12 January 2009

More about NRT

Studies show that your chances of successfully giving up smoking are greatly increased if make Nicotine Replacement Therapy (NRT) part of your quit-strategy.


Studies show that your chances of successfully giving up smoking are greatly increased if make Nicotine Replacement Therapy (NRT) part of your quit-strategy.

What is NRT?
NRT is a supplementary aid to be used during the first few weeks and months of stopping smoking. It supplies you with small doses of nicotine to help reduce your urge to smoke, and allows you to gradually wean yourself off the drug. The nicotine levels in NRT products are lower than those in cigarettes, and don’t give the same ‘kick’ – but the levels are sufficient to help relieve the cravings and withdrawal symptoms.

Smoking delivers nicotine to the bloodstream within a few seconds, while NRT generally works more slowly and delivers lower amounts than cigarettes do.

NRT is available in several different forms: nicotine gum, patches, oral inhalers and oral sprays can all be bought over-the-counter in South Africa. The gum and patches are currently the most popular forms. These products cost about the same or less than a pack of cigarettes per day, and you’ll save in the long run because you only have to use them for a short period.

What NRT can’t do
NRT is a great tool, but it isn’t going to keep you smoke-free all by itself. It only deals with the physical aspects of addiction, and should be combined with other smoking cessation methods that tackle the psychological component of smoking, such as a stop smoking programme.

Safety considerations
NRT products are far safer than smoking cigarettes, and carry a very low risk of dependency. (It’s most unlikely that NRT will make you more addicted to nicotine than you were as a smoker!)

Pregnant women and people with cardiovascular disease shouldn’t use NRT, unless your doctor considers that the benefits of smoking cessation outweigh the potential health risk in your case. If you have any doubts, consult your doctor first.

Don’t use NRT if you’re still using tobacco, and stop NRT if you start smoking again. The combined dose of nicotine could be dangerous, and can interfere with how the NRT products are designed to work most effectively. The best time to start NRT is on the first day you stop smoking, or soon after. Also: don’t use more than one NRT product at a time without your doctor’s knowledge. Combined use of these products may be useful, but the effectiveness and associated risks are still being researched.

If you start smoking again during or after a course of NRT, it’s best to consult your doctor before you attempt a new course. Also tell your doctor if you find yourself continuing to use NRT products over the recommended time period.

You may experience side effects from NRT, but these are usually mild and short-lived.

Forms of NRT

Nicotine patch
Nicotine patches are stuck directly onto the skin. The drug is gradually released and absorbed through the skin without producing the sudden peaks in nicotine levels that occur with smoking.

A week’s worth of patches cost about R100-R120. They come in different strengths: you begin with the highest dose and work your way down to the weakest. Depending on body size, most tobacco users should start using a full-strength patch (15-22 mg nicotine) daily for several weeks, and then gradually taper off with weaker patches (about 10-15mg, followed by 5mg). Two months may be sufficient in your case, although some people use the patch for up to five months. Longer than this is not recommended.

The patch should be applied in the morning to a clean, dry, non-hairy area, such as the inner arm, and the skin shouldn’t be broken or inflamed. Place each new patch on a different area of skin to the one before: this makes negative skin reactions less likely.

Possible side effects of the patch include: skin irritation, headache, dizziness, racing pulse, disturbed sleep, nausea, vomiting, digestive tract discomfort and stiff or sore muscles. If any of these occur, try switching to a lower dose patch, a different brand of patch, or a different form of NRT altogether.

Nicotine gum
Nicotine gum is a relatively fast-acting form of NRT that delivers nicotine into the bloodstream through the lining of the mouth. The gum is available in full strength dose (4 mg nicotine) and low strength (2 mg nicotine). The full strength dose is suitable for highly dependent smokers or those who find the 2 mg gum ineffective. Blood nicotine levels on the 2 mg dose are about one third those achieved by smoking; the 4 mg dose is about two thirds that of smoking. However, chewing 4 mg gum every hour can raise blood nicotine levels to equal those of smoking.

If you have sensitive skin, you may prefer gum to the patch. Another advantage of gum is that it allows you to control when the nicotine dose is administered. You can use the gum whenever you get the urge to smoke, or you can take it according to a set schedule (i.e. a certain amount at regular intervals) during the day. Unwrapping the gum, placing it in the mouth, chewing etc, is also useful for people who miss the ritualistic aspect of smoking.

A packet of 15 pieces of gum costs about R25, and you usually continue using it for one to three months, gradually reducing the number of pieces chewed each day. Don’t use more than 15 pieces of gum per day.

Nicotine gum shouldn’t be chewed continuously like ordinary chewing gum. Instead, a piece is chewed slowly until you notice a pronounced, sharp taste or a slight tingling in your mouth. This indicates that the chewing action has released nicotine from the gum. Then keep it against the inside of your cheek to allow the nicotine to be absorbed. After the taste or tingling is almost gone (after about a minute), chew slowly again until the taste is more pronounced. This process is repeated, i.e. chewing off and on for 20-30 minutes. Avoid acidic foods and drinks (including coffee) for at least 15 minutes before and during gum use, as these can interfere with absorption of the nicotine.

Possible side effects include: dizziness or light-headedness, mouth and throat irritation, mouth ulcers, hiccups, nausea, vomiting, digestive tract discomfort, jaw muscle ache, racing heartbeat and increased salivation. Many of these symptoms are caused by swallowing nicotine or chewing too quickly.

Long-term dependence is one potential disadvantage of nicotine gum. Research indicates that 15-20% of gum users who stop smoking continue using the gum for a year or longer. This is very likely to be safer than smoking, but still not advisable because little research has been conducted on the health effects of long-term NRT use.

Oral nicotine inhalers and sprays
Oral nicotine inhalers and sprays have the advantage of addressing some of the behavioural aspects of nicotine addiction; specifically, the hand-to-mouth action that many quitting smokers miss. Both also allow you to control your nicotine intake.

An inhaler consists of a mouthpiece and a replaceable nicotine cartridge. When you draw air into your mouth through the mouthpiece, the cartridge produces a nicotine vapor, most of which is delivered to the mouth and absorbed there. Very little vapour reaches the lungs, so the nicotine ‘peaks’ that occur with cigarette smoking are not as high and sudden. Blood nicotine levels are approximately 30% of those during smoking. Ten puffs are roughly equivalent to one puff on a cigarette.

An inhaler and 10 cartridges costs about R70. About six to 12 cartridges are used per day for up to three months. The following three months are used to gradually reduce the number of cartridges used.

The most common side effects, especially when first using the inhaler, include coughing, throat irritation and upset stomach.

The oral spray is sprayed into the mouth, usually onto the tongue, from where the nicotine is absorbed into the bloodstream. Four cannisters, which provide 12 weeks of treatment, cost about R300. The cannisters are inserted and used in sequence, from strongest to weakest nicotine dose.

Read more:
What do your cigarettes mean to you?
Nicotine is a stimulant


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