I have seen adverts for nicotine gum and patches. I smoke about 20 a day. Would nicotine replacement help me?

Some people are so addicted to nicotine that they need to be weaned off - they tend to be the people who need their first cigarette within 30 minutes of waking in the morning.

There are five sorts of nicotine replacements.

• The patch is like a thin plaster, which slowly gives out nicotine through the skin. It does not help if you have a sudden craving but, if you normally smoke steadily over a day, it will almost certainly suit your needs. Studies have shown that people using the patch, compared to those using a dummy patch (with no nicotine), had twice the success rate in stopping smoking. Patches come in different strengths, and heavy smokers (over 20 a day) may need to start high, weaning down to lower strengths over 2-4 weeks. Common products are Boots and Nicorette (5, 10 and 15 mg) and Nicotinell and NiQuitin CQ (7, 14 and 21 mg).

• Nicotine gum, inhalator, tablet or nasal spray help you respond to a sudden craving because they act quickly - so you may be more likely to need these if you smoke in response to sudden stress. Boots, Nicorette and Nicotinell gum (flavoured or plain) come in two strengths, 2 and 4 mg, and can be bought in chemist shops. Again, heavy smokers may need to start with the 4 mg strength; 8-12 pieces of either strength each day are recommended starting doses.

• The Nicorette nasal spray is prescription only (one spray each nostril up to twice an hour for 16 hours in every 24).

• Boots and Nicorette inhalators consist of a mouthpiece and replaceable nicotine cartridge - you should suck the nicotine vapour into the mouth (it does not reach the lungs). Each cartridge provides up to three 20-minute periods of intense use, and you may need 6-12 cartridges a day for 8 weeks, reducing to zero over the following 4 weeks. These can be bought in chemist shops.

• The Nicorette tablet (Microtab) is placed under the tongue and dissolves over 30 minutes, providing 1 mg of nicotine from a 2 mg tablet. You may need one or two every hour at first, and they can be bought in chemist shops.

The instructions must be followed carefully, and any concerns should be discussed with your family doctor or chemist. Do not use nicotine products if you are pregnant or breastfeeding.

Are there any side effects to the nicotine preparations?

or most people, side effects are not a problem. The gum may be awkward if you have dentures, and the patches may cause the skin to itch, so you may need to move them to a different place each day. The nasal spray may irritate the nose and throat and make your eyes water; the inhalator may cause a cough or irritation of the throat. The tablet can mildly irritate the mouth, but this tends to wear off with use. Sleep disturbance, vivid dreams, flushing or rashes, and nausea sometimes occur. Nicotine can upset a stomach (peptic) ulcer, so, if you are on treatment for an ulcer, check with your doctor first. If you have a history of heart attack, stroke, high blood pressure, diabetes or hardening of the arteries generally, check with your doctor first. If you are taking warfarin, inform your clinic, as there may be an interaction between the two drugs. Too much nicotine may make you feel sick, so do not smoke at the same time as using gum or patches.

Whilst combining nicotine preparations is not recommended by the manufacturers, some studies have shown improved success rates when the gum and patches, or the nasal spray and patches, are combined. Only do this after getting your doctor's advice.

Can I become addicted to the nicotine patches?

This is not a problem with the patches. However, the gum, spray tablet or inhalator, which deal with cravings, may need to be used for over a year. When you are trying to stop using nicotine replacements, wean off gently to avoid a withdrawal reaction. You will be more successful if you combine nicotine replacement with the support of smokers' clinics and family, rather than going it alone.

 
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