The nicotine in tobacco leads to actual physical dependence. This can cause unpleasant withdrawal symptoms when a person tries to quit. Nicotine replacement therapy (NRT) gives you nicotine – in the form of patches – but not the other harmful chemicals in tobacco. NRT can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting. Many studies have shown using NRT can nearly double the changes of quitting smoking.
Smokers who are significantly dependent on nicotine should consider nicotine replacement or drug therapy to help them quit. Signs of severe dependence are:
- Smoking more than 1 pack a day;
- Smoking within 5 minutes of waking up;
- Smoking even while sick;
- Waking up at night to smoke;
- Smoking to ease symptoms of withdrawal
The more of these that apply, the more serious the dependence.
How does NRT work?
Nicotine replacement therapy(NRT) can help with the difficult withdrawal symptoms and carvings that most people say is their only reason for not giving up tobacco.
Many people can quit tobacco without using NRT, but most of those attempt quitting do not succeed on the first try. In fact, smokers usually need many tries – sometimes as many as 10 or more – before they’re able to quit for good. Most people who try to quit on their own go back to smoking within the first month of quitting – often because of the withdrawal symptoms.
Together with counseling or other support, NRT has been shown to help increase the number of smokeless tobacco users who quit, too.
Getting the most from nicotine replacement therapy
Nicotine replacement therapy(NRT) only deals with the physical dependence. It’s not meant to be the only thing you use to help you quit smoking. You’ll need other methods that help with the psychological (emotional and mental) part of tobacco, such as a quit program. Use these support systems during treatment with NRT and for at least a few months after you quit. Studies have shown that this approach – pairing NRT with a program that helps to change behavior – can improve your chances of quitting and staying quit compared to approaches that use only one method.
The best time to start NRT is when you first quit. Often people first try to quit tobacco on their own then decide to try NRT a day or more into quitting. This does not give you the greatest chance of success, but don’t let this discourage you. There are many options for quitting and staying quit. Just remember that it often takes many tries.
Who should not use Nicotine Replacement Therapy?
The US Agency for Healthcare Research and Quality states that nicotine replacement therapy(NRT) is safe for all adult who want to quit smoking except pregnant women and teens. Still, it’s best to discuss NRT use with your healthy care provider before starting it. You may have medical problems that should be considered. When looking at NRT use, the benefits of quitting tobacco must outweigh the potential health risks of NRT for each person.
People who are still smoking or using other form of tobacco should not use NRT. The companies that make NRT products warn that you should not use them if you’re still using tobacco, and the FDA has not approved them to be used in this way. Get the advice of a health care provider if you want to use NRT and smoke or chew.
NRT has not yet been proven to help people who smoke fewer than 10 cigarettes a day. You might want to talk with your health care provider about a lower dose of NRT if you smoke less than that but feel you need nicotine replacement.
Can you get too much nicotine from NRT?
Nicotine overdose is rare, but possible. Nicotine replacement therapy products are labeled to match the amount of nicotine you get from NRT to the amount you got from tobacco. If used this way, you should get a nicotine dose fairly close to what you’ve been getting. You don’t want to get more than that, because higher doses of nicotine can cause harm. To avoid this, follow dosing instructions carefully. Also, don’t use heat on the skin near your nicotine patch – you could absorb more nicotine due to the increased blood supply.
Nicotine absorbs through the skin and mucous membranes, so you must store and dispose of your NRT safely. Nicotine overdose can cause death. Overdose is more of a problem in children and pets because of their smaller size. Keep NRT and used patches, safely away from children and pets. Never drop them on the street or in open trach cans where kids and animal can reach them.
Symptoms of nicotine overdose
Here are some symptoms of too much nicotine:
- Nausea and vomiting
- Belly pain
- Agitation, restlessness
- Fast or irregular heartbeat
- Cold sweat
- Pale skin and mouth
- Disturbed vision and hearing
- High blood pressure, which then drops
- Dizziness or faintness due to low blood pressure
- Fast breathing in early poisoning, breathing may stop later
Call Poison Control and get emergency help if you suspect an overdose. If you’re taking NRT as prescribed and are still having mild symptioms such as headache, vomiting, diarrhea, or sweating, lower your dose and talk to your health care provider.
How do I know whether I’m a light, average, or heavy smoker?
Most nicotine replacement therapy(NRT) products are recommended on the basis of how much you smoke. But there’s no formal category in any text book or group that defines a light, average, or heavy smoker.
These are general guidelines:
- Light smoker: Smokes fewer than 10 cigarettes per day
- Heavy smoker: Smokes a pack a day or more
- An average smoker falls in between.
Nicotine patches(transdermal nicotine systems)
The FDA has approved nicotine patches as nicotine replacement therapy.
Patches can be bought with or without a prescription.
Patches give a measured dose of nicotine through the skin. You’re weaned off nicotine by switching to lower-dose patches over a course of weeks. Many different types and strengths are available. Package instructions tell you how to use them, and list special considerations and possible side effects.
How to use nicotine patches: Depending on body size and smoking habits, most smokers should start using a full-strength path(21 mg of nicotine) daily for 4 weeks, and then use a weaker patch (14 mg of nicotine) for another 4 weeks. Finally, use the weakest patch (7 mg of nicotine) for another 4 weeks. The patch needs to be changed every day. It should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist – for instance, on the upper arm or chest. The FDA has approved using the patch for a total of 3 to 5 months.
Possible side effects of the nicotine patch include:
- Skin irritation (redness an itching)
- Racing heartbeat
- Sleep problems or unusual dreams
- Muscle aches and stiffness
No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because the dose of nicotine is too high for you. Stop using the patch and talk to your health care provider if this happens. You can also have nicotine withdrawal symptoms during this time if your NRT dose is too low.
What to do about side effects
- Try a different brand of brand of patch if your skin becomes irritated.
- Reduce the amount of nicotine by using a lower-dose patch.
- Sleep problems may go way in 3 or 4 days. If not, and you’re using a 24-hour patch, try switching to a 16- hour patch.
- Stop using the patch and try a different form of NRT.