Nicotine replacement therapy (NRT)

Published by Bupa's Health Information Team, December 2010.

This article explains what nicotine is, what nicotine replacement therapy (NRT) is and how you can use NRT to help you stop smoking.

Each year in the UK, around seven million people will try to stop smoking, but it's not a walk in the park. Smoking is addictive and if you're trying to stop, it's important to make sure you have all the support that you need. One line of support you might want to try is NRT.

For more information about nicotine, see our Why are cigarettes so addictive? article.

NRT involves replacing the nicotine you used to get from cigarettes. You can then gradually reduce the amount you take until you no longer need it. NRT helps you to overcome the nicotine cravings, and can increase your chances of staying off cigarettes for good.

Most people usually take NRT for eight to 12 weeks but it will depend on how much you smoke and what forms of NRT you decide to use.

Although NRT will help to reduce the withdrawal effects of stopping smoking you will still need to use some willpower.

Who can use NRT?

NRT is safe for most people who are trying to stop smoking. If you’re pregnant or under 17, speak to your local stop smoking advisor or GP about what method would be best for you.

Types of NRT

An advantage of NRT is that it’s available in a variety of different forms, including:

• gum
  
• patches
  
• inhalators
  
• nasal sprays
  
• lozenges or microtabs

With all of these to choose from, you’ll hopefully find a method of NRT that works well for you. It could be worth trying a few – you might find that you get more side-effects from one form compared with another. Maybe you’ll 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.

All NRT products are usually available from your pharmacist as well as with a prescription from your GP.

Nicotine gum

You can get nicotine gum in two different strengths, 2mg and 4mg, and a number of different flavours. The stronger 4mg strength may be more effective if you're highly dependent on nicotine. You can buy it from your pharmacist without the need for a prescription.

You will need to chew the gum slowly until you have a strong taste, then rest it between your cheek and your gums so the nicotine can be released. You’ll need to repeat this once the taste starts to fade, and you can carry on doing this for up to half an hour whenever you feel the urge to have a cigarette.

Nicotine patches

When you pop a nicotine patch on your arm, the nicotine in it is slowly released into your body through your skin. Patches usually come in three different strengths and last for either 16 or 24 hours so you get a steady supply of nicotine throughout the day.

Nicotine inhalators

A nicotine inhalator is a bit like a fake cigarette which contains nicotine but produces no smoke. When you suck hard on the mouthpiece you breathe in the nicotine. You can use your inhalator as and when you feel as if you want to smoke. Inhalators also act as a physical substitute for a cigarette while you’re stopping and want something to do with your hands.

Nasal spray

If you need your nicotine cravings satisfied quickly, you might want to try a spray that will squirt nicotine straight into your nostrils. Although they act fast, sprays can be difficult to get used to and they may irritate your nose.

Lozenges and microtabs

Suck a lozenge every couple of hours when you feel like you want to smoke, but be careful not to chew them or swallow them whole.

Microtabs are designed to be held under your tongue for 20 to 30 minutes – as they dissolve, nicotine is released and gets absorbed through the lining of your mouth.

Side-effects of NRT

Whatever method of NRT you choose, there’s a chance you will get some side-effects such as stomach upsets, headaches, a dry mouth, taste problems, sleep disturbance or feeling generally unwell. Some of these side-effects may be withdrawal symptoms from stopping smoking and not actually caused by the NRT.

The different types of NRT can have more specific symptoms as well. However, although these may be unpleasant, it’s worth trying to remember that the possible long-term health risks of smoking are likely to be far worse.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Electronic cigarettes

Electronic cigarettes, or e-cigarettes, are a battery-operated version of a normal cigarette and contain not only nicotine but other chemicals and flavourings. They work by vaporizing the nicotine and other chemicals so you can inhale them in the same way as you would from a normal cigarette.

Although many people have tried swapping to electronic cigarettes as a form of NRT, there is very little evidence on how safe or effective they are. In many countries they have been banned from sale until scientific evidence can show whether or not they are safe. This is partly because they contain products that are known to be toxic for humans.

If you want to stop smoking, it’s best to use a form of NRT that has been approved in the UK. Your local NHS stop smoking advisor can give you more advice and help you decide what suits you best.

For sources and links to further information, see Resources.