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Nicotine replacement therapy (NRT)

Published by Bupa's health information team, April 2009.

This factsheet is for people who would like information about taking nicotine replacement therapy (NRT) to help you stop smoking.

Stopping smoking may be difficult because you will have developed a physical addiction to nicotine which makes it hard to quit. NRT helps you to stop by replacing the nicotine you would have taken in when smoking cigarettes. You can then gradually reduce the amount until you are no longer dependent on nicotine.

Why would I take NRT?
What are the main types of NRT?
How does NRT work?
How do I take NRT?
Special care
Side-effects
Names of medicines
Further information
Questions and answers
Related topics
Sources

Why would I take NRT?

Smoking causes diseases and health problems such as lung cancer, heart disease and impotence. Cigarettes contain harmful chemicals like carbon monoxide, formaldehyde and hydrogen cyanide.

If you find that you can't quit smoking without help, NRT gives you the nicotine you crave when you stop smoking, without the harmful effects of cigarettes. The need to smoke comes from the nicotine withdrawal symptoms you have when you haven't had a cigarette. NRT replaces the nicotine, reducing your desire to smoke so you can concentrate on breaking the habit and overcoming the psychological effects of smoking.

What are the main types of NRT?

There are a number of different NRT options:

patches
nasal sprays or inhalers
chewing gum
tablets or lozenges

How does NRT work?

If you stop smoking, you may find you:

are irritable
have difficulty concentrating
crave another cigarette

NRT helps curb your physical need for nicotine and reduces the feelings you have when you try to quit. But you still need willpower to stop.

When you smoke, the nicotine has strong effects on your body and your brain which cause you to become addicted. This effect is replaced by NRT which allows nicotine to pass into your bloodstream in different doses through the skin, when chewing or sucking, or when you breathe it in. This reduces the physical craving which, as you reduce the amount of nicotine you take in, will decrease further.

How do I take NRT?

You can buy NRT over the counter from the chemist, or your GP can prescribe NRT for you with other smoking cessation measures (such as counselling) and advice. The nicotine will reduce your craving for cigarettes. You can then gradually lower the amount of nicotine until you no longer need NRT. You should decide which type of NRT is best for you and set a date to stop smoking.

Read all the instructions carefully in the package leaflets as advice may change over time and will be different depending on the type of NRT used.

Nicotine patches

The patches are self-adhesive and are stuck onto dry, non-hairy, unbroken skin on the body (eg hip or chest) or upper arms. The patches are generally clear, pink, beige or brown and look like big plasters. You need to adjust the location of the patches so they aren't on the same area every day.

Depending on how many cigarettes you smoke, you should decide how much nicotine you need in the patch you use. There are different strengths. If you are a heavy smoker, you may need the higher strengths to start with.

The patches can be used at the starting strength for about eight weeks then gradually cut down over the next four weeks, using patches with less nicotine. You should aim to no longer need to use patches 12 weeks after starting treatment.

Nicotine chewing gum

The chewing gum is available in different flavours such as mint, liquorice and fruit. This isn't used like regular chewing gum. The gum needs to be chewed slowly until you have a strong taste. You then rest it between your cheek and your gums so the nicotine can be released. This needs to be repeated once the taste starts to fade. You can continue doing this for up to half an hour when you feel the urge to have a cigarette.

The gum can be purchased in different strengths. The amount you use depends on how many cigarettes you smoke. You may need to use the higher strength, for example if you smoke over 20 cigarettes a day or have your first cigarette within 30 minutes of waking up.

After three months you should gradually reduce the dose that you started with. After nine months you shouldn't need to chew nicotine gum.

Nicotine lozenges

You can suck one of the lozenges every one to two hours when you feel like you need to smoke. They shouldn't be eaten like regular lozenges or sweets.

You may choose the higher nicotine dose if you smoke quite regularly during the day.

You should gradually cut down the amount you first use after about three months so you have them less often and decrease the strength. After six months use, you shouldn't need to continue taking the lozenges.

Nicotine microtabs

These tablets are put under your tongue. Depending on how many cigarettes you smoke, you should decide how many to take each day.

After three months, you should try to cut down and should aim to stop using the tablets within nine months from when you start taking them.

Nicotine nasal spray

This is used when you feel like you need a cigarette. You spray this into in each nostril when you use it.

After using the spray at the starting strength for about 8 weeks, you should then try to reduce its use over a four-week period until you can stop using it completely.

Nicotine inhalator

The inhalator is plastic and you hold it like a cigarette. You breathe in a powder, which contains nicotine from cartridges which you replace once they are used. It helps replace the hand to mouth action you may miss when you stop smoking.

The inhalator can be used at the dose you need to stop you smoking for about eight weeks. You should then try to reduce the use of the inhalator over a four-week period so you can stop using it completely. This can be done by halving the number of cartridges you use in the first two weeks and halving that number again in the second two weeks. You can then stop using the cartridges completely.

Always read the patient information leaflet that comes with your medicine.

Special care

NRT can be used while you are pregnant or breastfeeding but you need to take them with caution. They should only be used if you can't stop smoking without using them.

If you are aged between 12 and 18 you need to speak to a healthcare professional before you start taking NRT.

Side-effects

You may have side-effects such as stomach upsets (eg feeling sick), headache, dry mouth, taste problems, sleep disturbance or feel generally unwell. If you use the nasal spray, you may sneeze, have nose bleeds and your eyes may water. The lozenges or chewing gum may make you thirsty, you may have burning or prickling sensations, a sore throat or mouth ulcers. The patches can cause skin reactions. The tablets and inhalator can cause hiccups and throat irritations.

Names of medicines

Generic names	Examples of common brand names
Nicotine patches	Nicorette 5mg, 10mg, 15mg (16 hours)
	Nicotinell 7mg, 14mg, 21mg (24 hours)
	NiQuitin CQ 7mg, 14mg, 21mg (24 hours)
Nicotine chewing gum	Nicorette 2mg, 4mg
	Nicotinell 2mg, 4mg
	NiQuitin CQ 2mg, 4mg
Tablets/lozenges	Nicorette microtab 2mg
	Nicotinell lozenge 1mg, 2mg
	NiQuitin CQ lozenge 2mg, 4mg
Nasal spray	Nicorette
Inhalator	Nicorette 10mg

Further information

Electronic Medicines Compendium
www.emc.medicines.org.uk