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Nicotine replacement therapy

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • there is evidence that NRT doubles the smoking cessation rate compared with placebo
  • NRT is less addictive than smoking
  • NRT, unlike tobacco smoking, does not provide tar products and carbon monoxide
  • currently, there is no evidence that nicotine causes cancer
  • NRT provides nicotine in a slower and less satisfying way than tobacco smoking BUT is safer and much less addictive
  • nicotine does have vascular effects and product licences require caution in patients with established vascular disease, especially after a recent event. However continuance of tobacco smoking doubles risk of recurrent events and mortality
  • nicotine may cause nausea, dizziness, palpitations and headaches in patients who have not become tolerant to it
  • NRT is not a magic cure but helps with withdrawal and craving symptoms
  • use in pregnancy - see linked item
  • the majority of NRT studies fail to follow up patients for more than a year. Therefore it is difficult to assess if health improvements achieved by NRT use are maintained long term
  • a systematic review (4) regarding the use of NRT concluded:
    • all of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) are effective as part of a strategy to promote smoking cessation
    • NRT increases the odds of quitting approximately 1.5 to 2 fold regardless of setting
    • effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker -provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT

Notes:

  • GPs have been able to prescribe nicotine replacement therapy products from 17 April 2001
  • a systematic review of various pharmacotherapies for smoking cessation concluded that (2):
    • varenicline, bupropion and the 5 nicotine replacement therapies were all more efficacious than placebo at promoting smoking abstinence at 6 and 12 months

Reference:


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