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Nicotine replacement therapy (NRT)Published by Bupa's health information team, healthinfo@bupa.com, April 2008 The article explains what nicotine is, what nicotine replacement therapy (NRT) is and how you can use NRT to help you give up smoking. Smoking is addictive, which means it's hard to give up. Help is available though if you are trying to stop. One line of support is nicotine replacement therapy (NRT). This involves replacing the nicotine you used to get from cigarettes with nicotine absorbed through your mouth, nose or skin. NRT helps you to overcome the nicotine cravings, and increases your chances of staying off cigarettes for good. What is nicotine and what effect does it have on the body?Nicotine is one of the drugs and chemicals that come from the tobacco plant. When you burn tobacco and inhale the smoke, droplets of tar which contain nicotine enter the lungs and stay there. Nicotine is absorbed through the lining of your lungs into your blood, and distributed around your body. Or it can enter your blood through your skin (eg NRT patches), mouth (eg NRT gum) or nose (eg snuff). Effects on your heart and blood vesselsNicotine increases your heart rate and blood pressure, although you can become tolerant to this effect. This means that if you use nicotine regularly, your heart will begin to respond less to it over time. Nicotine also affects blood flow to your organs; for example, it narrows the arteries that supply blood to your heart muscle, and to your skin, which can make you pale. Effects on your metabolismNicotine speeds up metabolism, which means the average smoker burns more calories than a non-smoker. This is why smokers weigh an average of 4kg less than non-smokers. Effects on your brain and moodAfter inhaling, it takes 10 to 19 seconds for nicotine to reach your brain. Nicotine can make you feel dizzy, nervous or give you a headache. People who smoke claim it helps them to relax, but there isn't any scientific evidence that the drug has this effect. In fact, smoking a cigarette may just help to relieve any negative feelings you are having, such as irritability, that are caused by nicotine withdrawal. What is NRT and does it work?NRT involves replacing the nicotine that you used to get from cigarette smoke with controlled doses of nicotine that are absorbed through your skin or mouth. It can help you give up smoking because it helps to reduce nicotine withdrawal symptoms and prevent cravings while you get over the psychological addiction and habit of smoking. You are almost twice as likely to quit successfully if you use NRT compared to using willpower alone. NRT may also help you cut down the number of cigarettes you smoke if you can't give up altogether. Although NRT will help to reduce the withdrawal effects of stopping smoking, it may not completely remove your desire to smoke, so you will still need willpower. Who can use NRT?NRT is safe for most people who are trying to stop smoking. If you are pregnant and you want to quit, you can use NRT if you can't give up any other way, but you should talk to your GP first. If you are aged 12 to 18 you can also use NRT, but you should talk to your GP first. If you have a medical condition such as heart disease, an overactive thyroid gland, diabetes, severe kidney or liver disease, or stomach ulcers, you should only consider using NRT after you have discussed the risks and benefits with your GP. You can buy NRT over the counter from the chemist, or your GP can prescribe it for you. How long do I take it for?You should usually take it for eight to 12 weeks and then begin to reduce the amount you take. Most people don't need to keep taking it after three months. Side-effects of NRTSide-effects of NRT may be caused by the nicotine, or may be specific to the preparation you are using. Nicotine side-effects include the effects described above - headaches, dizziness and a racing pulse. Other effects of nicotine may include:
Other side-effects depend on the type of NRT you're using. With NRT gum, you may get jaw pain from chewing, hiccups or stomach pain. With patches, around half of people get skin irritation, although this is usually mild and most people don't need to stop using patches because of it. If you are getting disturbed sleep with 24-hour patches, you could try 16-hour patches that you don't wear overnight. Nicotine inhalers and nasal sprays may cause irritation in the mouth or nose, respectively. And lozenges for under the tongue can cause a burning feeling in your mouth, sore throat, mouth ulcers, dry lips or coughing. You should always follow the manufacturers' instructions on dosage and use. Types of NRTNRT is available in the form of:
There is not enough scientific evidence at the moment to say whether any of these methods is better than the others, so choosing your NRT is a question of personal preference. You might find that you get more side-effects with one form compared to another. You might prefer to have a steady supply of nicotine to stave off cravings, as you get with patches; or you may want quick hits of nicotine only when you crave it, as you get with a nasal spray. Nicotine gumNicotine gum looks like chewing gum and is designed to release nicotine into the mouth slowly when chewed. Whenever you have the urge to smoke a cigarette, chew one piece of nicotine gum slowly until the taste is strong and rest it between cheek and gum, chew again when taste fades and do this for half an hour. It's available without a prescription and in varying strengths. The stronger 4mg strength may be more effective if you're highly dependent on nicotine. Nicotine gum is simple to use and can provide a steady supply of nicotine. However, you may not want to be seen chewing gum in public and you may not like the taste of some nicotine gums. Nicotine patchesNicotine patches look like large sticking plasters, and you stick them onto your skin. The patch contains nicotine, which is slowly released into the body through the skin. Nicotine patches are simple to use and provide a steady supply of nicotine. They also are discreet (patches can easily be hidden from sight under clothing). Nicotine inhalatorsA nicotine inhalator, or inhaler, looks like a cigarette but produces no smoke. It holds a cartridge containing nicotine, and when you suck hard on the mouthpiece, it delivers a puff of nicotine vapour, which is absorbed through your mouth and throat. Inhalers are simple to use and act as a physical substitute for a cigarette while you are giving up. The supply of nicotine is not constant: you have it when you feel you need it. Inhalers are a very visible method of stopping smoking, which may be a disadvantage for some people and an advantage for others; some people may not like the taste of the inhalator nicotine cartridge. Nasal spraysYou spray nasal sprays into the nostrils with an air-pump plunger, via a nozzle. They are relatively easy to use and the nicotine is absorbed fast. But they can be difficult to get used to, as they may irritate your nose or make it run. Lozenges, tablets and microtabsLozenges are nicotine tablets designed to be held under the tongue for 20 to 30 minutes, until they dissolve. The nicotine is absorbed through the lining of your mouth. You should suck lozenges slowly and gently, and not chew or swallow them, which can cause heartburn or indigestion. Lozenges are simple to use, discrete and require no special chewing technique. Can NRT be harmful?The nicotine delivered by NRT is pure and doesn't contain the other harmful chemicals released by cigarettes, so NRT is less harmful than smoking. Nicotine from NRT is absorbed into the body at a much slower rate than nicotine from a cigarette, and there is little evidence that people can become addicted to NRT therapies. Key points
Further information
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