Nicotine Replacement Therapy

Section Contents: NRT Clean Delivery System
                            Nicotine Patch
                            Nicotine Inhaler
                            Nicotine Gum
                            Nicotine Withdrawal and Toxicity
                            Myths and Facts about NRT

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Nicotine is the drug that is inhaled from tobacco while smoking.

It enters the bloodstream and stimulates the brain.

When a person smokes a cigarette, plasma levels of nicotine peak within 10 seconds.

When the blood levels of nicotine fall, smokers experience withdrawal symptoms such as irritability, restlessness, headaches etc.

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NRT Clean Delivery System

Nicotine Replacement Therapy (NRT) is a safe way to provide the body with nicotine
                                                  
NRT delivers lower levels of nicotine at a much slower rate than smoking which in turn reduces the symptoms of nicotine withdrawal

NRT eliminates the intake of thousands of harmful chemicals and toxins such as carbon monoxide, benzene, formaldehyde and combustion products.

NRT doubles the chances of successful quitting compared to not using any aid.

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Nicotine Patch

A nicotine patch can be used overnight (24 hours) or removed before going to bed for day use only (16 hours). The patch is placed on the skin releasing a steady stream of nicotine into the bloodstream. The patch is beneficial for those people who have early morning cravings. Nicotine patches come in 3 doses: 7mg, 14mg, and 21mg. The starting dosage for a person vaires depending on their smoking history. The patch can be used alone or in combination with the nicotine inhaler or nicotine chewing gum.

How to use the patch:
• Apply to clean dry area
• Rotate site every day
• Remove old patch before applying new one
• Do not use lotion, moisturizing soap on the area the patch is to be applied
• May need to clean area with alcohol wipe
• Touch only small corner of adhesive
• Rub patch after application – ensure all corners are stuck
• Wash hands in water after application –don’t use soap
• Discard old patch out of reach of children, animals – can still be harmful

Possible Side Effects:
Skin irritations may result at the site of the patch; it is important to rotate the site daily to avoid this.

The patch may cause sleep disturbances or vivid dreams when worn overnight. If this occurs, stop using patch overnight  and try managing night time cravings with the nicotine inhaler.

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Nicotine Inhaler

Nicotine inhalers are thin plastic canisters resembling cigarettes into which nicotine cartridges are insterted. Inhalers provide the "hand to mouth" action similar to smoking cigarettes. The inhaler can be used alone in combination with the patch or gum.

How to use the inhaler:
The inhaler is meant to be “puffed” similar to a cigar and not inhaled deeply into the lungs.

The inhaler can be used up to 20 minutes continuously or as needed.

Possible Side effects:
When using the inhaler, the person may notice a burning, warm or cool sensation. This is not dangerous.

Throat or mouth irritations are possible.

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Nicotine Gum

Nicotine Gum comes in 2 doses: 2 mg or 4mg. Nicotine is absorbed via buccal mucosa and is absorbed into the bloodstream faster than the patch. The gum can be used alone or in combination with the inhaler or patch to respond to immediate urges, similar to breakthrough pain medication. Not recomended for those with dentures or throat, mouth, or jaw dysfunctions.

How to use the gum:
“Chew and Park” method:
• Bite the gum a few times slowly
• Then park it between your cheeks and gum
• Wait a minute while the nicotine is released
• Repeat bite

Possible side effects:
If chewed improperly stomach upset/aches and hiccups can result.

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Nicotine Withdrawal and Toxicity

Nicotine Withdrawal

Typically nicotine withdrawal can occur within a few hours of abstinence from nicotine, peak within a few days, and can last up to six months or longer.
 
It is important to be able to identify nicotine withdrawal.
  
The symptoms of nicotine withdrawal may be similar to symptoms of other disease processes. It may be helpful to look for symptoms that are unaccounted for by other mental health or physical conditions.

Immediate Onset
• Cravings to smoke
• Frustration
• Anger
• Anxiety
• Difficulty concentrating
• Restlessness

Later Onset (These symptoms tend to be more mild than immediate onset but can also last up to six months or longer)
• Nausea
• Diarrhea/constipation
• Shakiness
• Dizziness
• Appetite changes
• Fatigue
• Sleep disturbances
• Headaches
• Clumsiness

Nicotine Toxicity

It is important to monitor for signs that the resident may be receiving too much nicotine. 

If a resident presents with any of the following symptoms, reassess the level of nicotine intake. 
• Nausea and/or vomiting
• Sweating
• Vertigo
• Tremors
• Confusion
• Weakness
• Racing heart
• Light-headedness

If the resident is smoking, he/she should be encouraged to further reduce their cigarette intake or the dose of the patch should be reduced. 

If the resident is not smoking, the current NRT should be discontinued or the dose should be reduced.

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Myths and Facts about NRT

There are a number of myths related to Nicotine Replacement Therapy.

Myth: Smoking while on the patch increases the risk of a heart attack.

Fact: Use of NRT while smoking does not increase the smoker’s cardiovascular risk

From the Ontario Medical Association (OMA) position paper on NRT. Click here to see the full text if the OMA paper.