This is available in three strengths: 2mg, 4mg and 6mg and in several flavours. The 4mg and 6gm gum is better for more dependant smokers usually smoking more than 20 a day. The gum allows good control of the dose of nicotine because a piece can be chewed whenever the need for more nicotine arises. A chew-rest-chew technique should be used so that the nicotine is absorbed through the mouth lining and is not swallowed. Hold the gum between the cheek and the gum between chewing.
When the taste fades, it should be chewed again and then parked. Any swallowed nicotine is wasted as it is not absorbed when digested. Gum should be used for 3 months and then gradually reduced by switching to sugar free gum or reducing the number of pieces chewed. Most smokers will use 10-15 pieces of gum per day.
The gum can taste unpleasant at first although people do get used to the taste of it. The gum can cause mouth ulcers and indigestion.
Gum can be used on its own or in combination with a patch.
The patch delivers a measured dose of nicotine through the skin. They are available as 16 hour and 24 hour versions in varying doses. The patch is very discreet and easy to use, being put on each morning and with the 16 hour patch, taken off at night. High dose patches have been shown to be more effective than low dose patches for smokers of more than 15 cigarettes a day. If sleep disturbances occur with the 24 hour patch, try switching to a 16 hour patch.
Patches should be applied to clean, dry non-hairy skin – the upper arm or trunk are most commonly used. Use a different site each day to minimise any irritation. It can take up to 2 hours after applying the patch before the full dose is received. Some people find that taking gum or lozenge to supplement the patch more effective. At present, labelling on NRT products restricts usage to just one product. However there is little scientific evidence to support this.
This is the strongest form of NRT available and is generally recommended for more dependent, heavier smokers. This is the most rapid form of nicotine delivery available and the nicotine is absorbed through the permeable membrane of the nose. The spray is a bottle of nicotine solution that delivers a dose of nicotine in a spray when the top is pressed down. Again it allows good control of the dose. It can be difficult to use, causing sore nose, runny eyes sneezing and be generally unpleasant, although people who persevere soon get used to it and are able to tolerate it.
This is a plastic mouthpiece with a supply of replaceable nicotine cartridges that fit inside it. The nicotine is absorbed in the mouth and throat by sucking in on the inhalator and holding the nicotine filled air in the mouth for as long as possible. This gives the nicotine a chance to be absorbed by the blood vessels running on the surface of the mouth and gums. The inhalator is useful for smokers who like the ritual of smoking and allows control over the dose. Some people describe the taste as unpleasant but it doesn’t take long to get used to it.
Microtab (small tablet)
This is a small tablet which is placed under the tongue where it dissolves over a period of about 30 minutes. It is not chewed, sucked or swallowed. It is discreet and flexible and similar to the gum, gives good control over the dose of nicotine. Once again this is not a pleasant taste and can cause mouth ulcers and indigestion.
Useful for people working in a job that doesn’t allow eating or chewing, for example as a bank clerk, shop assistant or medical staff.
Lozenge / mini lozenge
The nicotine in lozenges is absorbed through the lining of the mouth like the gum and the microtab and so it is easy to regulate the dose. They come in two different sizes as well as different strengths and are sugar free. They can be used on their own or in combination with a patch.
Mini lozenge (4mg, 2mg and 1.5mg) – place lozenge in your mouth and allow to dissolve. It can last up to 10 minutes. Do not chew or swallow.
They can cause gastric upset, stinging in the mouth, hiccups or localised irritation eg of mouth ulcers
Spray into the side or top of your mouth whenever the urge to smoke is felt or you expect to feel – 1 to 2 sprays every 30 minutes to 1 hour. This product is fast acting and easy to regulate the dose. There are a number of possible side effects including hiccups, taste disturbance, headache, nausea, dyspepsia, vomiting, dry mouth, burning lips. It can be used on its own or in combination with a patch.
Place a strip on your tongue and push to the roof of your mouth. It will take about 3 minutes to dissolve. This product is suitable if you smoke your first cigarette of the day more than 30 minutes after waking. They come in one strength – 2.5mg and act within 1 minute. They are easy to use, discreet and sugar free. They can be used on their own or in combination with a patch. They may aggravate symptoms of oesophagitis, gastric or peptic ulcers.