nicotine doses. The gum can be chewed as needed or on a fixed schedule during the day. The most recent data has shown that scheduled dosing is more effective. A schedule of one to two pieces per hour is common. With an as-needed schedule, the smoker can chew more nicotine during a craving. Also, people with sensitive skin may prefer the gum to the patch.

Side effects of the gum can include a bad taste, throat irritation, mouth ulcers, hiccups, nausea, jaw discomfort, and racing heartbeat. Symptoms related to the stomach and jaw are usually caused by improper use of the gum, such as swallowing nicotine or chewing too rapidly. Long-term dependence is one disadvantage of nicotine gum. In fact, research has shown that 15%-20% of gum users who successfully quit smoking continue using the gum for a year or longer. Although the maximum recommended length of use is six months, continuing to use the gum is likely to be safer than going back to smoking. But since there is little research on the health effects of long-term nicotine gum use, most health care providers still recommend limiting its use to six months.

Available in India
Nicorette - Pharmacia & Upjohn
Gum 2mg
Approximate cost: 15 pieces Rs. 150=00

Nicotine nasal spray delivers nicotine quickly to the bloodstream as it is absorbed through the nose. It is available by prescription only. Nasal spray gives immediate relief of withdrawal symptoms and offers the smoker a sense of control over nicotine cravings. Because it is easy to use, smokers report great satisfaction. Generally, it should not be used for longer than six months, tapering the dose at the end of three months. The most common side effects, which last about one to two weeks, include nasal irritation, runny nose, watery eyes, sneezing, throat irritation, and coughing. There is also the danger of using more than is needed. If you have asthma, allergies, nasal polyps, or sinus problems, your doctor may suggest another form of nicotine replacement.

Nicotine inhalers, a form of nicotine replacement introduced in 1998, is available only by prescription. The nicotine inhaler is a plastic rod with a nicotine plug. When a person puffs on the inhaler, the plug provides a nicotine vapor. Unlike other inhalers, which deliver most of the medication to the lungs, the Nicotine inhaler delivers most of the nicotine vapor to the mouth. Common side effects are coughing and throat irritation. Using a nicotine inhaler, a smoker may feel like they are substituting some of the behavioral aspects of smoking.

Not Available As Yet In India

Which type of nicotine replacement is right for you?

When choosing which type of nicotine replacement you will use, think about which method will best fit your lifestyle and pattern of smoking. Consider whether or not you want something to chew or occupy your hands. Are you looking for once a day convenience? Nicotine gum is an oral substitute and allows you to control your dosage to help keep cravings at bay. Nicotine nasal spray works very quickly when you need it. Nicotine inhalers mimic cigarettes by puffing and holding the inhaler. Nicotine patches are convenient and only have to be applied once a day.

Are they within your financial reach? In india they are expensive for common man.
Other methods of quitting

Zyban (Bupropion) is a prescription antidepressant in an extended-release form that reduces symptoms of nicotine withdrawal. This drug affects chemicals in the brain that are related to nicotine craving. Zyban can be used alone, or together with nicotine replacement. In one study, Zyban helped 49% of smokers quit for at least a month. Thirty-six percent of nicotine patch users in the same study were able to quit for a month. Use of both methods helped 58% to remain smoke free for over a month. This medication is not intended for those with a history of seizures, anorexia, heavy alcohol use, or head trauma.

(Not available in India).

Hypnosis can be useful for some people. Ask your doctor if he or she can recommend a good hypnotist.

Acupuncture has been used for quitting smoking but there is little evidence to support its effectiveness.

Filters that reduce tar and nicotine in cigarettes are generally not effective since studies show that smokers who use filters actually tend to smoke more.

Between one-fourth and one-third of smokers who use nicotine replacement or bupropion can remain smoke-free for over six months. About 5-16% of people is able to quit smoking for at least 6 months without any medicine to help with withdrawal.

Your own success in quitting is under your control. Behavioral and supportive therapies increase quit rates.