Day Nine

Nicotine Replacement Therapy (NRT)

Symptoms of nicotine withdrawal can include physical symptoms (e.g., headache, sleep problems, tiredness, difficulty concentrating, dizziness) and emotional symptoms (e.g., irritability, moodiness, depression, anger, frustration, restlessness). These symptoms can last for a few days or several weeks or more.

Although cigarette smoking results in an addiction to nicotine, it is also a habit, or familiar routine. Nicotine replacement therapy (NRT) helps people who are trying to quit to adjust to giving up this familiar routine while limiting the discomforts of nicotine withdrawal. In general, NRT is most effective when used as a part of a complete tobacco cessation program—one that includes information, support, and counseling.

Nicotine replacement therapy works by delivering a dose of nicotine through a gum, skin patch, lozenge, nasal spray, or inhaler. The nicotine gum, lozenge, and skin patch are available over the counter, allowing those who are not enrolled in formal cessation programs to use them on their own. The nasal spray and inhaler require a prescription.

NRT products vary in how (and how fast) the nicotine is delivered, in side effects, in difficulty in stopping use, and in cost per day. For example, the nicotine patch is worn all day and gradually delivers a constant level of nicotine and nasal spray delivers a quick dose that is similar to the delivery of a cigarette.

Most NRT products are available in different nicotine doses and the dosage chosen depends in part upon how much the person smoked per day before attempting to quit. In later stages of therapy, the dosage is lowered and eventually stopped.

The length of time that NRT products are used also varies. The minimum course is usually 8 to 12 weeks and it is recommended that doses not be skipped. In some cases, a low dose NRT product is recommended for a longer period of time. Although it is preferred to stop using nicotine altogether, using an NRT product is generally considered less harmful than smoking or using other tobacco products.

Side effects vary from one nicotine replacement product to another. Patients should be sure to consult a healthcare provider to help choose the best product and should be sure to follow recommendations and instructions. In some cases, a combination of NRT products (e.g., one for a regular dose and another to suppress urges as they arise) is used.

Women who are pregnant and people with heart disease experience greater risks when using NRT products and should be monitored closely by a healthcare provider.