Stop smoking aids: replace nicotine, reduce cravings

Nicotine replacement therapy (NRT) aims to ease cravings and reduce the short-term effects of quitting. It gives your body nicotine in a cleaner way while you wean the body off nicotine and kick the habit.

NRT can be used as long as needed to help move away from smoking; however, a target of 12 weeks is usually advised, and weaning off slowly in three steps, after every 2-4 weeks.

Which type of NRT is best for me?

NRT comes in various forms, so you can find one to suit you. These include patches, chewing gums, lozenges, nasal sprays, and inhalers. Factors influencing your choice include: whether you smoke heavily (20+ cigarettes a day) or you’re a lighter smoker (less than 10 cigarettes a day), whether you crave a cigarette first thing in the morning, or whether you have a hectic lifestyle.

Those who smoke regularly throughout the day should use a patch that can release a steady dose of nicotine into the bloodstream, over 16 to 24 hours.

Those who smoke at specific times of the day, are pregnant, or otherwise don’t require a constant dose of nicotine, may prefer nicotine on demand. In this case – say, you are stressed in a traffic jam or after a meeting at work – a lozenge, gum, or spray provides instant relief. You can combine NRT forms, too.

Evidence suggests that all forms of NRT boost the chance of succeeding in your attempt to quit smoking. Some studies showed that it increased the chances of stopping smoking by 50% to 60%.

Most NRT products do not require a prescription and are widely available at pharmacies and retailers. The NRT nasal spray and inhaler do require a prescription. NRTs should usually be your first strategy in stopping smoking, as they are generally safer and less likely to interfere with other medications or medical conditions, as opposed to anti-craving tablets. And you don't need to bother with a prescription.

Nicotine patches work for 16 to 24 hours, depending on the brand you choose. Step 1 would normally be a higher dose giving 21 mg of nicotine throughout use, which would typically be used for the first 4-6 weeks, then progressing on to Step 2 (14 mg per daily patch) for 2 weeks then step 3 (7 mg), for 2 weeks.

Nicotine patches are discreet; many people find them useful. Most say that they help them to transition away from smoking. Some people find their skin is sensitive to the patches or patch adhesives, causing localized skin irritation, so they may want to switch to another method instead.

Nicotine gums or lozenges come in a range of strengths and flavors, so there is a wide variety to choose from. As with patches, it is usually best to stick with a stepwise approach and wean off at 4-week intervals. They are fairly safe, low-calorie, and sugar-free. Some people may develop mouth ulcers directly related to the lozenges or gums themselves, but this may also be a side effect of quitting smoking.

Nicotine nasal sprays and inhalers: Nicotine nasal sprays are well tolerated and can give a very quick burst of nicotine on demand. Nicotine inhalers contain a refillable cartridge and differ from e-cigarettes since no smoke or vapor is released. Inhaler devices are particularly useful for those who miss the feeling of a cigarette between their fingers out of habit. This mimicking of holding a cigarette can help reassure and relieve tension for some users, particularly heavy smokers, knowing they have access to nicotine to alleviate their cravings.

Which step should I start on?

If you are a moderate smoker (10 to 20 cigarettes a day) or a heavy smoker (20+ cigarettes a day), then starting at step 1 is probably the best place to start. Those who smoke less frequently (less than 10 cigarettes per day) may want to see how they manage by starting at step 2, with additional nicotine on demand, such as a lozenge or gum.

Other treatments reduce cravings and the enjoyment of smoking. There are two main brands:

Varenicline (Chantix)

Chantix tablets contain the active ingredient varenicline. This works by binding to nicotine receptors in the brain, meaning that cravings are reduced, and smoking becomes less pleasurable due to the brain’s reward system being blocked.

Varenicline has been shown to increase the chances of quitting smoking for good. It is a prescription-only medicine. The brand name is no longer available in the US.

Bupropion (Zyban)

Zyban is a medicine that was originally developed to treat depression. Later it was discovered to help smokers to stop smoking. The exact mechanism of how it works is not clearly understood. However, it is known to alter the level of some chemicals in the brain (neurotransmitters), especially feel-good ones like dopamine. This can help smokers remove the pleasure component of smoking and overcome cigarette cravings.

Many people report that vaping can help cut down on cigarettes and even help people stop altogether. There is not enough evidence to support their use, and there is no regulation over what each product contains, unlike our highly regulated medicines market. As they’re so new, there is little evidence to say if they carry any long-term risks. However, some scientists think they could be as dangerous to your health as smoking cigarettes.