Types of Nicotine Substitutes ( For Quit Smoking)

Types of Nicotine Substitutes

The Food and Drug Administration (FDA) has approved five types of nicotine replacement therapy.

Nicotine patches (transdermal nicotine systems): Patches give a measured dose of nicotine through the skin. You are weaned off nicotine by switching to lower nicotine dose patches over a course of weeks. Patches can be bought with or without a prescription. Many 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 if you are a light-to-average smoker. It is 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 is not helpful for 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 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 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 arm. The FDA recommends using the patch for a total of 3 to 5 months.

Side effects are related to:

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the dose of nicotine
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the brand of patch
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skin characteristics (such as the person's tendency to have a skin reaction to the patch)
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how long the patch is used
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how it is applied

Some possible side effects of the nicotine patch include:

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skin irritation -- redness and itching
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dizziness
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racing heartbeat
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sleep problems or unusual dreams
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headache
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nausea
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vomiting
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muscle aches and stiffness

What to do about side effects:

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Do not smoke while you are using a patch.
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Try a different brand of patch if your skin becomes irritated.
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Reduce the amount of nicotine by using a lower dose patch.
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Sleep problems may be short-term and pass within 3 or 4 days. If not (and you're using a 24-hour patch), try switching to a 16-hour patch.
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Stop using the patch and try a different form of nicotine replacement.

Nicotine gum (nicotine polacrilex): 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 on 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 to 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.

If you smoke a pack or more per day, smoke within 30 minutes of waking up, or have trouble not smoking in restricted areas, you may need to start with the higher dose (4 mg). Chew no more than 20 pieces of gum in one day. Nicotine gum is usually recommended for 1 to 3 months, with the maximum being 6 months. Tapering the amount of gum chewed may help you stop using it.

If you have sensitive skin, you may 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 chewed as needed or on a fixed schedule during the day. The most recent data have 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 chew more gum during a craving.

Some possible side effects of nicotine gum:

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bad taste
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throat irritation
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mouth sores
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hiccups
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nausea
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jaw discomfort
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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 fast. The gum can also damage dentures and dental prostheses.

Long-term dependence is one possible disadvantage of nicotine gum. In fact, research has shown that 15% to 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 6 months, continuing to use the gum is probably 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 6 months.

Nicotine nasal spray: The nasal spray delivers nicotine to the bloodstream as it is quickly absorbed through the nose. It is available only by prescription.

The nasal spray relieves withdrawal symptoms very quickly and lets you control your nicotine cravings. Smokers usually like the nasal spray because it is easy to use. However, the FDA warns users that since this product contains nicotine, it can be addictive. It recommends that the spray be prescribed for 3-month periods and should not be used for longer than 6 months.

The most common side effects last about 1 to 2 weeks and can include the following:

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nasal irritation
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runny nose
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watery eyes
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sneezing
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throat irritation
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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: Introduced in 1998, these inhalers are available only by prescription. The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. When you puff on 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. In terms of similar behavior, nicotine inhalers are the closest thing to smoking a cigarette, which some smokers find helpful.

The recommended dose is between 6 and 16 cartridges a day, for up to 6 months.

The most common side effects, especially when first using the inhaler, include:

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coughing
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throat irritation
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upset stomach

At this time, inhalers are the most expensive forms of NRT available.

Nicotine lozenges: Nicotine-containing lozenges as an over-the-counter aid in smoking cessation are the newest form of NRT on the market. As with nicotine gum, the Commit® 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.

The lozenge manufacturer recommends using it as part of a 12-week program. The recommended dose is one lozenge every 1 to 2 hours for 6 weeks, then one lozenge every 2 to 4 hours for weeks 7 to 9, and finally, one lozenge every 4 to 8 hours for weeks 10 to 12. The manufacturer also recommends the following:

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Stop all smoking when you begin to use the lozenge.
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Do not eat or drink for 15 minutes before using the lozenge. (Some drinks can reduce how well the lozenge works.)
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Suck on the lozenge until it is fully dissolved, about 20 to 30 minutes. Do not bite or chew it like a hard candy, and do not swallow it. The medicine is taken in through the tissues of the mouth.
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Do not use more than 5 lozenges in 6 hours, or more than 20 lozenges total per day.
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Stop using the lozenge after 12 weeks. If you still feel you need to use the lozenge, talk to your doctor.
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Do not use the lozenge if you continue to smoke, chew tobacco, use snuff or any other product containing nicotine (e.g., nicotine patch or gum).

Possible side effects of the nicotine lozenge include:

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trouble sleeping
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nausea
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hiccups
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coughing
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heartburn
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headache
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flatulence (gas)