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Nicotine replacement therapies aid smoking cessation.

Nicotine replacement therapy (NRT) is available in a range of product formulations including nicotine gum, inhalator, lozenge, sublingual tablet, mouth spray, mouth strips, nasal spray and patch. It is a well-established treatment for smokers attempting to quit, with more than 110 trials comparing different forms of NRT with non-NRT controls. Trials have generally recruited smokers of >10 cigarettes per day and included some behavioural support.

The different forms of NRT do not appear to differ in effectiveness.. Fewer trials of the sublingual tablets and lozenges (and none of the mouth strips) and of over-the-counter NRT have been published, but their results are consistent with trials of other products and in other settings. Combining patch and faster acting NRT increases quitting. The evidence for using NRT before a planned quit date is inconclusive. Meta-analysis suggests an overall small non-significant benefit but more recent larger studies have shown less evidence of benefit than initial trials.

NRT delivers nicotine at a lower concentration and more slowly than cigarettes, so logically any risks from nicotine alone should be lower than those from smoking. Though a Cochrane review showed an increase in chest pain and palpitations with NRT compared with placebo (2.5% vs 1.4%), there is no evidence that NRT increases the risk of cardiac ischaemia. Addiction to NRT is rare.

Continued use of NRT for longer than the standard duration of treatment course is safe and may reduce relapse whilst used, but it is unclear whether a benefit persists once medication use stops.

Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub4.

Medicines and Healthcare products Regulatory Agency Committee on Safety of Medicines. Report of the Committee on Safety of Medicines Working Group on Nicotine Replacement Therapy. 2011.

Bullen C, Howe C, Lin RB, Grigg M, Laugesen M, McRobbie H et al. Pre-cessation nicotine replacement therapy: Pragmatic randomized trial. Addiction. 2010; 105 (8):1474-1483.

Pre-cessation nicotine replacement therapy: Pragmatic randomized trial. Addiction. 2010; 105 (8):1474-1483.

Lindson N, Aveyard P. An updated meta-analysis of nicotine preloading for smoking cessation: investigating mediators of the effect. Psychopharmacology 2011; 214: 579-592.

Joseph AM, Norman SM, Ferry LH, et al. The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Engl J Med 1996;335:1792-8. logo
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