Before using nicotine products

• Tell your doctor or healthcare professional if you are taking or have recently taken any other medicines, including those obtained without a prescription.
• Do not give nicotine products to children under 12 years of age and ask your doctor before giving them to older children.
• Pregnancy. Nicotine products are likely to be safer than smoking and so their use can be justified in pregnant women who are finding it difficult to stop smoking. Nicotine products that are taken when required (such as gum, lozenge, spray, inhalator) are preferred to patches. This is to minimise the exposure of nicotine to the unborn baby.
• Breast-feeding. The amount of nicotine that gets into breast milk is probably similar whether the mother smokes or uses nicotine products. Breast-feeding within one hour of smoking or taking a nicotine product can significantly increase the levels of nicotine in breast milk. Therefore, nicotine products that are taken intermittently are probably best if nicotine products are used during breast-feeding. Avoid using the nicotine product for at least one hour before breast-feeding.
• If you have any of the following conditions it is best to discuss these with a doctor before using nicotine products:
  • Severe heart problems.
  • Diabetes.
  • Stomach ulcers and problems (this only applies to products taken by mouth).
  • Uncontrolled thyroid problems.
  • Liver or kidney problems.
  • Lung or throat problems (this only applies to the inhalator or the nasal spray).

How to use nicotine products

Nicotine gum
Two different strengths of gum are available. You should use the 4 mg strength if you smoke 20 or more cigarettes a day, and the 2 mg strength if you smoke less than this. To release the nicotine, chew the gum slowly until the taste becomes strong, then rest it between your cheek and gums to allow the absorption of nicotine into your bloodstream. Chew the gum again when the taste fades, and rest it again when the taste is strong, and continue like this. One piece of gum lasts for about 30 minutes or so. You can use the gum as often as you need to, up to 15 pieces a day. As soon as you feel ready (this may be after a number weeks or months) you should use the gum less and less. For example, you can reduce the time you chew the gum, cut the gum into smaller pieces, or alternate the nicotine gum with a sugar-free gum. Gradually stop the gum completely.

The disadvantages of gum are that some people do not like the taste or always having something in their mouth. Gum is not suitable if you wear dentures.

Nicotine patches
The patches come in different strengths. The manufacturers normally recommend that you reduce the strength of the patch you use, gradually over time, before stopping completely.

A nicotine patch stuck on to your skin releases nicotine into your bloodstream. Apply one patch each day to an area of dry, non-hairy skin on your hip, chest or upper arm. Hold it in place for 10-20 seconds to make sure it sticks well. Some patches work for 16 hours and are worn during waking hours and removed at bedtime. Other patches work for 24 hours and are worn day and night and then removed before the next day's patch is applied. Place the next day's patch on a different area. Do not apply them to broken or infected skin.

The advantages of patches are that they are discreet and easy to apply. The disadvantage of patches is that a steady amount of nicotine is delivered. This does not mimic the alternate high and low levels of nicotine when you smoke.

Nicotine inhalator
This resembles a cigarette. Nicotine cartridges are inserted into a plastic holder, and inhaled in an action similar to smoking. You should use the inhalator whenever you feel the urge to smoke, or whenever you would normally expect to have cravings to smoke. It is up to you how many inhalations to take, how often to take them and for how long, but do not use more than 12 cartridges a day. The amount of nicotine you get from one puff of an inhalator is less than with a cigarette, so it is necessary to inhale more often than with a cigarette. As soon as you feel ready (which could be after a number of weeks or months), you can reduce the number of cartridges you use each day. Inhalators are particularly suitable if you miss the hand-to-mouth movements of smoking.

Nicotine lozenges
If you are using the lozenges, place one lozenge in your mouth every 1-2 hours when you feel the urge to smoke, and suck it until the taste becomes strong. Rest the lozenge between your gums and cheek and then suck it again when the taste has faded. Continue like this to allow it to dissolve. Do not chew the lozenge or swallow it whole. It will last for about 10 to 30 minutes depending on the lozenge size. Do not eat or drink while the lozenge is in your mouth and do not use more than 15 each day.

Nicotine nasal spray
The nicotine in the spray is rapidly absorbed into the bloodstream from your nose. This form of nicotine product closely mimics the rapid increase in nicotine level that you get from smoking cigarettes. This may help to relieve sudden surges of craving. Use one spray in each nostril when the urge to smoke occurs. You can use it up to twice every hour, but do not use more than 64 sprays a day. You can gradually reduce the amount you use by using one spray into one nostril only.

Nicotine sublingual
If you are using the sublingual form of nicotine products, place the tablet under your tongue and allow it to dissolve slowly. This allows the nicotine from the tablet to be absorbed into your bloodstream from the lining of your mouth. Do not chew or swallow the tablets. You can use one or two tablets each hour (one if you normally smoke 20 or less cigarettes a day, two if you normally smoke more than this amount). Do not use more than 40 tablets each day.

Nicotine oral spray
If you are using the oral spray, release one spray into your open mouth from as close to your mouth as you can while avoiding your lips. This allows nicotine to pass quickly into your body through the lining of your mouth. Do not breathe in as you spray, and try not to swallow for a few seconds after using it. You can use 1-2 sprays when you feel the urge to smoke or to prevent you craving a cigarette. You can use up to four sprays an hour but do not use more than 64 sprays each day.

Getting the most from your treatment

• Remember that you will need determination and setting a 'quit date' often helps.
• Before you start using nicotine products, read the manufacturer's printed information leaflet from inside the pack.

Can nicotine products cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

How to store nicotine products

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

References

• British National Formulary; 62nd Edition (Sep 2011) British Medical Association and Royal Pharmaceutical Society of Great Britain, London (link to current BNF)