Which type of nicotine replacement may be right for you?

There's no evidence that any one type of nicotine replacement therapy (NRT) is any better than another. When choosing which type of NRT you will use, think about which method will best fit your lifestyle and pattern of smoking. Do you want/need something to chew or occupy your hands? Or are you looking for once-a-day convenience?

Some important points to think about:

* Nicotine gums, lozenges, and inhalers are substitutes you can put into your mouth that allow you to control your dosage to help keep cravings under better control.
* Nicotine gums and lozenges are generally sugar-free, but if you are diabetic and have any doubts, check with the manufacturer.
* Nicotine nasal spray works very quickly when you need it.
* Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler.
* Nicotine patches are convenient and only have to be put on once a day.
* Both inhalers and nasal sprays require a doctor's prescription.
* Some people may not be able to use patches, inhalers, or nasal sprays because of allergies or other conditions.

Whatever type you use, take your NRT at the recommended dose, and for as long as it is recommended. If you use a different dose or stop taking it too soon, it can't be expected to work like it should. If you are a very heavy smoker or a very light smoker, you may want to talk with your doctor about whether your NRT dose should be changed to better suit your needs.

Combining the patch and other nicotine replacement products: Using the nicotine patch along with shorter-acting products such as the gum, lozenge, nasal spray, or inhaler is another method of NRT. The idea is to get a steady dose of nicotine with the patch and to use one of the shorter-acting products when you have strong cravings.

The few studies that have been done on combination NRT used in the way described above have found that it may work better than a single product. Still, more research is needed to prove this and to find safe and effective doses. And the combined use of NRT products has not yet been approved by the FDA. If you are thinking about using more than one NRT product, be sure to talk it over with your doctor first.

High-dose nicotine replacement therapy for heavy smokers: Another NRT option is to give smokers a higher dose based on the amount of nicotine that they have been getting from cigarettes. Sometimes this method has required larger doses of NRT than have been used before. High-dose NRT with patches has been studied with patients getting from 35 mg to 63 mg of nicotine per day. The research suggests that patients' withdrawal symptoms go away with these higher doses and their cravings improve without harmful effects on the heart and circulation. Patient were carefully watched in these studies to make sure they were doing well and were not becoming ill or having any problems. But not much is known about this option and it should be considered only with a doctor's guidance and supervision.
Stopping nicotine replacement therapy

As mentioned before, most forms of NRT are meant to be used for limited periods of time. Use should be tapered down to a low dose before NRT is stopped. Research is still being done to refine the use of NRT. For example, even though the patch is usually used for 3 to 5 months, some studies have suggested that using it for 8 weeks or less works just as well. But other researchers have noted that the risk of relapse goes up when nicotine replacement is stopped, even after it has been used for 5 months. These differences have not been fully explained. More studies are needed to learn which smokers are likely to be successful using shorter or longer NRT than usual. If you feel that you need NRT for a different length of time than is recommended, it is best to discuss this with your doctor.