Pharmacist/Client Discussion on NRT

Summary

This conversation focuses on the challenges of quitting smoking and the role of nicotine replacement therapies (NRT). The doctor explains the low success rate of quitting cold turkey and introduces products like nicotine patches, gum, lozenges, and inhalers to help manage cravings and withdrawal symptoms. Emphasis is placed on the importance of using the patch for baseline nicotine levels and combining it with oral products for cravings. The doctor offers insights into how these products work, how to use them effectively, and reassures the patient that slips won't immediately cause harm, encouraging them to move away from cigarettes altogether.

Takeaways

• 😀 Quitting cold turkey is not the most effective method for most smokers, with a success rate of 5% or less.
• 😀 Clean nicotine products like patches, gum, lozenges, and inhalers can help smokers manage cravings while reducing nicotine intake.
• 😀 Nicotine patches provide a baseline nicotine level but take 4 to 6 hours to fully take effect, which may lead to cravings in the early morning.
• 😀 It’s safe to combine a nicotine patch with oral nicotine products like gum, lozenges, or inhalers to help with cravings before the patch kicks in.
• 😀 Smoking while using nicotine replacement products does not trigger a heart attack, but it’s still advisable to avoid smoking due to the long-term heart risks of smoking.
• 😀 Nicotine gum should be used by biting down until a tingly sensation is felt, then parking it to avoid continuous nicotine release that can cause side effects.
• 😀 Drinking only water, not coffee or other beverages, while using nicotine oral products helps improve nicotine absorption and reduce side effects like tummy upset.
• 😀 Nicotine lozenges release nicotine steadily as they dissolve, providing a slightly higher nicotine dose than gum without the need for chewing.
• 😀 The nicotine inhaler mimics the action of smoking by allowing users to puff on a device, which can help with the hand-to-mouth habit, though it may take some getting used to.
• 😀 The goal with nicotine replacement is to maintain a steady nicotine level using the patch, while the oral products act as needed to manage cravings and prevent relapse into smoking.

Q & A

What is the success rate of quitting smoking cold turkey?

The success rate of quitting smoking cold turkey is likely 5% or less. It is not a highly effective method for most people.

Why is using clean nicotine products recommended instead of quitting cold turkey?

Using clean nicotine products helps maintain a more gradual nicotine level, which increases the chances of success. Cold turkey leads to withdrawal and cravings, making it harder to quit.

How much nicotine do you absorb from one cigarette?

On average, you absorb about 2 milligrams of nicotine per cigarette. A person who smokes 20 cigarettes a day may consume around 40 milligrams of nicotine.

What is the purpose of the nicotine patch, and how does it work?

The nicotine patch provides a steady, controlled release of nicotine to help reduce cravings and withdrawal symptoms. It is designed to be worn for 24 hours, but some people may remove it at night depending on their needs.

How long does it take for the nicotine patch to start working?

It takes about 2 hours to begin feeling some nicotine effects and 4 to 6 hours for it to peak and provide optimal nicotine levels.

Can you use other nicotine products while wearing the nicotine patch?

Yes, you can use other nicotine products, such as gum, lozenges, or inhalers, alongside the patch to help manage cravings, especially in the early hours when the patch starts working.

Is it safe to smoke while using a nicotine patch?

It is not recommended to smoke while using the nicotine patch, as it could increase the risk of heart disease, which persists regardless of whether you smoke your last cigarette.

How should nicotine gum be used to avoid side effects?

Nicotine gum should be chewed until a peppery or tingly sensation is felt, then parked in your cheek until the sensation fades. This pulse-dosing method helps avoid side effects like nausea or dizziness.

What should you drink while using nicotine gum, lozenges, or inhalers?

It is recommended to drink only clear water while using these products. Other beverages, like coffee, can interfere with nicotine absorption and worsen side effects.

What are the advantages and disadvantages of the nicotine inhaler?

The nicotine inhaler mimics the hand-to-mouth habit of smoking, which can help some people. However, it may also reinforce the physical habit of smoking, which is a disadvantage. Additionally, inhaling too deeply can cause a head rush.