Nicotine Replacement Therapy: Treatment, Effects & Risks

Anyone who has smoked for any length of time and has tried at least once to kick the habit knows how difficult it is to persevere. Withdrawal symptoms are unpleasant and can cause the decision to waver again. Nicotine replacement therapy can temporarily help with withdrawal.

What is nicotine replacement therapy?

In nicotine replacement therapy, nicotine is delivered to the body in a dosed form, through nicotine gum or patches, for example, to ease physical withdrawal symptoms. Many smokers do not manage to stop smoking on their own initiative because the nicotine addiction is too strong, especially if one has smoked for a long period of time. Therefore, in nicotine replacement therapy, nicotine is delivered to the body in a dosed form to alleviate physical withdrawal symptoms. The replacement products also release nicotine, but in a smaller form and more slowly than cigarettes. In addition, nicotine replacement products do not contain tar, carbon monoxide or other carcinogens found in cigarettes. Such nicotine replacement products are sold as nicotine gum, patches, lozenges, inhalers (e-cigarette) or nasal sprays.

Function, effect and goals

Nicotine is partly responsible for smokers’ addiction to tobacco products, but by itself it is not as addictive as animal studies and human drug use studies have shown. However, when combined with other substances found in a cigarette, it increases the risk of addiction. Even a few days of moderate cigarette use can be enough to create physical dependence. That is why nicotine replacement products contain only nicotine. There are several types of nicotine replacement products:

Nicotine patches regularly deliver a specific dose of nicotine to the body through a membrane or adhesive layer to keep nicotine levels constant. They come in different strengths, depending on how many cigarettes a smoker has previously smoked in a day. Nicotine patches are particularly suitable for people who want to quit and have a moderate to severe nicotine dependence and a relatively high cigarette consumption (at least 10 up to more than 40 cigarettes) spread evenly throughout the day. Nicotine gum should be chewed slowly and gently until the effects of nicotine kick in. When sufficient nicotine has been absorbed, the gum should remain in the cheek pocket. Nicotine gums are most suitable for smokers with low to moderate cigarette consumption (up to 15 cigarettes per day). They are also helpful when smoking is mainly linked to certain situations, e.g. in stressful situations, in company, in a restaurant, in front of the TV, etc.). In these critical moments, the nicotine gum is a useful substitute for the cigarette. Nicotine lozenges release nicotine for 10 to 30 minutes, acting through the oral mucosa. The tablets are most suitable for moderate to heavy cigarette use that is not evenly distributed throughout the day. Usually they are recommended as 2-mg tablets, but heavy smokers should rather take tablets with 4-mg. Nasal sprays are rapidly delivered to the body through the nasal mucosa and are relatively high doses. Therefore, they are primarily suitable for smokers with a strong craving and a cigarette consumption of at least 30 cigarettes per day. With a nicotine inhaler (e-cigarette), you inhale nicotine through a mouthpiece, just as you would with a cigarette. In addition to nicotine, the inhaler also contains flavorings such as menthol. One cartridge contains 10 or 15 mg of nicotine. Except for the nicotine nasal spray, all nicotine replacement products are available over-the-counter in pharmacies.

Risks, side effects and dangers

Smokers who want to quit should be aware that while nicotine replacement products can support cessation on a physical level, they are not intended to be a substitute for cigarette smoking. Nicotine replacement therapy is only suitable for bridging the initial period of bad physical withdrawal symptoms. First and foremost, smoking cessation is about changing a harmful behavior. Studies show good effectiveness of replacement therapy as an intermediate step to finally quitting cigarettes.When used correctly, nicotine gums etc. have only minor side effects such as dizziness, headaches, mild stomach/intestinal problems, and more rarely palpitations or chest pain. For people with sensitive skin, nicotine patches can cause skin redness and itching, and chewing gum and tablets can irritate mucous membranes. But since smoking does more permanent damage to the body, especially if cigarette consumption is high, temporary nicotine replacement therapy is the lesser of two evils, especially since – as studies have shown – it can effectively promote cigarette cessation. Deciding which type of replacement to consider depends on what type of smoker someone is. For heavy smokers, nicotine patches are best, which can be supplemented with gum or pills as needed in critical situations. Nicotine replacement therapy should not extend beyond 12 weeks, if possible, to avoid trading cigarette dependence for dependence on nicotine replacement products. To improve stamina, supplemental smoking cessation classes or programs are useful to practice behavioral measures for a smoke-free life while on replacement therapy. Anyone taking medication must take into account during replacement therapy that nicotine may cause medication to be excreted more quickly and to have less effect during this time. Nicotine replacement therapy cannot be recommended for pregnant women because potential health risks to the child have not yet been researched. They are better served by conventional smoking cessation.