Nicotine Replacement Therapy Product Guide

Information taken with permission from manufacturers’ data sheets and monographs; Pharmacia Ltd and Novartis Consumer Healthcare.

Product / Advantages / Disadvantages / Technique / Dosage / Cautions
Nasal Spray
Nicorette
10mg
Single Pack
Dual Packs / Very fast acting, mimics action of cigarettes / Sneezing and watering eyes
Throat irritation
Allergic reactions
Not to be used whilst driving or operating machinery.
Users may become dependent. / Prime the spray before first use or if not used for 2-3 days: press the shoulders of the spray device up to 7 or 8 times until a fine spray appears.
Keeping the head level, gently tilt the spray and insert the nozzle of the nostril. Press the shoulders of the bottle to activate the spray / One dose = one spray into each nostril.
1-2 doses per hour, no more than 3 doses per hour
Maximum dose: 64 sprays (32 doses) in 24 hours
Use when required for 8 weeks, then taper the dose over the next 4 weeks and stop. (500mcg/spray) / Chronic nasal disorders
Respiratory/COPD
Microtabs
Nicorette
2mg
30 Pack
100 Pack / Fast acting
Discreet
Good Control
Can help to stop overeating.
Suitable for Diabetics. / Hiccups
Mouth and throat irritation
Nausea
Dyspepsia (nausea)
Only lemon flavour available. / Place the tablet under the tongue and allow to dissolve slowly when the urge to smoke occurs.
Do not chew or swallow
Avoid acidic drinks before use / Smoke > 20 a day:
Use 2 tablets an hour.
Smoke <20 a day:
Use 1 tablet an hour.
Maximum of 40 tablets in 24 hours.
Gradually reduce the dose after 3 months. / Gastric or peptic ulcer
Lozenges
Niquitin
2mg and 4 mg
36,72,96 Packs
Mini Lozenges
Niquitin
1.5mg and 4mg
20, 60 Packs
Mint and Cherry flavours / Oral stimulation can help with over eating.
Slower acting / Hiccups
Sore mouth or throat irritation
Taste
Indigestion / Place the lozenge in to the mouth and suck until nicotine is activated
Place to the side of the mouth against the mouth lining
At intervals, bring the lozenge back to the middle and suck again then move to the other side of the mouth. Repeat this action for 20-30 minutes until the lozenge is completely dissolved
Do not chew or swallow whole
Do not eat or drink while a lozenge is in the mouth immediately before or after. / Initially 1 lozenge every 1 or 2 hours. Usual dose 8-12 per day.
Max 15 lozenges daily.
Withdraw gradually after 8 weeks so nicotine free by 3 months.
Review with a healthcare professional if need to keep using after 6 months. / Gastric or peptic ulcer
Heartburn
Indigestion
Cools Lozenges
Nicorette
2mg and 4mg
20,80 Packs
Icy mint
Flavor / Oral stimulation
Discreet
Good Control
Can help with over eating.
Slower acting. / Hiccups
Sore mouth or throat irritation
Taste
Indigestion / Place lozenge into the mouth and allow it to dissolve, moving it from one size to the other. Best results suck lozenge slowly – don’t chew or swallow it and avoiding eating and drinking while it is in your mouth.
The lozenge may take about 10 and 20 minutes to dissolve. / Smoke > 20 a day : 4mg lozenge.
Smoke<20 a day : 2mg lozenge.
Max 15 lozenges daily.
Withdraw gradually after 8 weeks so nicotine free by 3 months. / (As Above in lozenges)
2 & 4 mg Gum
Nicorette
25,105, 210 Packs
Icy White, Freshfruit & Freshmint / Slower acting
Oral stimulation
Good control / Some dislike chewing gum
Taste
May be difficult for dentures
Increased salivation
Mouth or throat irritation
Hiccups / Chew, when you feel a tingling sensation or when the taste becomes strong park the gum between the cheek and teeth
At regular intervals start chewing again then re park on the other side
Chew each piece of gum for until taste has faded.
Avoid acidic drinks for 15 minutes before and during chewing / Smoke > 20 a day: 4mg gum
Smoke ≤ 20 a day: 2mg gum
Max. 15 pieces per day of 4mg gum
A piece lasts approx 30 mins.if used correctly. Withdraw use gradually after 3 months.
Initially use an average of one piece of gum per waking hour (12-15 pieces per day)
Full dosage for two months then gradually taper off. Stop when down to 1-2 pieces per day. Treatment beyond 12 months not recommended. / (as above for lozenges)
Gastritis
Oesophagitis
Pharyngitis
Strips Oral Film
Niquitin
2.5mg
15,60 Packs
Mint / Fast acting within 50 secs
Discreet
Good control
Can help with over eating / Taste
May be difficult for dentures
Increased salivation
Mouth or throat irritation
Hiccups / Open pack
Place on tongue
Press to roof of mouth.
Marketed for people who smoke <10 per day and can go 30mins in the morning until first cigarette. / During weeks 1-6 use 1 strip every 1-2 hours
During weeks 7-9 use 1 strip every 2-4 hours
During weeks 10-12 use 1 strip every 4-8 hours
Inhalator
Nicorette
15mg
4,20,36 Packs / Fast acting
Oral stimulation
Hand to mouth activity. Can help to reduce over eating / Heartburn
Nausea
Cough
Throat irritation
Not very good for heavy smokers and may attract attention in public. Necessary to inhale more often than when smoking a cigarette. / Pull the two parts of the mouthpiece apart, insert a cartridge and re-assemble the mouthpiece. This breaks the seals on the cartridge
Inhale through the mouthpiece
Once a cartridge is inserted into the mouthpiece, it should be disposed of within 48 hours, even if it has not been used. / Smokers should use 6 cartridges per day (15mg/cartridge) initially for up to 8 weeks. N.B. One 15mg cartridge will last for 40mins of intensive use (8 x 5 mins).
Reduce use by half over next 2 weeks and stop after a further 2 weeks.
Review treatment if abstinence not achieved in 3 months.
Change cartridges as required, when no longer get nicotine taste in mouth. Ten puffs on the inhalator equals one puff on a cigarette / Thyroid conditions if not used correctly or not on medication for the condition.
Quick Mist
(Mouth Spray)
1mg
Single Pack
Dual Pack / Very fast acting (60-90 seconds) so quick relief of cravings.
Quick and discreet / Tingling lips, heartburn, strong taste, hiccups, watering eyes, oral soft tissue pain, ulcers, increased saliva.
Can be hard to open and use for arthritis sufferers or the very frail. / Prime the spray before when new or not used for 2-3 days. Spray 2 – 3 times till a fine mist appears.
Point the spray nozzle towards the inside of the cheek, holding it as close as possible. Press the top of the dispenser to release one spray into the mouth, avoiding the lips.
For best results, avoid swallowing for a few seconds (as long as possible) after spraying. / Use 1-2 sprays in the mouth when the urge to smoke occurs or to prevent cravings.
Maximum of 2 sprays per dosing episode.
Maximum of 4 sprays per hour (maximum of 64/daily) for a period of 8 weeks, then reduce usage by half over next 2 weeks and aim to withdraw after a further 2 weeks. / Anecdotally, this appears to be a common product for addiction transference so ensure patients follow wean off instructions.
16 Hour Patches
Nicorette
(Invisi Patch)
10mg, 15mg, 25mg / Once daily application
Discreet / Relatively slow acting, takes up to an hour to act
Adhesives can cause allergies / Apply to clean, dry intact areas of hairless skin on hip, trunk or upper arm.
Using a different site every day, do not re use same site within a 7 day period
Re-apply a new patch every day (usually in the morning)
Remove the patch at night approximately one hour before sleep. / 25mg/15mg/10mg
Smoke>10 a day 25mg/16hr patch for 8 weeks
then
15mg/16hr for 2 weeks
then
10mg/16hr for the final 2 weeks.
Smoke < 10 a day: start on a middle strength patch. / Chronic skin conditions
24 Hour Patches
Nicotinell
Niquitin
7mg, 14mg, 21mg / Once daily application
Discreet
24 hour cover - can help with early morning craving. / Nightmares, sleep disturbance
Adhesives can cause allergies
Relatively slow acting, takes up to an hour to act/allergy to adhesive possible / Remove metal backing, put on the skin and hold in place with the palm of the hand for 10-20 seconds
Apply to clean, dry, intact areas of hairless skin on the hip, chest or upper arm
Re-apply a new patch every day, do not re use same site in 7 days if possible. / 21mg/14mg/7mg
Smoke>10 a day:
21mg/24h for 6 weeks
then
14mg/24hr for 2 weeks
then
7mg/24hr for the final 2 weeks.
Smoke < 10 a day: start on a middle strength patch. / Chronic skin conditions

Main Precautions for all nicotine containing products:

*Unstable cardiovascular disease, diabetes mellitus, hepatic or renal impairment, uncontrolled hyperthyroidism, phaeochromocytoma, G.I disease, keep out of reach and sight of children. Stopping smoking may alter the metabolism of certain drugs.

* Many GPs and Health professionals do not recommend a quit attempt within 4 weeks of any cardiovascular event (heart attack, stroke,etc.) as this may cause stress and further episodes, however, if a patient presents and is very motivated and despite advice about possible concerns still wishes support to quit then they can use NRT and quit.

Diabetics should ideally only use microtabs and patches if using NRT. If they opt for other products ensure you have explained that other products contain ingredients that are contraindicated for their condition.