Nicotine replacement therapy has been available for 3 decades. It has a well-recognised record of effectiveness and safety. Many people who have used NRT to stop smoking in the past and found that it didn't work, usually find it's because not using the products correctly or not using the right strength NRT at key times.
NRT is safe AND effective when used correctly
–Combination NRT is even more effective
–NRT is a medication and it may take a short time to adjust to using it.
–It works by providing some of the nicotine smokers would normally obtain from cigarettes.
–Nicotine absorption is released more slowly and in smaller quantities’ compared to cigarettes.
–Most products do not mimic the immediate sensations smokers get from a cigarette, but it do make abstinence more achievable by reducing withdrawal symptoms.Treatment is not a magic cure. Effort and determination are required for long term quit
Managing nicotine withdrawal
The elements of effective management of nicotine withdrawal or cessation of smoking are:
–Correct assessment of nicotine dependence
–Good understanding of smoking habit and triggers to smoking
–Clear explanation and demonstration of the correct way to use recommended nicotine product
Nicotine dependence
•Cigarette consumption alone is not a good indicator of dependence, as it does not take into account the different ways people smoke their cigarettes. This may be particularly true for smokers who cut down the number they smoke but continue to get the same amount of nicotine from their reduced number of cigarettes by taking deeper and more frequent puffs, smoking more of each cigarette or blocking the vent holes.
•The Fagerström Questionnaire provides a useful assessment of the level of nicotine dependence experienced by an individual smoker. Once the level is comprehensively assessed, the advisor can recommend the correct level of Nicotine Replacement Therapy for the patient.
–What associations does the patient make between their behaviour and when they smoke, i.e. after waking, after meals, in certain situations.
•A Smoking Diary can help a patient to get a clearer picture of their smoking habit
Choosing which NRT is right for you
•NRT works best provided in combination i.e. a transdermal NRT patch with a second, oral form of NRT (gum, inhalator, sublingual tablet, lozenge, mini lozenge, mouth spray and oral film) or a nasal spray
•The patch is administered daily and the dosage of the second product is adjusted as needed by the patient
How to use NRT patches
24hr Patch - 21mg, 14mg, 7mg – Change every 24hrs, Can cause vivid dreams/nightmares if this happens take off before bed. Not suitable for pregnant smokers.
16hr Patch - 25mg, 15mg, 10mg – reduces chances of having disturbed sleep. Takes 20mins to kick in once applied. To be taken off before bed. Suitable for pregnant smokers.
Both should be rotated around the body to reduce irritation.
Pack size x7 / x14.
For people who smoke up to 10 per day try a low dose, 10-15 per day try a middle dose and 15+ try a high dose.
•How to use it: apply to tops of arms (or anywhere it will stick), rotate location point daily •Cautions: skin problems such as eczema
Do
Apply once a day at about the same time of day (usually morning)
Apply to clean, dry, non hairy, oil, cream and talc free area of skin. Let the skin cool down after a bath or shower before applying. Areas where the patch can be worn are the upper arm or trunk.
If the patch has been stored in a cool dry place, warm it between hands before applying.
Press the patch firmly onto the skin and hold for 10-20 seconds. Rub around the edges to ensure that the patch sticks well.
Alternate where you wear the patch so that you irritation is minimised.
Don’t
Apply to warm, damp or recently moisturised skin – the patch won’t stick properly and won’t be effective
Apply to broken or already irritated skin
Cut them in half to reduce absorption – if you feel you need less ask to change to a lower dose
How to use NRT gum
Gum - 2mg, 4mg. Max 15 per day. Chew until nicotine is activated (peppery taste) then park in the side of the mouth then chew to reactivate and park. Dispose when tired of chewing or peppery taste stops. To be used as an when required. Liquorice flavour not suitable for pregnant smokers. If using as a second product only issue low dose. Pack Size x96 / x105. (x105 is most popular)
•How to use it:
Gum is good for day-long treatment. For maximum effect, chew the gum slowly, then park it in the side of your mouth. The nicotine is then absorbed through the lining of your mouth. •Cautions: indigestion
Do
Practice the technique required for each product as directed on the instructions
Read the instructions on maximum amounts permitted each day
Gum should not be swallowed.
Individual pieces of gum, should be chewed slowly to release the nicotine before being “parked” in the mouth.
Take care if you use dentures.
Don’t
Swallow too much saliva whilst using the product as this can cause hiccups, heart burn or gastric upset.
Use these products within 15 minutes of drinking a fizzy or fruit juice drink (before or after) as acidic drinks reduce the effectiveness of the absorption of the NRT in the product.
How to use NRT lozenges
Lozenges – 1mg, 2mg, 4mg. Takes 15mins to be active. Suck until nicotine is activated (peppery taste) then park in the side of the mouth then suck to reactivate and park. Dispose when tired of sucking or dissolves. To be used as an when required. If using as a second product only issue low dose. Pack Size for 1mg and 2mg 1 x 96 max dose 30 per day and for 2mg and 4mg 1 x 72 max 15 per day.
Mini Lozenges - 1.5mg, 4mg. Takes 5mins to be active. Max 15 per day. To be used as an when required. Small and discreet. To be sucked until dissolved. If using as a second product only issue low dose. Pack size x20 / x60.
•How to use it: Lozenges are sucked slowly to release the nicotine and take up to 30 minutes to dissolve. •Cautions: indigestion
Do
Practice the technique required for each product as directed on the instructions
Read the instructions on maximum amounts permitted each day
Lozenges should not be chewed or swallowed whole.
Individual lozenges and mini tabs should be sucked slowly to release the nicotine before being “parked” in the mouth.
Take care if you use dentures.
Don’t
Swallow too much saliva whilst using the product as this can cause hiccups, heart burn or gastric upset.
Use these products within 15 minutes of drinking a fizzy or fruit juice drink (before or after) as acidic drinks reduce the effectiveness of the absorption of the NRT in the product.
How to use NRT microtabs
Micro Tab - 2mg. Takes 15mins to be active. Max dose 1-2 per hour. Small and discreet. Pop under the tongue and let it dissolve. To be used as an when required. Pack Size x100.
•How to use it: These small tablets contain nicotine and dissolve when you place them under your tongue. •Cautions: irritation
Do
Practice the technique required for each product as directed on the instructions
Read the instructions on maximum amounts permitted each day
Mini tabs should not be chewed or swallowed whole.
Individual mini tabs should be chewed or sucked slowly to release the nicotine before being “parked” in the mouth.
Take care if you use dentures.
Don’t
Swallow too much saliva whilst using the product as this can cause hiccups, heart burn or gastric upset.
Use these products within 15 minutes of drinking a fizzy or fruit juice drink (before or after) as acidic drinks reduce the effectiveness of the absorption of the NRT in the product.
How to use NRT inhalators
Inhalator - 15mg. Takes 15mins to be active. Max 6 Cartridges per day. Mimics hand to mouth action. To be puffed into the mouth not inhaled. To be used as an when required. Can cause irritation to the throat if inhaled incorrectly. Change cartridge once peppery taste stops. Last for up to 60mins of puffing. Pack Size x4 / x20 / x36.
•How to use it:
Much like a plastic cigarette, the inhalator releases nicotine vapour which gets absorbed through your mouth and throat. This might suit you if you miss having something to do with your hands when not smoking. Light puffs to be inhaled across the tongue for the nicotine to be absorbed (not inhaled past the throat) •Cautions: Irritation in the mouth and throat
Do
Practice the technique required for each product as directed on the instructions
Read the instructions on maximum amounts permitted each day
With the inhalator , allow the vapour to circulate in the mouth for a few seconds to promote absorption of the nicotine – don’t inhale straight into the lungs.
Don’t
Use these products within 15 minutes of drinking a fizzy or fruit juice drink (before or after) as acidic drinks reduce the effectiveness of the absorption of the NRT in the product.
How to use NRT nasal spray
Nasal Spray 10mg/ml – 0.5mg per spray. Takes 5mins to be active. Max dose 1-2 squirts per nostril per hour. To be used as an when required. Pack Size 1 x 10ml. Can cause hay fever type symptoms when first using. To be used with caution if driving or using heavy machinery.
•How to use it: nasal spray delivers a swift and effective dose of nicotine through the lining of the nose or mouth. This might come in handy if you need a more instant dose of nicotine (such as first thing in the morning, or if you find the slower release products take a bit too long at first). •Cautions: Hay fever symptoms
Do
Follow the instructions: prime the spray before use, one spray each nostril, pointing tip towards the back of the nose.
Be aware that initial use can cause nasal irritation such as sneezing, runny nose, watering eyes, cough at first but these should reduce after 2-3 days.
Don’t
Do more than one spray to each nostril twice an hour
How to use NRT mouth spray
Oral Spray - 1mg. Takes 1min to be active. Max 2 squirts every 30mins. Squirt under the tongue or into the side of the mouth. Ensure the spray is primed before use and is producing a mist not a jet. Advised not to swallow too quickly as can cause hiccups. To be used as an when required. Pack Size 1 x 13.2ml / 2 x 13.2ml.
•How to use it: mouth spray delivers a swift and effective dose of nicotine through the lining of the nose or mouth. This might come in handy if you need a more instant dose of nicotine (such as first thing in the morning, or if you find the slower release products take a bit too long at first). Swallow first so the mouth is dry and spray mist into the side of the tongue and cheek. •Cautions: can cause hiccups
Do
Practice the technique required for each product as directed on the instructions
Read the instructions on maximum amounts permitted each day
With the inhalator and the mouth spray, allow the vapour to circulate in the mouth for a few seconds to promote absorption of the nicotine – don’t inhale straight into the lungs.
Don’t
Use these products within 15 minutes of drinking a fizzy or fruit juice drink (before or after) as acidic drinks reduce the effectiveness of the absorption of the NRT in the product.