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Guide to Over-The-Counter Smoking Cessation Products

Substantial benefits from quitting smoking can be realized at any age. It is never too late to quit to achieve many of the associated health benefits. Some of these health benefits are incurred shortly after quitting, while others are incurred over time. In fact, only 24 hours after quitting smoking your risk for having a heart attack decreases and the numerous health benefits just keep increasing the longer you abstain from smoking. There are many different options for patients wanting to quit smoking including several over-the-counter (OTC) nicotine replacement products.

Nicotine Replacement Therapy:

Nicotine replacement therapy (NRT) products are used to help cigarette smokers quit. Three of the NRT products including the gum, lozenge and patch are all nonprescription. NRT provides smokers with nicotine to help reduce the withdrawal symptoms of nicotine that usually occur after abstinence from tobacco. Therefore, the patients are not exposed to the harmful carcinogens and toxic constituents present in tobacco. NRT should begin on the chosen quit date and all other forms of tobacco should be discontinued on this date. The use of tobacco products in combination with NRT can increase the risks of nicotine related side effects like nausea, vomiting, and abdominal pain.

Nicotine Gum:

Nicotine gum is one option for NRT for people wanting to quit smoking. This gum is available as 2 mg and 4 mg strengths, in original, cinnamon, mint, and fruit flavors. The recommended dosage of nicotine gum is based on the time to first cigarette of the day. If the time to first cigarette of the day is 30 minutes or less from waking up, then therapy should be started using the 4 mg gum. If the time to first cigarette is more than 30 minutes, then therapy should be initiated with the 2 mg gum. During the first 6 weeks of therapy, patients should use one piece of gum every 1-2 hours while awake. Patients can use up to 24 pieces of gum per day if cravings occur between the scheduled doses.

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Nicotine Lozenges:

The nicotine lozenge is another option for patients. The lozenge is available in a sugar-free mint or cherry-flavored lozenge. Similarly to the nicotine gum, the dosing for the lozenge is based on the time to first cigarette. If the time to first cigarette is 30 minutes or less, therapy should be started with the 4 mg lozenge. If the time to first cigarette is more than 30 minutes, then therapy should be started with the 2 mg lozenge. During the first 6 weeks of therapy, patients should use 1 lozenge every 1-2 hours while awake with a maximum of 5 lozenges in 6 hours or 20 lozenges per day.

Nicotine Patches:

Nicotine patches are another good option for patients wanting to quit smoking. They deliver continuous, low levels of nicotine through the skin over 24 hours. The dosing of this product is based on how many cigarettes the patient smokes per day. If you smoke more than 10 cigarettes per day then start with the 21 mg patch. If you smoke 10 or less cigarettes per day then start with the 14 mg patch. To minimize the risk for local skin reactions, the patch should be applied to a different area of skin each day.

When to Seek Further Medical Attention:

  • All forms of NRT: stop using and seek medical attention if irregular heartbeat or palpitations occur, or if you have symptoms of nicotine overdose such as nausea, vomiting, diarrhea, weakness, or dizziness
  • For nicotine gum: stop using if mouth, teeth or jaw problems develop
  • For nicotine lozenge: stop using if mouth problems, persistent indigestion, or severe sore throat develops
  • For nicotine patch: stop using if the skin swells, a rash develops, or skin redness caused by the patch does not subside with use of nonprescription hydrocortisone cream or does not go away after 4 days

If you have any questions or concerns, please refer to your local NuCara pharmacist!

Martin, B.A. et al (2017). Chapter 47: Tobacco Cessation. In Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 19th Edition. Washington, District of Columbia: American Pharmacists Association. doi: 10.21019/9781582122656.ch47