Treatment Options

The most commonly used agent to aid smoking cessation is nicotine replacement therapy. Nicotine replacement therapies are medications that help decrease or stop a patient?s withdrawal symptoms by replacing the nicotine that was supplied by cigarettes. While these medications substitute the nicotine found in cigarettes, but do not contain the dangerous chemicals found in cigarette smoke. Do not use any other nicotine products (do not smoke) when on NRT because toxic levels of nicotine will occur. In addition, persons who have had a recent heart attack, history of arrhythmias, or severe chest pain should not use nicotine replacement therapy.

Several different formulations of nicotine replacement exist. They include chewing gum, patches, nasal inhalers, oral inhalers, and lozenges. The best formulation varies from person to person, depending on personal factors. Read on to learn the pros and cons of each formulation of NRT.

Chewing Gum

Nicotine chewing gum is useful in patients who miss the sensory involvement of the cigarette with the mouth. If you have dentures or braces, avoid the gum because it will stick to dental work. Possible side effects of the nicotine chewing gum include mouth and jaw soreness, heartburn, headache, vomiting, and hiccups. Nicotine chewing gum may be purchased over-the-counter in both 2mg and 4mg strengths. Persons who smoke less than twenty-five cigarettes per day should begin with the 2mg gum. Persons who smoke more than twenty-five cigarettes per day should purchase the 4mg gum (Nicorette DS).

A process of gum chewing known as "chew and park" should be used in order get the best benefit from the gum. Chew and park whenever you feel the need to smoke. However, if you would like a more structured schedule for chewing, below is an appropriate chew and park regimen:

1. Week 1-6 of smoking cessation attempt: Chew one piece of gum every 1-2 hours.
2. Week 7-9 of smoking cessation attempt: Chew one piece of gum every 2-4 hours.
3. Week 10-12 of smoking cessation attempt: Chew one piece of gum every 4-8 hours.

Chew and Park

1. Chew one piece of gum slowly until a peppery taste and tingling sensation occurs.
2. Park the gum between the cheek and gums (approximately 1-5 minutes) until the peppery taste subsides.
3. Once the peppery taste subsides, repeat the chew and park process for 30 minutes.
4. Do not use the same piece of gum for longer than 30 minutes.
5. Park the gum in different areas of the cheek and gums during each rotation.
6. Avoid eating and drinking 15 minutes before and during gum use.
7. 2mg gum: do not chew more than 30 pieces per day; 4mg gum: do not chew more than 20 pieces per day.

Nicotine patches

Several different brands of nicotine patches are currently available to aid in smoking cessation. Nicotine patches are beneficial in persons on the go, not wanting to spend time chewing and parking gum every few hours. The patch is easy to use, has no oral side effects, and provides a constant amount of nicotine to the body. Side effects of nicotine patches include skin irritation, sleeping problems, and vivid dreams. Hydrocortisone ointment can be bought over-the counter to help with skin irritation; removing the patch at bedtime may help persons who experience sleeping problems and vivid dreams.

How to use a nicotine patch

1. The patch must be applied every morning to a hairless upper part of the body. Many people apply the patch to their upper arm or back. If you having difficulty keeping the patch attached to your body, medical tape from your local pharmacy taped in an "X" fashion over the patch should keep it in place.
2. Rotate the site you place the patch each day.
3. Always remove the used patch before applying a new patch, because the used patch will still contain some nicotine that has not yet made it to the body.
4. Dispose of the patch in the original foil package because the remaining nicotine is enough to harm children and animals.
5. Wash hands thoroughly after patch application-nicotine can irritate your eyes and nose if you accidentally make contact with your face.

Which patch should you use?

Other Forms of NRT

Three other nicotine replacement products include nasal inhalers, oral inhalers, and nicotine lozenges. Some persons become addicted to the nasal inhaler so it is not used routinely. The regimen of the oral inhaler is slightly complex, in that for the best benefit, continuous puffing for 20 minutes is needed. The nasal and oral inhalers must also be used for a longer periods of time (12 weeks and 24 weeks, respectively) than that of the chewing gum and Nicoderm CQ patches. The lozenges are similar to the gum, but must dissolve when used.

Drugs in the class

Nicotine Gum ( Equate Nicotine Gum,  Leader Nicotine Gum,  NICOrelief Gum,  Nicorette Gum,  Nicotine Polacrilex Gum,  Walgreens Nicotine Polacrilex Gum )

Nicotine Inhaler ( Nicotrol Inhaler )

Nicotine Lozenges ( Commit Lozenges,  NICOrelief Lozenges,  Nicotine Polacrilex Lozenges,  Walgreens Nicotine Polacrilex Lozenges )

Nicotine Nasal Spray ( Nicotrol Nasal Spray )

Nicotine Transdermal Patches - 16 hour ( Nicotrol Transdermal Patches (Step 1),  Nicotrol Transdermal Patches (Step 2),  Nicotrol Transdermal Patches (Step 3) )