Nicotine replacement products

Quitting smoking, also known as smoking cessation, can be tough, but you don’t have to do it alone.

Nicotine replacement therapies may help to reduce nicotine cravings when you stop smoking or cut back.

Nicotine replacement therapies were first introduced in the 1980s with Nicorette gum. Over the following years, other products were introduced.

These include:

• Patches
• Lozenges
• Inhalers
• Nasal or oral sprays

“These products are all designed to deliver set amounts of nicotine into the bloodstream to help control and minimise the chemical cravings people get when reducing the amount they smoke,” says Bupa GP, Janice Tan.

“It’s a controlled weaning therapy which can be more realistic and effective for some people than simply quitting cold turkey.”

“Nicotine has several implications for our health,” says Dr Tan. “If you smoke from a young age, nicotine can impact brain development.

“It also raises blood pressure which is a risk factor for cardiovascular disease.

“Nicotine can cause mucus in the lungs that is linked to respiratory illness, and it has been linked to poor mental health outcomes.”

Because nicotine, even without smoking, is bad for you, nicotine replacement products should not be used long-term.

“Every person’s quitting journey is different, but I tell my patients that these products should only be used for between 12-24 weeks.”

Although they are all designed with the same goal, which is to help people reduce their cigarette dependence, nicotine replacement products all work slightly differently.

Some slow-release versions, such as patches, can be used all day and even through the night, whereas other fast-acting therapies can be useful when you have sudden cravings and need a solution immediately.

“Patches are a set-and-forget solution, whereas things like gum or sprays can be helpful in the moment and give you something to do with your hands, which can help with the more social or habitual sides of cigarette addiction,” says Dr Tan.

You don’t need a prescription to access all nicotine replacement therapies (NRT), many options, such as patches, gum and lozenges, are available over the counter at your local chemist.

Depending on your private health insurance, you may also be able to claim a rebate on the cost of these products. Additionally, some NRT options are listed on the Pharmaceutical Benefits Scheme (PBS), which means they may be subsidised if prescribed by your doctor.

How does it work?

Nicotine patches can be worn for 24 hours or less. Containing a set amount of nicotine, generally ranging from 7mg to 25mg, the patch delivers a slow release of nicotine into the bloodstream through the skin. The patches can be worn all day or only at certain times. “It should be noted for pregnant people, that while no nicotine is always best, patches are preferred to smoking during pregnancy,” says Dr Tan.

Side effects

Skin allergies are common and may be reduced by moving the patches to different areas of the body when possible. Nausea is also common.

How does it work?

Nicotine gum delivers a small amount of nicotine to the bloodstream through the lining of the mouth. NSW Health recommends chewing until you can taste a strong pepper flavour or experience tingling, then keeping the gum inside the lining of the cheek or under the tongue until the taste fades. This should be repeated for around 30 minutes before throwing the gum away.

Nicotine gum may not be as effective if not used correctly or treated as regular chewing gum.¹ “This kind of quick release nicotine replacement product can help to treat both the chemical withdrawal but also the social and cultural, or habitual, aspects of addiction,” says Dr Tan.

“You can have it on the go and use it while out with friends or before a stressful meeting when you might usually have a cigarette and you experience that craving in the moment.”

Side effects

Nausea, mouth ulcers, dizziness, irritability and insomnia are common side effects of nicotine gum.²

How does it work?

A small plastic tube is placed in the mouth to inhale a small amount of nicotine. Not a vape or e-cigarette, a nicotine inhaler can help address the chemical craving as well as the action of inhaling you get with cigarette smoking, which some people might want when reducing their dependence.

Side effects

Headaches, hiccups, mouth and throat irritation and dizziness are among common side effects that may occur.³

How does it work?

NSW Health recommends rolling the lozenge around the mouth for a few minutes and then keeping it in the cheek or under the tongue, repeating these actions every five minutes for 30 minutes or until the lozenge is dissolved.

Side effects

Sore throat, indigestion and heartburn are among common side effects.4

How does it work?

Delivered nasally or orally, nicotine sprays are absorbed through the nose or mouth lining and deliver a quick release of nicotine into the bloodstream. It’s recommended to direct the spray into the side of the cheek or nasal passage and not directly down the throat or up the nose.

Side effects

If you experience any burning sensation or irritability in the nose, throat or mouth, do not use and consult a doctor.

Your GP can prescribe medication that can help you on your quitting journey.

“Common prescription medications for people wanting to quit smoking are varenicline, which is available under the brand name Champix, and bupropion, also known as Zyban,” says Dr Tan

Varenicline works by blocking the brain’s access to the enjoyable part of nicotine, whereby bupropion reduces the urge to smoke and the symptoms of withdrawal.⁵