Smoking Cessation

Using Over the Counter Nicotine Replacement to Help You Stop Tobacco Use

Congratulations! Making the decision to stop using tobacco is one of the most important things you can do to improve and protect your health, as well as the health of those around you. Trying to quit on your own, sometimes called "cold turkey", may be difficult and uncomfortable. Quitting is easier if you have the help and support you need, including medications to decrease your cravings and help reduce withdrawal symptoms.

Nicotine Replacement Helps You Quit.

Nicotine replacement therapy (NRT) provides you with some of the nicotine you would normally receive if you used tobacco and more than doubles your chances of success. Most NRT is available "over the counter" or "OTC" without a prescription. For information about medications that require a prescription [nicotine inhalers and nasal spray, bupropion (also known as Wellbutrin® or Zyban®) and varenicline (also known as Chantix®)], see the ATS Patient Information Series Fact sheet at www.thoracic.org/patients or ask your healthcare provider.

OTC nicotine replacement products include:

• nicotine patches
• nicotine gum
• nicotine lozenges

These medicines can—and in most cases should—be combined to best control your symptoms. You should plan to use these products for at least 8-12 weeks or as long as you need them, slowly decreasing the amount of nicotine you receive. For more about nicotine dependence and cravings, see ATS Patient Information Series fact sheets at www.thoracic.org/patients.

How Can I Get Started?

Make a plan: Think about who can support you and help you make a plan. It could be family, friends, healthcare providers, or other people in your support network. You can also call your state quite line, tell them of your decision to quit, and ask for help with your plan.

Decide on a Dose: The more you smoke, the more nicotine replacement you will need to control your cravings. Your healthcare provider or pharmacist can help you decide what dose is right for you. If you smoke more than 10 cigarettes/day or smoke soon after waking, combining a patch with either gum or lozenges will give you the greatest chance in successfully stopping.

Learn how to beat cravings: Get ready to use NRT to control the urge to smoke. Whatever medication or combination you choose, make sure you use it as directed. Carry your lozenges and gum with you for immediate cravings and change your patch every day. Combining medications with counseling, such as a quit line, will maximize your likelihood of success.

Key Facts About Nicotine Replacement

• FDA approved for use in people 18 years of age and older.
• If you are pregnant or breastfeeding, check with your healthcare provider before using these products.
• Plan to cut back on using tobacco products while using NRT. Using tobacco products while using NRT may give you very high doses of nicotine, which may make you nervous or cause abnormal dreams, difficulty sleeping, headache, heartburn, nausea, dry mouth, or joint and muscle pain.
• Be sure to keep all nicotine replacement products out of the reach of children.

Serious side effects are rare. You should seek medical help if any of the following symptoms develop, as they may be a sign of an allergic reaction or high nicotine levels:

• hives
• breathing difficulty
• chest tightness
• fast or irregular heartbeat
• increase in your blood pressure
• jaw, teeth or mouth problems
• severe diarrhea

Will The Nicotine in These Medications Cause Cancer?

It is important to know that nicotine alone does not cause cancer. There are more than 7,000 chemicals you are exposed to while smoking tobacco, and some are known to cause cancer. Nicotine addiction is a major reason people continue to use tobacco products, exposing themselves to these cancer-causing chemicals. Using nicotine replacement products will help you slowly wean off nicotine, while avoiding the risks of inhaling burning tobacco.

Which Nicotine Replacement Product Is Right for Me?

Talk to your healthcare provider about which products are best for you. Many people do not use enough nicotine replacement products to control their cravings. Combining nicotine replacement products (such as using the patch and the gum at the same time) is safe, can make you more comfortable, and more successful in stopping tobacco for good. Many times, these medications are covered by insurance plans, including Medicaid. Ask your healthcare provider or insurance company to help reduce the cost of OTC medications.

Below are more details on each of these products:

Nicotine Patch

The nicotine patch is a skin patch applied in the morning and worn all day. It should be applied anywhere on the body above the waist, preferably on an area with little or no hair. Rotate the sites where you apply the patch to avoid skin irritation. Nicotine patch is most effective when worn continuously for 24 hours. If you have difficulty sleeping while using the nicotine patch, you can try taking the patch off one hour before bedtime to help reduce nightmares and poor sleep.

If the patch falls off, you must reapply a new one. Do not cut patches in half. The patch delivers nicotine continuously through the skin. Cutting the patch will change the amount of nicotine you get. The nicotine patch is available in 7, 14 and 21 mg doses. People often start with a higher dose patch and then gradually work down to lower doses. Consult your healthcare provider about the best dose for you.

Nicotine Gum

Nicotine gum is nicotine available in a chewing gum and works best to control cravings throughout the day. You do not chew it like candy or bubble gum. The proper use of nicotine gum is to chew it a little and “park it” between your cheek and gum. This allows the nicotine to be absorbed through your cheek and gums. Do not continually chew the gum and swallow the juice. Swallowing too much juice can cause hiccups, nausea and abdominal pain. Also do not keep the gum in your mouth overnight, because you could choke, and it loses its potency after 30 minutes to an hour. The gum is available in 2mg and 4mg doses and can be used along with the patch to treat cravings. A tobacco counselor or your healthcare provider can recommend the best dose for you.

Nicotine lozenge

This nicotine replacement comes in the form of a dissolving lozenge and is also used to control cravings throughout the day. Moisten the nicotine lozenge and park it between your cheek and gum. Do not chew the lozenge. Lozenges lose their potency after 30 minutes to an hour. The lozenge is available in 2mg and 4mg doses and can be used along with the patch to treat cravings. A tobacco counselor or your healthcare provider can recommend the best dose for you.

Can I Use Electronic Cigarettes to Help Me Stop Smoking?

The current evidence does not support the use of electronic cigarettes (or vaping) to assist with smoking cessation. While some studies suggest that these products may help with quitting smoking, many other studies show that they are ineffective at doing so. Electronic cigarettes are not FDA approved for helping with quitting smoking, whereas OTC nicotine replacement and prescription medications (nicotine inhalers and nasal spray, bupropion [also known as Wellbutrin® or Zyban®] and varenicline [also known as Chantix®]) are proven to be effective and safe.

Authors: Tobacco Action Committee of the American Thoracic Society, Anne Melzer, MD, MS; Patricia Folan, RN, MS; Hasmeena Kathuria, MD; Christine Fardellone, DNP, RN, CTTS; Raisa Abramova, FNP, CTTS.
Reviewer: Krishna Reddy, MD; Michelle Eakin, PhD; Marianna Sockrider, MD, DrPH

RX Steps

• Speak with your healthcare provider or call your local Quitline to understand what products and dosage are right for you.
  
• Make a plan on how you are going to cut out your tobacco use as you start nicotine replacement therapy and ask a friend or family member to help support you in this effort.
• Remember, becoming free from tobacco products is your most important goal.
• Don’t give up! Most people take several tries to quit for good.