Shopping for over-the-counter quitting aids can be a little overwhelming because there are now five distinct forms of nicotine replacement therapy (NRT) to choose from, each in its own colorful array of brands. (Not to mention that nicotine gum and nicotine patches may be stowed somewhere behind the checkout counter near the cigarettes.)
But your chances of successfully quitting smoking double when you reach for the patch, gum, lozenges, the inhaler, or the spray, so it's usually worth the effort to sort through the facts about NRTs and reach for at least one.
Choosing an NRT
When used correctly, all five NRTs have about the same efficacy, according to the 2008 Clinical Practice Guideline for treating tobacco use and dependence, published by the U.S. Department of Health and Human Services. But each method addresses a different combination of physical and psychological withdrawal.
Start by assessing your own situation. Ask yourself how many cigarettes you smoke per day and the circumstances under which you generally decide to light up. If you tend to panic at the first twinge of nicotine withdrawal, for instance, then the easy-to-grab gum may be your best option. On the other hand, if you happen to miss inhaling smoke, the inhaler might be right for you.
Talk to your doctor about how you handled any previous attempts to quit and don't forget to consider physical conditions that may interfere with a particular type of NRT (if you wear dentures, for instance, the gum won't work for you). These questions may steer you toward one NRT in particular, or they may suggest a combo.
Either way, it's your choicebecause you're the one who has to make it work. "If a patient doesnt want what you give them, theyre not going to do it," says Steven A. Schroeder, MD, a distinguished professor of health and health care at the University of California San Francisco School of Medicine and the head of UCSFs Smoking Cessation Leadership Center.
The nicotine patch, approved by the FDA as a prescription drug in 1991 and for over-the-counter purchase in 1996, is a small square of adhesive that functions as a sort of nicotine Band-Aid. Usually attached to your upper arm, it delivers a steady but low level of nicotine through your skin and into your bloodstream. The patch was invented in the 1980s by Murray E. Jarvik, MD, the pharmacologist who first showed that nicotine was the addictive factor in cigarettes, and his student Jed Rose, PhD, who now directs the Center for Nicotine and Smoking Cessation Research at Duke University.
The patch's great advantage is that it's hard to use it wrong. A 1999 study published in the Archives of Internal Medicine reported that considerably more people used the patch correctly than any other form of NRT.
It's also a lot more private than the inhaler or spray, and because it only has to be changed every 24 hours, it doesn't demand a lot of you. You pick your starting doseit comes in 7 mg, 14 mg, and 21 mg, and you can lower the amount when you feel readyand the patch does the rest.
But what if your nicotine cravings come in bursts, not the steady sort of withdrawal that demands the patch? Thats where nicotine gum comes in. Approved by the FDA for prescription use in 1984 and over-the-counter purchase in 1996, the gum provides a surge of relief that you can control. (Lozenges, the inhaler, and the spray are also short-acting, but they are less popular because they require a prescription.)
Your complete control is both the gums great advantage and its great drawback, however, as many quitting attempts fail because of underdosing. The gum comes in both 2 mg and 4 mg doses (if you start with the higher dose, you're advised to lower it later), and experts recommend that new quitters not only chew a piece to satisfy strong cravings but also pop one in their mouth every one to two hours to help prevent cravings in the first place.
Many people end up chewing the gum less frequently than doctorsand the boxs instructionsrecommend, whether because of its cost (20–50 cents per piece) or its peppery flavor. Even though Nicorette, a leading brand of nicotine gum, now comes in flavors such as mint, cinnamon, and Fruit Chill, nicotine gum is likely never going to taste like Bubble Yumand besides, the peppery taste is actually an important signal of nicotine release.
Once a piece gets peppery (this is also commonly described as a tingling sensation), you move the gum to the side of your mouth and "park" it. When the taste subsides, you resume chewing until it returns again. After about 30 minutes, the taste is completely gone and that means the gums nicotine has been used up.
Gum plus patch
While there is no clear front-runner among the NRTs when they are used individually, the 2008 Clinical Practice Guideline reports that combining a nicotine patch with either gum or nasal spray is more effective than the nicotine patch alone.
Doctors tend to have the same take. "All things being equal, the most important thing is to give them the best shot at quitting, and the evidence is that the combination therapy tends to work better," says Dr. Schroeder.
But talk to your own doctor about whether monotherapy (using only one form of NRT) or combination therapy would be better for you. Or try a variation: Some doctors recommend starting a first quit attempt with one form of NRT and then adding a second if necessary.
On the other hand, if you smoked fewer than 10 cigarettes a day, combination therapy will probably provide too much nicotine to your system, and you would be better off with a single short-acting NRT.