Smoking Cessation Drugs: Nicotine Replacement Products

Do Not Smoke

Smoking and using nicotine replacement products can be dangerous because nicotine can build up to toxic levels. Since your goal is to quit smoking entirely, you should not smoke while using a nicotine replacement product. If you still have the urge to smoke, you may need a new strategy to quit.

A recent study showed use of nicotine replacement product before the actual quit day could be beneficial. Talk to your doctor to find out if the strategy is safe for you. ]]> * ^¹]]>

See Your Doctor

Patches, lozenges, and gums can be purchased over-the-counter, but the nasal spray and inhaler require a prescription. Your doctor will help you determine the appropriate dosage. Also, your doctor can prescribe additional smoking cessation aids and can refer you to a counselor, support group, or other services that may help you quit smoking. People who combine several quitting strategies often have the most success.

Don't Overuse These Products

• Nicotine patch—Do not use for longer than 12 weeks.
• Nicotine gum—Do not chew or use more than 24 pieces a day, and do not use for longer than six months.
• Nicotine lozenges—Do not use more than 20 lozenges a day and do not use longer than 12 weeks.
• Nicotine nasal spray—Do not use for longer than six months.
• Nicotine inhaler—Do not use for longer than six months.

It may be appropriate for some people to continue using nicotine replacement products longer than the recommended duration. Some people continue to use them for 12 months or longer. Weaning off the medication is encouraged, but continuing on the nicotine replacement medication is preferable to smoking because cigarette smoke contains so many harmful chemicals besides nicotine.

If You Are Pregnant or Breastfeeding, Talk to Your Doctor

If you are pregnant, planning on becoming pregnant, or breastfeeding, talk to your doctor so she can help you find a safe method to quit smoking. Ask if nicotine replacement products are a good option for you. ]]>*²]]>

Be Careful Around Children

Children can be seriously harmed by any amount of nicotine. Keep these products, including used patches, away from children.

Use With Adolescents and Older Adults

Nicotine replacement products are believed to be safe for adolescents and older adults. People with dentures, though, should avoid using nicotine gums.

Manage Your Medications

Tell your doctor about all the medications you take; some should not be taken when you are quitting smoking with nicotine replacement products, while others may require a different dosage level. The following are especially important for your doctor to know about:

• Bronchodilators ( ]]>Aminophylline]]> , Oxtriphylline, ]]>Theophylline]]> )
• Benzodiazepines such as ]]>Xanax]]>, ]]>Ativan]]>, ]]>Librium]]>, ]]>Valium]]>, ]]>Klonopin]]>, and ]]>Serax]]>
• Beta-adrenergic blocking agents
• ]]>Clozapine]]> (Clozaril)
• ]]>Fluvoxamine]]> (Luvox)
• Insulin
• ]]>Olanzapine]]> (Zyprexa)
• Opioids such as ]]>OxyContin]]>, Percodan, and codeine
• ]]>Prazosin]]> (Minipress)
• ]]>Propoxyphene]]> (Cotanal-65, Darvon)
• ]]>Isoproterenol]]> (Isuprel, Medihaler-Iso)
• ]]>Phenylephrine]]> (Alconefrin, Doktors, Duration, Neo-Synephrine, Nostril, Rhinall, Vicks Sinex)
• Tricyclic antidepressants (with inhaler only)
• Nasal decongestants (nasal spray only)
• Foods and medications containing caffeine

Be Cautious With Certain Medical Conditions

The presence of other medical conditions may affect the use of nicotine replacement products. Tell your doctor if you have any other medical problems, especially the following:

• ]]>Allergies]]> (with nasal spray only)
• ]]>Asthma]]> or other breathing problems (with inhaler and nasal spray only)
• Common ]]>cold]]> or a stuffy nose (with nasal spray only)
• Dental problems (with gum only)
• ]]>Type 1 diabetes]]>
• ]]>Heart]]> or blood vessel disease
• ]]>High blood pressure]]>
• Inflammation of mouth, throat, or esophagus (with gum only)
• Skin irritation or disorder (with patch only)
• Liver disease
• Nose polyps (with nasal spray only)
• ]]>Overactive thyroid]]>
• ]]>Pheochromocytoma]]>
• ]]>Sinus problems]]> (with nasal spray only)
• ]]>Stomach ulcer]]>
• Recent ]]>stroke]]>
• ]]>Temporomandibular joint disorder]]> (with gum only)

Nicotine Patch

• Nicotine patch products vary in strength, number of patches, and time they should be worn. Talk with your doctor about the specific dosage and strength of nicotine patch that is appropriate for you, and how to taper off the product.
• Read the instructions that come with your specific patch to learn how and where to apply your patch.
• Keep the patch on even when you are showering, bathing, or swimming.
• Nicotine patches should be removed from the skin during strenuous exercise. If a patch is left on, too much nicotine may pass through your skin and into your bloodstream.
• If you are using a 24-hour patch and begin having unusual dreams or disturbed sleep, you may take the patch off before going to bed and put a new one on when you wake up in the morning.
• Mild itching, burning, or tingling may occur when the patch is first applied, and should go away within 24 hours. After a patch is removed, the skin underneath it may be red. It should not remain red for more than a day. If you get a skin rash from the patch, or if the skin becomes swollen or very red, call your doctor. Do not put on a new patch.

Nicotine Gum and Lozenges

• Read the instructions that come with the nicotine gum or lozenges to learn how to use it properly.
• The proper dosage differs for each person. Talk with your doctor to determine the appropriate dosage and weaning schedule for you.
• Do not drink acidic beverages, such as citrus fruit juices, coffee, soft drinks, or tea within 15 minutes before or after, or while you are using the product. Acid, as well as caffeine, can interfere with nicotine absorption.
• Carry nicotine gum or lozenges with you at all times in case you feel the sudden urge to smoke.

Nicotine Nasal Spray and Inhaler

• Read the instructions that come with the nasal spray to learn how to use it properly.
• The proper dosage differs for each person. Talk with your doctor to determine the appropriate dosage and weaning schedule for you.
• For the nasal spray only: During the first week of use, you may have a hot, peppery feeling in the back of your throat or nose; coughing; runny nose; sneezing; or watery eyes. Do not stop using the nasal spray at this point; if you continue to use it regularly, your body will adjust to these effects. However, if these effects do not lessen after one week, check with your doctor.
• For the inhaler only: The nicotine inhaler should be used at or above room temperature. Cold temperatures decrease the amount of nicotine you inhale. Avoid drinking coffee, juices, or soft drinks less than 15 minutes before or during use of the inhaler. Acidic drinks interfere with absorption of nicotine.

Possible Side Effects

The side effects listed here have been reported for at least one of the nicotine products, not necessarily all of them. However, since many of the side effects of nicotine products are similar, it is possible that these side effects may occur with any one of these medicines, although they may be more common with some than with others.

Contact your doctor as soon as possible if any of the following side effects occur.

These side effects are considered more common:

• Feelings of dependence
• Injury or irritation to the mouth, teeth, or dental work (with gum only)
• Swelling of gums, mouth, or tongue
• Chest pain or tightness
• Hiccups
• Stomach upset or heart burn
• Nausea
• Aching jaw
• Cough
• Runny nose
• Nasal irritation
• Skin irritation
• Tingling in arms, legs, hands, or feet

These effects are considered less common:

• Burning, tingling, or prickly sensation in nose, mouth, or head
• Confusion
• Difficulty swallowing
• Dizziness
• Vivid dreams
• Dryness or pain in throat
• Fast or irregular heartbeat
• Fever and/or chills
• Severe or worsening headache
• High blood pressure
• Insomnia
• Joint or muscle pain
• Nasal blister or sore
• Vomiting
• Numbness of nose or mouth
• Trouble breathing or wheezing
• Skin rash, itching, or ]]>hives]]>

Symptoms of Nicotine Overdose

Contact your doctor immediately if you experience any of these symptoms (which will probably occur in this order):

• Nausea and/or vomiting
• Increased watering of the mouth (severe)
• Abdominal or stomach pain (severe)
• ]]>Diarrhea]]> (severe)
• Pale skin
• Cold sweat
• Headache (severe)
• Dizziness (severe)
• Disturbed hearing and vision
• Drooling
• Tremor
• Confusion
• Weakness (severe)
• Extreme exhaustion
• Fainting
• Low blood pressure
• Difficulty in breathing (severe)
• Fast, weak, or irregular heartbeat
• Convulsions/seizures
• Death

Check with your doctor if any of the following side effects occur frequently and/or become bothersome:

• Back pain
• Belching (with gum only)
• Constipation
• Mild to moderate headache
• Hot, peppery feeling in the back of the throat or nose (with nasal spray)
• Increased appetite
• Increased watering of mouth (with gum only)
• Indigestion
• Nausea
• Jaw muscle ache (with gum only)
• Redness, itching, and/or burning at site of application of patch
• Runny nose
• Sneezing
• Sore mouth or throat (with gum only)
• Watery eyes