What does nicotine replacement therapy do? 

Nicotine replacement therapy replaces nicotine in a controlled way and reduces cravings and withdrawal symptoms while the patient remains smoke-free.

Nicotine patch

Patches are discreet and convenient once you have them on, allowing you to forget they are there and carry on with your day. They release a steady amount of nicotine into the skin throughout the day, and help to relieve some of the physical cravings for nicotine.
Depending on your needs, you can choose clear or skin colour versions.

How do I use nicotine patches?

Patches can last either 16 hours, (take off an hour before bedtime), or 24 hours depending on your nicotine needs. Ask your GP, pharmacist, nurse or advisor to help you choose the right patch for you.

They come in three stages, (steps 1 to 3). The step you start with and the amount of time you stay on each stage varies depending on the particular patch and the amount that you smoke in a day.

It is best to change the site you put them on each day as this reduces the risk of irritation and allows the previous day’s site time to recover.

You should put the patch on a clean, dry and hairless area of skin. The most popular sites to apply the patches are on the upper arm, lower abdomen or thigh.

Avoid broken areas of skin or tattoos (as nicotine can irritate them and cause soreness).

If you have skin conditions or known allergies to patches or plasters you may get the same with the patches.

They can now be used alongside other nicotine preparations.

Nicotine gum

Chewing nicotine gum releases nicotine through the lining of the mouth. They are available in 2mg and 4mg strengths and should be used when you feel cravings starting and also at regular intervals to prevent cravings becoming stronger.

Nicotine gum is particularly useful for those who generally enjoy chewing gum.

How do I use nicotine gum?

It is important to use the gum regularly making sure you have enough pieces of gum in the day to avoid experiencing strong withdrawal symptoms and prevent going back to smoking. Usually 10 to 15 pieces a day.

You normally use the ‘chew and park’ technique. You chew the gum until the taste gets strong and then park the gum at the side of your mouth until the taste gets less. You repeat this until you feel you have had enough. Usually this lasts around 30 minutes.

2mg nicotine gum is most effective for smokers of 20 cigarettes a day or less. The 4mg nicotine gum is most effective for smokers of more than 20 cigarettes a day or who have their first cigarette within 30 minutes of waking.

Liquorice flavour is not suitable if you are pregnant as it can cause severe cramps.

Nicotine inhalator

The inhalator is small tube about the size of a cigarette with a cartridge containing nicotine within the tube.

Nicotine is absorbed through the lining of the mouth, not the lungs, and works best at room temperature.

It is a very popular medication and is often used as well as patches because it gives you something to do with your hands.

How do I use the nicotine inhalator?

At the start, you may need to use 6-12 cartridges a day.

Each cartridge can be used 2-3 times, although the number, frequency and duration of inhalations will vary depending on how you feel you need to use it.

This is not the best product for people with asthma, and those with lung problems such as COPD often find it hard to use properly.

Nicotine sublingual tablet

The nicotine 2mg sublingual tablet is placed under the tongue and slowly disintegrates within 30 minutes providing a discreet alternative for those either not able or not wishing to use the other forms of nicotine.

How do I use the nicotine sublingual tablet?

It is suitable for both light and heavy smokers and you would normally take one to two tablets an hour. Up to 16 tablets can usually be taken daily but do not exceed 40.

Nicotine lozenge

The nicotine lozenge comes in strengths of 1, 2 or 4mg and they cater for the whole range of light and heavy smokers. They are most suitable for those who prefer the action of sucking and those who are unable or do not wish to have the other preparations that are available.

How do I use the nicotine lozenge?

Suck the lozenge until it dissolves completely, using a similar ‘park and rest’ technique as nicotine gum.

Do not chew or swallow the lozenges as this may reduce their effect.

Use enough lozenges to improve the chance of success. Up to 15 a day.

These lozenges contain sodium, (salt), so if you have high blood pressure or have been told to have a low sodium diet then the lozenges are not the best medication for you

Nicotine mini lozenges

This is a new medication and is a small tablet that rapidly dissolves in the mouth. It is available in strengths of 1.5mg and 2mg lozenges for the lighter smoker and 4mg lozenges for the heavier smoker.

How do I use the mini lozenges?

Use up to 15 lozenges a day.

It is free of salt so can be used as an alternative to the other nicotine lozenges.

Being a small tablet, the mini lozenge provides a rapid but discreet alternative for those who are unable or do not wish to have the other preparations that are available.

Nicotine mouth spray

A nicotine solution is sprayed into the mouth and is absorbed via the lining of the mouth.

The spray starts to take effect within a few minutes, delivering nicotine faster than any other NRT.

It is, however, slower to deliver nicotine than a cigarette and is ideal for the highly dependent smokers who are either looking to stop completely or cut down.

How do I use the nicotine mouth spray?

The recommended initial dose is 1 to 2 doses per hour.

A dose is equal to one spray in each side of the mouth.

Maximum dose is 64 sprays a day, (4 sprays per hour).

Can cause local irritant side effects such as a sore throat, a burning sensation, hiccups, and nausea. These symptoms are usually mild and well tolerated. Dizziness has also been reported.

Nicotine nasal spray

Nicotine solution is sprayed into the nostrils and is absorbed via the lining of the nose.

This is fast-acting nicotine and takes effect in around 10 minutes.

How do I use the nicotine nasal spray?

Recommended initial dosage is 1 to 2 doses per hour.

One dose is equal to one spray in each nostril.

Can cause local irritation to the nose or throat, a runny nose and sneezing. These generally lessen with regular use.

Can I use two nicotine treatments at once?

Better results can be increased when you use two or more NRT products together. For example, if you use nicotine gum and a nicotine patch at the same time you increase your chance of staying stopped compared with a single treatment.

What do I need to know about nicotine replacement therapy?

Apart from the patches, most of the oral nicotine preparation doses are reduced at three months.

Most preparations, except for the patch and the nasal spray, are absorbed through the lining of the mouth so it is best to not have acidic drinks such as orange juice for 15 minutes before using the oral nicotine and for 15 minutes after.

Nicotine replacement therapy is available at most supermarkets and chemists or can be obtained on prescription from your GP or NHS Stop Smoking services (where with support and guidance you can quadruple your chances of success).

Generally, what side effects can I expect from nicotine replacement therapy?

• Indigestion.
• Heartburn.
• Skin irritation, (mainly when using patches and nasal spray).
• Mouth ulcers. Mainly from the oral therapies but also as a result of stopping smoking.
• Sleep disturbance. Nightmares and vivid dreams mainly happen with the 24-hour patches.

Extract taken from Stop Smoking – The Essential Guide by Simon Daubney. For more information on nicotine replacement therapy and the help available for giving up smoking, take a look at the book - available now in printed and eBook format. By the printed version and get the eBook free!