Using the Nicotine Patch, Nicotine Gum, Nicotine Nasal Spray or Nicotine Inhaler - June 1, 2001

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An article on this topic is available in this issue of AFP.

Using the Nicotine Patch, Nicotine Gum, Nicotine Nasal Spray or Nicotine Inhaler

When you are ready to quit smoking, you may want to use nicotine replacement therapy to help you give up cigarettes. The cost of nicotine replacement therapy is about the same or less than the cost of cigarettes.

The nicotine patch, gum, nasal spray and inhaler are all forms of nicotine replacement therapy. All forms of nicotine replacement can help lessen your urge to smoke. This means you have less craving for nicotine when you stop smoking. You may still feel a craving to smoke, but don't smoke while using the patch, gum, nasal spray or inhaler.

Who should use nicotine replacement therapy?

Almost every smoker can benefit from using nicotine replacement therapy. If you are pregnant or if you have heart or blood vessel problems, your doctor will be careful about giving you the nicotine patch or gum.

How do I know what strength is right for me?

Patch. Most smokers should start using a full-strength patch (15 to 22 mg of nicotine) every day for 4 weeks and then a weaker patch (5 to 14 mg of nicotine) for another 4 weeks.

Gum. Many smokers should start using the 2-mg dose. However, you may want to start with 4-mg gum if you:

Smoke more than 20 cigarettes a day.

Smoke as soon as you wake up in the morning.

Have severe withdrawal symptoms when you don't smoke.

Have tried to quit on a lower dose and failed.

If you are a very light smoker (less than 10 to 15 cigarettes a day) or have health problems, your doctor can help you select the right dose.

Should I use the nicotine patch, gum, nasal spray or inhaler?

Any of these treatments can help once you are ready to quit. The choice is up to you. Some people don't like the taste of the gum or don't like chewing in public. They prefer the patch. Other people have been unable to quit on the patch and want to try the gum. Some people prefer to use a nasal spray and some prefer the inhaler. Using the nicotine patch, gum, nasal spray or inhaler almost doubles your chances of quitting. Here is some information to help you decide which one is right for you.

Nicotine Patch

Directions for use: At the start of each day, place a new patch on a part of your body between the neck and the waist. Put the patch on a new spot each day to lessen skin irritation.

Treatment period: The patch is usually used for up to 8 weeks.

Side effects: Some people who use the patch get a rash on their body where the patch is placed. Skin rashes are usually mild and easily treated. Moving the patch to another area of the body helps.

If you have any side effects from the patch, be sure to tell your doctor right away.

How to get the patch: You can buy the patch without a doctor's prescription. To be safe, carefully read and follow the directions inside the package. You can talk to your doctor about how to use it and how long to use it.

Nicotine Gum

Directions for use: The gum must be chewed in a special way to make it work. Chew it slowly until you notice a "peppery" taste. Then stop chewing and move the nicotine gum between your cheek and your gum. Each piece of nicotine gum should be kept in your mouth for about 30 minutes.

Treatment period: A regular schedule (at least one piece of nicotine gum every 1 to 2 hours for 1 to 3 months) may give the best results. Some people don't chew enough pieces of gum a day and or they don't chew the gum for 8 weeks. They might not get the most benefit from nicotine gum.

Side effects: Some people have mild side effects such as hiccups, upset stomach or sore jaws. Most of these side effects go away if the gum is used correctly.

If you have any side effects from the gum, be sure to tell your doctor right away.

How to get nicotine gum: You can buy the gum without a doctor's prescription. To be safe, carefully read and follow the directions inside the package. Also, you can talk to your doctor about how to use it and how long to use it.

Nicotine Nasal (nose) Spray

Directions for use: Apply one spray in each nostril. Use the spray one to two times each hour while you are awake. Use the spray at least 8 times a day. Don't use it more than 40 times a day.

Side Effects: The nasal spray may cause nasal irritation, diarrhea and a fast heart rate. If you have hay fever or sinus infection, ask your doctor about using one of the other forms of nicotine replacement therapy.

If you have any side effects from the nasal spray, be sure to tell your doctor right away.

How to get the nasal spray: You can only get the nasal spray with a doctor's prescription. To be safe, carefully read and follow the directions inside the package.

Nicotine Inhaler

Directions for use: Inhale from a cartridge when you have a desire for a cigarette. Use no more than 16 cartridges a day for up to 12 weeks.

Side Effects: You might have irritation of throat and mouth when you first start to use the inhaler. It might make you cough. You should get over this after a while.

If you have any side effects from the inhaler, be sure to tell your doctor right away.

How to get the inhaler: You can only get the inhaler with a doctor's prescription. To be safe, carefully read and follow directions inside the package.

Adapted from the Centers for Disease Control and Prevention handout, "You Can Quit Smoking," retrieved May 2001, from: http://www.cdc.gov/tobacco/quit/canquit.htm. The information in this handout was taken from "Treating Tobacco Use and Dependence," a Public Health Service-sponsored Clinical Practice Guideline.

This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.

Visit familydoctor.org for information on this and many other health-related topics.

Copyright © 2001 by the American Academy of Family Physicians.
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.

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