Nicotine replacement therapy

• there is evidence that NRT doubles the smoking cessation rate compared with placebo
• NRT is less addictive than smoking
• NRT, unlike tobacco smoking, does not provide tar products and carbon monoxide
• currently, there is no evidence that nicotine causes cancer
• NRT provides nicotine in a slower and less satisfying way than tobacco smoking BUT is safer and much less addictive
• nicotine does have vascular effects and product licences require caution in patients with established vascular disease, especially after a recent event. However continuance of tobacco smoking doubles risk of recurrent events and mortality
• nicotine may cause nausea, dizziness, palpitations and headaches in patients who have not become tolerant to it
• NRT is not a magic cure but helps with withdrawal and craving symptoms
• use in pregnancy - see linked item
• the majority of NRT studies fail to follow up patients for more than a year. Therefore it is difficult to assess if health improvements achieved by NRT use are maintained long term
• a systematic review (4) regarding the use of NRT concluded:
  • all of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) are effective as part of a strategy to promote smoking cessation
  • NRT increases the odds of quitting approximately 1.5 to 2 fold regardless of setting
  • effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker -provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT

Notes:

• GPs have been able to prescribe nicotine replacement therapy products from 17 April 2001
• a systematic review of various pharmacotherapies for smoking cessation concluded that (2):
  • varenicline, bupropion and the 5 nicotine replacement therapies were all more efficacious than placebo at promoting smoking abstinence at 6 and 12 months

Reference:

• (1) Drug and Therapeutics Bulletin 1999; 37(7): 52-56.
• (2) British Heart Foundation, Factfile 6/99.
• (3) MeReC Bulletin 1999, 10 (3): 9-12.
• (4) Silagy C et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004; (3):CD000146
• (5) Eisenberg MJ et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ. 2008 Jul 15;179(2):135-44