Stop smoking aids: replace nicotine, reduce cravings

Nicotine replacement therapy (NRT) aims to ease cravings and reduce these 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 4 weeks.

Which type of NRT is best for me?

NRT comes in a variety of formats, so you can find one to suit you. These include patches, chewing gums, lozenges, nasal sprays, mouth sprays, inhalator devices or e-cigarettes. 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 day, or whether you have a hectic lifestyle.

Those who smoke regularly throughout the day, may be best having a patch which can give a steady dose of nicotine into the blood stream, 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 mouth spray provides instant relief. You can combine NRT formats, too.

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

NRT products do not require a prescription, and are widely availabe to buy at pharmacies and retailers. NRTs should usually be your first port of call 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 between 21mg to 25 mg of nicotine over the duration of use, which would typically be used for the first 4 weeks, then progressing on to Step 2 (14mg to 15mg per daily patch) and step 3 (7mg to 10mg), at intervals of every 4 weeks.

Nicotine patches are discreet and many people find them useful, especially when going long periods without smoking. 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 a localised skin irritation, so they may want to switch to another method instead.

Nicotine gums or lozenges come in a range of strengths and flavours, 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 which may be directly related to the lozenges or gums themselves, but may also be a side effect of quitting smoking.

Nicotine mouth sprays and inhalators: Nicotine mouth sprays are well tolerated, and can give a very quick burst of nicotine on demand. Nicotine inhalator devices are registered medical devices and have a well-established safety record. They specifically licensed to use for quitting smoking, and contain a refillable cartridge and differs from e-cigarettes since there is no smoke or vapour that is released.

These inhalator 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 heavy smoker (20+ cigarettes a day), then starting at step 1 is probably the best place to start. Those who smoke less frequently, ie 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 spray, lozenge or gum.

Other treatments such as tablets to reduce cravings and enjoyment of smoking. There are two main brands, plus the option of vaping:

Varenicline (Champix)

Champix 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.

Champix has been shown to more than double the chances of quitting smoking for good. It is a prescription-only medicine, available from the NHS Stop Smoking service, doctors, and nurses and pharmacists who have been certified as stop smoking advisers and prescribers.

Bupropion (Zyban)

Zyban is a medicine that was originally developed to treat depression. However 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, and this can help smokers remove the pleasure component of smoking and overcome the cravings for cigarettes. It is still used in some cases for stopping smoking, but it has mostly been superceded by newer drugs like Champix.

Many people report vaping helps cut down on cigarettes and even help people stop altogether. They are not available on an NHS prescription as 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, scientists think that they are likely to be less dangerous to your health than smoking cigarettes.

You’re welcome to try these, but bear in mind you may have to go through the giving-up process with these, too, at some stage, and they can be expensive.