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Smoking Cessation Drugs: Nicotine Replacement Products

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Type of Medication:

Nicotine replacement

Medications and Their Commonly Used Brand Names

Type of medication	Brand name
Nicotine patch/transdermal nicotine	Habitrol NicoDerm CQ Nicotrol ProStep
Nicotine gum/lozenges	Nicorette/Commit
Nicotine nasal spray	Nicotrol NS
Nicotine inhaler	Nicotrol Inhaler

What They Are Prescribed For

Nicotine replacement products are used to help people stop smoking . These products work best as part of a program that also includes education, counseling, and/or psychological support.

How Nicotine Replacement Products Work

These products provide nicotine without the cigarette and help to wean your body off of nicotine. The typical effects of withdrawal are reduced as your body adjusts to not smoking. The products provide you with progressively lower doses of nicotine until you stop using them.

Nicotine patch releases nicotine through your skin and into your bloodstream.

Nicotine gum is chewed slowly, and then stored between the gum and cheek so that the nicotine can be absorbed through the lining of your mouth and into your bloodstream.

Nicotine lozenges are allowed to dissolve slowly in your mouth to release nicotine at a slow rate.

Nicotine nasal spray contains small doses of nicotine that are sprayed into your nasal passages and absorbed into your bloodstream.

Nicotine inhaler contains nicotine that is inhaled through the mouth and is absorbed in the mouth and throat.

Sometimes these products are used in combination, like the patch along with the lozenges, which may help some people stay smoke-free.

Precautions While Taking These Medicines

Do Not Smoke

Smoking and using nicotine replacement products can be dangerous because nicotine can build up to toxic levels. Since your goal is to quit smoking entirely, you should not smoke while using a nicotine replacement product. If you still have the urge to smoke, you may need a new strategy to quit.

One study showed that the use of a nicotine replacement product before the actual quit day could be beneficial. Talk to your doctor to find out if this strategy is a good approach for you.

See Your Doctor

Patches, lozenges, and gums can be purchased over-the-counter, but the nasal spray and inhaler require a prescription. Your doctor will help you determine the appropriate dosage. Also, your doctor can prescribe additional smoking cessation aids and can refer you to a counselor, support group, or other services that may help you quit smoking. People who combine several quitting strategies often have the most success.

Do Not Overuse These Products

After quitting smoking, the goal is to end your use of the nicotine replacement products as well. Here are guidelines for how long you should use these products:

Nicotine patch—Do not use longer than 6-12 weeks.

Nicotine gum—Do not chew or use more than 24 pieces a day; do not use longer than 12 weeks.

Nicotine lozenges—Do not use more than 20 lozenges a day; do not use longer than 12 weeks.

Nicotine nasal spray—Do not use longer than 12 weeks.

Nicotine inhaler—Do not use longer than 12 weeks.

If You Are Pregnant or Breastfeeding, Talk to Your Doctor

If you are pregnant, planning on becoming pregnant, or breastfeeding, talk to your doctor to select a safe method to quit smoking. Ask if nicotine replacement products are a good option for you.

Be Careful Around Children

Children can be seriously harmed by any amount of nicotine. Keep these products, including used patches, away from children.

Use With Adolescents and Older Adults

Nicotine replacement products are believed to be safe for adolescents and older adults. People with dentures, though, should avoid using nicotine gum because it could cause damage.

Manage Your Medications

Tell your doctor about all the medications you take. Some should not be taken when you are quitting smoking with nicotine replacement products, while others may require a different dosage level.

Be Cautious With Certain Conditions

The presence of other conditions may affect the use of nicotine replacement products. Tell your doctor if you have any other medical problems, such as:

Allergies

Asthma or other breathing problems

Common cold or a stuffy nose

Dental problems

Type 1 diabetes

Heart or blood vessel disease

High blood pressure

Inflammation of mouth, throat, or esophagus

Skin irritation or disorder

Liver disease

Nose polyps

Overactive thyroid

Pheochromocytoma

Sinus problems

Stomach ulcer

Recent stroke

Temporomandibular joint disorder

Possible Side Effects

There are side effects associated with taking nicotine replacement products. The side effects you may experience will depend on the type of product you choose. For example, rash has been associated with using the patch while nasal irritation has been associated with using the nasal spray.

If you experience side effects, talk to your doctor. A different product may be recommended.

Symptoms of Nicotine Overdose

It is possible to overdose on nicotine when you use nicotine replacement products. Some symptoms of an overdose include:

Nausea and/or vomiting

Increased watering of the mouth

Abdominal pain

Diarrhea

Lightheadedness

Disturbed hearing and vision

Confusion

Difficulty breathing

Seizures

Smoking Cessation Success

Your chance of long-term success depends a great deal on your motivation and commitment to quitting, regardless of which therapy you choose.

RESOURCES:

American Cancer Society

http://www.cancer.org

Smokefree.gov

http://www.smokefree.gov

CANADIAN RESOURCES:

Canadian Cancer Society

http://www.cancer.ca

Health Canada

http://www.hc-sc.gc.ca

References:

Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service. May 2008.

Guide to quit smoking. American Cancer Society website. Available at: http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-types-of-nrt. Updated January 17, 2013. Accessed March 8, 2013.

Nicotine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated January 18, 2013. Accessed March 8, 2013.

Nicotine lozenges. Colorado QuitLine website. Available at: https://colorado.quitlogix.org/preparing_to_quit/nrt/lozenge.aspx. Accessed March 8, 2013.

Nicotine replacement & other pharmaceutical therapies. Memorial Sloan-Kettering Cancer Center website. Available at: http://www.mskcc.org/mskcc/html/2553.cfm. Accessed March 8, 2013.

NRTs. Tobacco-Free website. Available at: http://www.tobaccofreeqc.org/quitting/nrts/. Accessed March 8, 2013.

Quit guide. Smokefree.gov website. Available at: http://www.smokefree.gov/qg-index.aspx . Accessed March 8, 2013.

Smokeless tobacco and cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless. Accessed March 8, 2013.

Using the nicotine patch and lozenge to help you stop smoking. University of Wisconsin Heart and Vascular Center website. Available at: https://www.healthdecision.org/assets/patient_edu_docs/Nicotine_Replacement.pdf. Accessed March 8, 2013.

10/14/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis. Addiction. 2008;103:557-563.

12/16/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Strandberg-Larsen K, Tinggaard M, Nybo Andersen AM, Olsen J, Gronbaek M. Use of nicotine replacement therapy during pregnancy and stillbirth: a cohort study. BJOG. 2008;115:1405-1410.

11/13/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Piper ME, Smith SS, Schlam TR, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry. 2009;66(11):1253-1262.

11/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: US Food and Drug Administration. Propoxyphene: withdrawal—risk of cardiac toxicity. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm234389.htm. Published November 19, 2010. Accessed November 30, 2010.

Last reviewed March 2013 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.