Replacement therapies can help heavy smokers quit

If you're a heavy smoker who's ready to quit, nicotine replacement therapy offers an alternative to the cold turkey option.

Nicotine replacement helps relieve cravings through products that provide the user with low doses of nicotine without the toxins found in smoke. It gives the greatest benefit to moderate-to-heavy smokers, those who smoke more than 15 cigarettes a day.

The US Food and Drug Administration (FDA) has approved 5 types of nicotine replacement therapy: patch, gum, nasal spray, inhalers, and lozenges.

Nicotine patches
Patches give a measured dose of nicotine through the skin. You are weaned off nicotine by switching to lower-dose patches over a course of weeks. Patches can be bought with or without a prescription. Many types and different strengths are available. Package instructions tell you how to use the product, and list special considerations and possible side effects. Follow the directions carefully.

The 16-hour patch works well if you are a light-to-average smoker. It’s less likely to cause side effects like skin irritation, racing heartbeat, sleep problems, and headache. But it does not deliver nicotine during the night, so it may not be right for those with early morning withdrawal symptoms.

The 24-hour patch provides a steady dose of nicotine, avoiding peaks and valleys. It helps with early morning withdrawal. But there may be more side effects like disrupted sleep patterns and skin irritation.

Depending on body size and smoking habits, most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5-14 mg of nicotine) for another 4 weeks. The patch should be put on in the morning on 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 upper arm or chest. The FDA has approved using the patch for a total of 3 to 5 months.

Nicotine gum
Nicotine gum is a fast-acting form of replacement in which nicotine is taken in through the mucous membrane of the mouth. You can buy it over the counter without a prescription. It comes in 2 mg and 4 mg strengths.

For best results, follow the instructions in the package. Chew the gum slowly until you get a peppery taste or tingle. Then hold it inside your cheek until the taste fades. Chew it to get the peppery taste back, and park it again. Do this off and on for 20 to 30 minutes. Food and drink can affect how well the nicotine is absorbed, so don’t eat or drink for at least 15 minutes before and during gum use.

In choosing your dose, think about whether you smoke 25 or more cigarettes per day, smoke within 30 minutes of waking up, or have trouble not smoking in restricted areas. If any of these describe you, you may need to start with the higher gum dose (4 mg).

Chew no more than 24 pieces of gum in one day. Nicotine gum is usually recommended for 6 to 12 weeks, with the maximum being 6 months. Tapering down the amount of gum you use as you approach 3 months may help you stop using it.

If you have sensitive skin, you might prefer the gum to the patch.

Another advantage of nicotine gum is that it allows you to control the nicotine doses. The gum can be used as needed or on a fixed schedule during the day. The most recent research has shown that scheduled dosing works better. A schedule of 1 to 2 pieces per hour is common. On the other hand, with an as-needed schedule, you can use it when you need it most — when you have cravings.

Nicotine nasal spray
The nasal spray delivers nicotine to the bloodstream quickly because it’s absorbed through the nose. Nicotine nasal spray requires a doctor’s prescription.

Nicotine nasal spray: The nasal spray delivers nicotine to the bloodstream quickly because it’s absorbed through the nose. Nicotine nasal spray requires a doctor’s prescription.

The nasal spray relieves withdrawal symptoms very quickly and lets you control your nicotine cravings. Smokers usually like the nasal spray because it’s easy to use. Nicotine is addictive, and a person can transfer their dependence from cigarettes to the fast-delivering nasal spray. Use it only as long as you need it, as prescribed by your doctor. The FDA recommends that the spray be prescribed for 3-month periods and that it not be used for longer than 6 months.

There’s 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 NRT.

This form of NRT poses a more serious risk to small children and pets, since even empty bottles of nasal spray contain enough nicotine to harm them. Nicotine absorbs through the skin as well as mucous membranes like the mouth or eyes, and can cause serious harm. If there’s any skin contact, rinse thoroughly with plain water right away. If a bottle breaks or liquid leaks out, put on plastic or rubber gloves to clean it up. Call Poison Control and get emergency help if there’s any question of overdose.

Nicotine inhalers
Inhalers are available only by prescription. The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. It looks a bit like a fat cigarette with a mouthpiece. When you take a puff from the inhaler, the cartridge puts out a nicotine vapor. Unlike other inhalers, which deliver most of the medicine to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth where it’s absorbed into the bloodstream. Nicotine inhalers are the FDA-approved nicotine replacement method that’s most like smoking a cigarette, which some smokers find helpful.

The recommended dose is between 4 and 20 cartridges a day, for up to 6 months.

This form of NRT poses an extra risk to small children and pets because the used cartridges still have enough nicotine in them to cause harm if it gets on skin or mucous membranes (for instance, if licked or touched to the eyes, mouth, or other mucous membrane). Be sure to store and dispose of the cartridges away from children and pets.

At this time, inhalers are the most expensive forms of NRT available. They are not the same as electronic cigarettes, which are not approved by the FDA to help people quit smoking. (For more on these, see “Other nicotine and tobacco products not reviewed or approved by the FDA” in the “Other methods of quitting” section.)

Nicotine lozenges
Nicotine-containing lozenges can be bought without a prescription. Like nicotine gum, the lozenge is available in 2 strengths: 2 mg and 4 mg. Smokers choose their dose based on how long after waking up they normally have their first cigarette.

Lozenge makers recommend using them as part of a 12-week program. The recommended dose is 1 lozenge every 1 to 2 hours for 6 weeks, then 1 lozenge every 2 to 4 hours for weeks 7 to 9, and finally, 1 lozenge every 4 to 8 hours for weeks 10 to 12.

Whatever type you use, take your NRT at the recommended dose, and use it only for as long as it’s recommended. If you use a different dose or stop taking it too soon, it can’t be expected to work like it should. If you are a very heavy smoker or a very light smoker, you may want to talk with your doctor about whether your NRT dose should be changed to better suit your needs.

Source: The American Cancer Society: www.cancer.org