Which Nicotine Replacement Product Appeals to You?

Which Nicotine Replacement Product Appeals to You?

Although they have nicotine in common, the four nicotine replacement products have some important differences.

Nicotine Patch

Known generically as the nicotine transdermal system, this method has been available in the United States by prescription since 1992 and over-the-counter since July 1996. It is sold OTC under the brand names Nicoderm and Nicotrol and by prescription under the names Habitrol and Prostep.

Each day, a new patch that looks like a big bandage is applied to a different area of dry, clean, non-hairy skin and left on for the amount of time recommended in the product’s labeling.

A mild itching, burning or tingling at the site of the patch when it is first applied is normal, but should go away within about an hour. After removing the patch, the skin might be red for up to a day. If the skin develops a rash or becomes swollen or very red, a doctor should be consulted. The patch may not be a good choice for those with skin problems or allergies to adhesive tape.

Nicotine Gum

FDA approved Nicorette gum (nicotine polacrilex) for prescription sale in 1984, and began allowing its sale without a prescription in February 1996. Chewing Nicorette releases nicotine into the bloodstream through the lining of the mouth.

Unlike gum chewed for pleasure, Nicorette requires a measured routine–it is chewed slowly until a slight tingling occurs or a peppery taste comes out, then placed between the cheek and gum until the taste or tingling is almost gone. The cycle is repeated for about 30 minutes per piece.

Most people find that chewing 9 to 12 pieces a day controls their urge to smoke, but the maximum number of pieces that can be safely chewed in a day is between 20 and 30, depending on the type of Nicorette.

Chewing nicotine gum may not be the right choice for those with temporomandibular joint disease (TMJ) or for those with dentures or other vulnerable dental work.

Nicotine Inhaler

FDA approved the Nicotrol nicotine inhalation system for smoking cessation in May 1997. The nicotine enters the user’s mouth through a mouthpiece attached to a plastic cartridge. Although the product is called an “inhaler,” it does not deliver nicotine to the lungs the way a cigarette does.

Almost all of the nicotine travels only as far as the mouth and throat, where it is absorbed through the mucous membranes. Side effects from the inhaler can include cough or throat irritation. Anyone with a bronchospastic disease such as asthma should use it with caution.

Nicotine Nasal Spray

FDA approved Nicotrol-brand nicotine nasal spray in March 1996, for sale by prescription only. The nicotine is inhaled into the person’s nose from a pump bottle and absorbed through the nasal lining into the bloodstream.

Nasal and sinus irritation is a common side effect of the nicotine nasal spray. While most people can tolerate the irritation, the spray is not recommended for people with nasal or sinus conditions, allergies, or asthma.

Generally, people should not use the nasal spray for longer than six months. The manufacturer is continuing to gather data on use of the nasal spray to ensure that neither smokers nor nonsmokers are abusing it. If you decide you want to try one of the four nicotine replacement products, you need to remember the following:

– Keep nicotine replacement products, including those that have been used and thrown away, out of reach of children and pets. Even very small amounts of nicotine can cause them serious illness.

– Don’t smoke, chew tobacco, or use snuff or other nicotine-containing products while using any of the four therapies. It is possible to get an overdose of nicotine. Signs of overdose include headaches, dizziness, upset stomach, vomiting, diarrhea, mental confusion, weakness, or fainting.

– Depending on how much you smoked, you may still experience some withdrawal symptoms, or you may feel some side effects from the nicotine, such as headache, nausea, upset stomach, dizziness, or disturbing dreams.

– Consult a doctor before beginning any nicotine replacement therapy, even one that is available over-the-counter, if you have a medical problem such as heart disease or high blood pressure.

– If you take any medications, especially drugs for asthma or depression, speak to your doctor. The dose of a medication may need to be adjusted because, with or without nicotine replacement, the body changes when one stops smoking.

– If you are pregnant or breast-feeding, speak to your doctor before trying a nicotine replacement product.





Tamar Nordenberg is a staff writer for FDA Consumer. (