Nicotine replacement therapy in a nutshell
A synthesis of over 100 studies has shown that nicotine replacement products are effective. Compared to a dummy treatment (placebo), nicotine replacement therapy (NRT) doubles your chances of quitting smoking! It is not in itself a miracle solution and to be successful it needs to be accompanied by motivation and anti-relapse strategies; but this type of treatment helps by relieving the withdrawal symptoms caused by the lack of nicotine.
How do they work?
NRT attenuates withdrawal symptoms. The products work by releasing nicotine in relatively small doses; this arrives in the bloodstream little by little. The nicotine rush obtained by smoking is replaced by a gradual release that makes the withdrawal less painful.
- Nicotine, when inhaled with tobacco smoke, creates a physical dependence.
- When you quit, nicotine withdrawal can cause unpleasant symptoms: cravings, irritability, depression, difficulty concentrating, anxiety, sleep disorders, headaches, weight gain, and increased appetite.
- NRT partially replaces the missing nicotine. It provides the nicotine that you used to get from smoking.
- NRT reduces withdrawal symptoms and allows you to focus on the other important aspects of quitting; the social, behavioral and psychological aspects of smoking.
- By using NRT you avoid inhaling tar, toxic substances, carbon monoxide and other irritant gases that are found in smoke.
NRT products are medicines. Please read the information leaflet or consult a specialist. A smoking cessation specialist will advise you taking into account other obstacles to your quitting, psychological and environmental barriers.
Logically, the more you smoke, the more dependent you are and the more you will suffer from withdrawal symptoms. In this case you need to increase the dose of your chosen NRT. The first thing to do is to calculate the dose you were accustomed to, as a smoker. On average, one cigarette provides 1 to 2 mg of nicotine, a smoker who is used to smoking over 20 cigarettes a day will chose, for example, a 21 mg 24-hour patch. Under-dosing is common and can lead to a relapse: do not under-dose and take the treatment for the recommended duration (8 to 12 weeks).
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Many experts believe that the dose of NRT should be about 1 mg of nicotine per cigarette consumed. According to this principle, a person who smokes 25 cigarettes a day should use a 24.9 mg patch or take 12 x 2 mg microtabs. However other things must also be taken into account. First, it must be remembered that gums and patches only release 70% to 75% of the nicotine they contain, unlike microtabs where all the nicotine is ingested. Second, recent research shows that whilst the number of cigarettes smoked per day is important we should also bear in mind the intensity with which the smoker draws on their cigarette. On the other hand, the type of cigarette, mild or strong, has no influence on the quantity of nicotine absorbed: so-called light cigarettes can deliver as much nicotine as normal cigarettes!
People who draw very hard on their cigarettes and who can't manage to cut down the number of cigarettes they smoke will probably need a higher dose of NRT. In general, highly addicted smokers will greatly benefit from NRT and monitoring by a specialist. On the other hand, people who smoke fewer than five cigarettes a day, who smoke their first cigarette of the day over an hour after waking and who do not experience withdrawal symptoms are probably not dependent. For these people NRT is less useful. If they still feel very dependent, it is possible that the addiction is less physical than psychological or behavioral. In such cases, medical or psychological support is recommended.
Overdosing and under-dosing
Everyone does not react in the same way to the same dose of nicotine. Specific psychological factors, often inherited, determine the proportion of nicotine that becomes available in the bloodstream and the body's sensitivity to it.
Overdosing on NRT is rare. But it does happen, so you'd better learn to recognize the signs: total disgust of tobacco, unpleasant taste in the mouth, headaches, dizziness, sleeplessness, increased heart rate, nausea or diarrhea. In case of overdose, it is usually sufficient to remove the patch or spit out the gum or microtab.
Under-dosing is a much more common phenomenon. Withdrawal symptoms reappear and there is an increased risk of a relapse.
How can you tell from the symptoms if you are overdosing or under-dosing?
Some symptoms are indeed identical (nervousness, insomnia) and it is not always easy to tell if it is because we are taking too little NRT or too much. In principle, if you still want to smoke, it's under-dosing. And if tobacco totally disgusts you it's overdosing.
If you suffer from such symptoms or if there is any doubt as to the dosage, the best thing is to see a doctor.
Duration of treatment
NRT generally lasts two to three months. After this period the dose can be reduced gradually. The idea is to let the body get used to being without nicotine so that you don't suffer withdrawal symptoms. But it is primarily a question of personal strategy, that you determine alone or with your therapist. We recommend that, when you stop using NRT, you keep some to hand during the first weeks; in case of urgent need (anything is better than lighting up a cigarette!)
Treatments can be extended if necessary, if the urge to smoke is still felt and premature interruption significantly reduces their effectiveness!
To recap, for or against?
It's an individual choice. NRT is not a panacea but greatly increases the chance of quitting, especially for people with a strong addiction.
It works best when it is accompanied by other treatments and the support of a specialist. It is just as important to treat the psychological dependence as the physical dependence.
Moreover, these treatments have few side effects and little risk of addiction. The slow diffusion of NRT, in contrast with the rapid diffusion of cigarettes smoked (with a nicotine rush in less than 7 seconds) guards against this risk. Indeed, the addiction depends also and especially on the rate of absorption of nicotine.
- Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub3
Auteur: Grégoire Monney