What Nicotine Replacement Therapy Does
While it may seem counter-intuitive to put nicotine into your body when you are trying to quit, it has proved to be very effective -- in studies, users of nicotine replacement therapies are twice as likely to successfully quit smoking.

The Theory
Quitting smoking can be very difficult since dependence on cigarettes combines both the physical addiction to nicotine--the addictive substance in tobacco--and the strong habit of smoking cigarettes. The patch, gum and the lozenge provide a way for you to first deal with the cigarette habit, and then decrease your nicotine intake in a systematic way.

The basic idea behind both the patch, gum and the lozenge is to slowly taper the smoker off the nicotine in cigarettes by replacing it with another, controlled source.

How It Works
When tobacco smoke is inhaled, the nicotine contained in the smoke is transported swiftly across the membranes in the lungs. Since the lungs are designed to move oxygen rapidly into the bloodstream, other chemicals can also be moved into the blood quickly and easily.

This contributes to the addictiveness of the drug. After inhaling a "puff" of cigarette smoke, the blood containing the nicotine reaches the brain within seconds. The current nicotine replacement products provide nicotine in a slower manner, by letting it leach across the membranes of the mouth or across the skin. This prevents the "bolus" effect, i.e., a powerful surge of nicotine.

Once the smoker has switched over to the nicotine replacement product, they can begin to work on becoming comfortable with not smoking. Typically, an ex-smoker will spend several weeks at the initial level of nicotine replacement, either wearing the same size patch or using the same daily amount of gum or lozenge. During this period the new ex-smoker can become accustomed to dealing with everyday events without cigarettes, such as talking on the telephone, riding in the car, and other potential smoking triggers.

Once the new ex-smoker has stabilized at this level of nicotine replacement, they can begin to bring their nicotine intake down in a controlled way, either by systematically decreasing the amount of gum or lozenge they use or by switching to the next smaller patch size.

Effects On Your System
Since these products don't put anything into your body that wasn't already there, direct effects from the nicotine are for the most part the same as when you were smoking. You may notice some change in your sleep (such as vivid dreams or insomnia) while on the patch, or the patch itself may leave a skin rash.

However, stopping smoking results in a few temporary reactions that can be uncomfortable until your body finishes healing itself. You may find you cough more, even bringing up mucous, as the defenses in your lungs come "back on line." As you decrease the amount of nicotine in your body, you may experience symptoms ranging from constipation to difficulty concentrating. These are temporary; our quitting guides can provide you with more information on why this happens and what to do about it.

Ask your Doctor before Use if You:

• are under 18 years of age
• are pregnant or nursing
• have heart disease or recent heart attack
• have high blood pressure not controlled by medication
• have a stomach ulcer
• take insulin for diabetes

Content author: Alan S. Peters, CTTS-M
Reviewed by: Andy Perez, MD, MBA, FACEP, February 2009

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