Nicotine Patches and Gums: How to Use, Dose, Duration, Side Effects

Cigarette smoke contains many ingredients, most of them being toxic, health-degenerating and even lethal. Smoking is an addiction and that is what makes it dangerous. There are various reasons why people take up smoking and once habituated, it very difficult to give it up.

The success rate of giving up smoking for good on your own is 2 to 5% — that is, only 2 to 5 out 100 smokers who want to quit succeed in giving up. That indicates the enormous difficulty in giving up the smoking habit.

This is because of the withdrawal symptoms that manifest when you quit tobacco. They appear due to the withdrawal of nicotine (the addictive substance in cigarette tobacco smoke) from the blood.

Nicotine is very addictive. To make it easier to quit there are certain aids that significantly increase your chances to succeed. Nicotine skin patches and gums are the most popular.

They form part of the nicotine replacement therapy (NRT), which also include lozenges and nicotine inhalers.

NRT works on the fact that since nicotine is the addictive component of tobacco smoke, you supply the body with it through means other than smoking.

The plus point is that though you get nicotine, you are deprived of the other toxic contents of cigarette smoke and their dangers.

Nicotine patches

Nicotine patches are small patches applied on the skin. They are available with different strengths of nicotine that is gradually released into the person’s bloodstream through the skin. This is called transdermal absorption.

The presence of nicotine in the blood reduces the craving for a cigarette smoke.

Having nicotine levels in the blood with help of these nicotine replacements also reduces the severity of the smoking withdrawal symptoms, thereby helping to curb the craving for a smoke. These nicotine replacements are then gradually reduced over time.

Nicotine patches do not cause addiction as does inhalation of it through the cigarette smoke.

Research is looking at its other potential uses including treatment for Alzheimer’s disease, and for some cognitive impairment like memory loss and dementia.

How to apply the patch?

After removing the nicotine patch from its cover, do not touch the sticky side of the patch.

Apply and stick the patch on your skin on an area, which is not covered by hair such as the upper arm or sides of the stomach.

Press the nicotine patch flat against the skin with the flat of your palm for about 10 seconds. Make sure the nicotine patch is planted smoothly and flat against the skin.

Wash your hands with soap and water as nicotine on your hands from the patch could get into your eyes or nose and cause burning.

Wear the patch for a time as instructed on the cover of the patch, which is about 16 to 24 hours.

Dispose off the nicotine patch by folding it and disposing it off in the cover of the patch so that it does come in contact with children and pets.

The next patch should be used in a different area. Wait for a week before you apply the patch on an area that you have already used.

You can shower and bathe with the patch on, because it is waterproof. If the patch peels off, stick it back on.

If you feel uncomfortable using it during sleep, you can remove it and use a fresh patch in the morning.

The patch delivers nicotine steadily throughout the day though more slowly than the gums.

Dose of the patch

The 24-hour 21 mg patch or the 16-hour 15 mg patch usually satisfies the need of most smokers.

At times, a combined therapy of a patch with a gum or an inhaler may be required. You can even use two nicotine patches at the same time.

A 24-hour 21 mg patch is preferred because it prevents morning withdrawal symptoms.

For people with low nicotine dependence, the 24-hour 14 mg patch or the 16-hour 10 mg patch would be ideal.

During the later period of weaning, the 24-hour 7 mg patch and the 16-hour 5 mg patch are used.

However, it is advised that you take the advice of your smoking cessation doctor.

Duration of treatment with patch

The recommended duration of treatment is at least 8 to 12 weeks. It may be extended in cases where the nicotine addiction is very strong.

The U.S. Food and Drug Administration (FDA) first approved the use of nicotine patches for eight weeks

Recently, however, based on new research, the FDA recommended the use for six months on the theory that this prolonged use helps the smokers quit more easily and surely than just eight weeks of use.

Side effects of nicotine patches

Side effects of nicotine patches consist of itching and redness at the site where the patch was applied, headache, anxiety, lack of sleep, change of taste, rapid irregular heartbeat and menorrhagia (painful menstruation).

Nicotine Gums

Another useful NRT product is the nicotine gum. Lozenges are also available. It is convenient in the sense you can keep them in the pocket and pop them into your mouth when you feel the need for nicotine.

How to use nicotine gums or lozenges?

Nicotine gum is a very hard in consistency and is available in individual foil packed containers. It comes in various flavors and you have a choice to choose your favorite.

Each gum contains either 2 or 4 mg of nicotine, which approximately equals the amount of nicotine in 1/3 of a cigarette.

Each cigarette contains on an average 12 mg of nicotine, but only 1 mg of it is absorbed with each cigarette smoked.

You should not use nicotine gums or lozenges immediately after eating or drinking because that will reduce the absorption of nicotine from the stomach. An empty stomach facilitates a faster absorption.

You have to chew the gum till it becomes soft and produces a tingling sensation or a spicy taste. It is then tucked away between the gums and the cheek.

You should chew it again after the tingling sensation ends following which you should park it in another location in the mouth.

Chew the gum slowly, not fast. Do not chew more than one gum at a time.

Repeat the process for about 30 minutes after which the gum gets depleted of nicotine and the craving fades away.

Dose of nicotine gum

If you are used to smoking your first cigarette after 30 minutes of waking up, you should use the 2-mg gum.

If you smoke the first cigarette earlier than 30 minutes after waking up, you should then use the 4-mg gum.

You should regularly chew one piece of gum every 2 hours for the first 6 weeks, followed by one piece every 4 hours for 3 weeks, and then one piece every 8 hours for 3 weeks.

Chew at least 9 pieces of nicotine gum each day for the first 6 weeks. This will give a better success rate.

Stop chewing gum after 12 weeks. If you still feel you need more time with the gum, talk to your smoke cessation expert for further guidance.

Do not use NRT products if you are pregnant.

Side effects of nicotine gum 

Side effects of the stop smoking gum consist of soreness of gums, change of taste, mouth blisters, nausea, vomiting, hiccups, abdominal discomfort, flatulence, fast or irregular heartbeat, and breathing difficulty.

Side effects are more likely if you continuously chew one gum after another.

Availability of NRT skin patches and gums

Originally in the 1980s, NRT products were sold only on prescription. Now the norms are relaxed but different policies exist worldwide.

Nicotine gums are now available over-the-counter at pharmacies, tobacco outlets, petrol stations, and supermarkets.

However, in most of the EU they are subject to the same restrictions on underage purchases as tobacco. They are also available even in schools and sold only to the above 12 year old students.

Nicotenell is the biggest selling brand in the United Kingdom and is available as skin patches, gums and lozenges. Nicotrol, another big brand, is available as inhaler only.

The National Health Service (U.K., Scotland, Wales, Ireland) provides NRT products at a discounted price and even free of charge.