Is it better to switch from nicotine vaping to a nicotine replacement therapy (NRT) patch or inhaler?

From the Guidelines

Switching from nicotine vaping to a combination of nicotine replacement patch and inhaler is the most effective approach, as it offers the greatest potential benefits for cessation attempts. Both nicotine patches and inhalers are better than vaping because they deliver controlled nicotine doses without the harmful chemicals found in vape aerosols. Nicotine patches (available in strengths of 7mg, 14mg, and 21mg) provide steady nicotine release over 16-24 hours and are ideal for managing background cravings, while nicotine inhalers (like Nicotrol, delivering 4mg per cartridge) more closely mimic the hand-to-mouth action of vaping and provide faster relief for acute cravings 1.

Key Considerations

• Start with a patch strength matching your current nicotine intake, typically 21mg for heavy vapers, and gradually step down over 8-12 weeks.
• Use inhalers for breakthrough cravings, as they require more frequent use.
• Many people benefit from combining both: using patches for baseline control and inhalers for breakthrough cravings.
• When switching, expect some adjustment as NRTs deliver nicotine more slowly than vaping.
• Side effects are generally mild and include skin irritation from patches or throat irritation from inhalers.

Evidence-Based Recommendation

The Cochrane network meta-analysis data published in 2013 support the superiority of combination NRT over single forms of NRT, with smokers using combination NRT being almost 3 times as likely to succeed (OR, 2.73; 95% CI, 2.07–3.65) 1.

Important Notes

• The success of NRT may be contingent on concurrent behavior therapy to support cessation.
• The addition of behavior therapy to NRT increased the odds of success nearly 3-fold 1.

From the FDA Drug Label

NICOTROL Inhaler is indicated as an aid to smoking cessation for the relief of nicotine withdrawal symptoms. The answer to whether it is better to switch to a nicotine replacement patch or inhaler for nicotine vaping is not directly addressed in the provided drug label.

• The label only discusses the use of the nicotine inhaler as an aid to smoking cessation.
• There is no mention of nicotine replacement patches or a comparison between the two.
• Therefore, based on the provided information, no conclusion can be drawn about which option is better 2.

From the Research

Nicotine Vaping Cessation

To determine whether it is better to switch to a nicotine replacement patch or inhaler for nicotine vaping cessation, we can look at the available evidence.

• Nicotine Replacement Therapy (NRT): Studies have shown that NRT can be effective in aiding smoking cessation 3, 4, 5. The odds ratio for abstinence with NRT compared to control was 1.74 (95% confidence interval 1.64 - 1.86) 5.
• Nicotine Replacement Patch: One study found that higher doses of nicotine patch may produce small increases in quit rates 5. Another study showed that titrating the dose of transdermal nicotine patch up to 84 mg/day over 4 weeks prior to a target quit date and titrating down again over 4 weeks afterwards can be effective in aiding smoking cessation 3.
• Nicotine Inhaler: The odds ratio for the nicotine inhaler was 2.08, indicating that it may be more effective than other forms of NRT 5.
• Comparison of NRT and Other Interventions: One study found that there is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy, and their combination when used with behavioural support in clinical practice 6. Another study found that varenicline may be more effective than NRT for quitting vaping 7.

Pharmacological Interventions for Quitting Nicotine Vaping

• Combination NRT: The point estimate for combination NRT indicated possible benefit, but the CI incorporated the possibility of no benefit and a potential benefit of control (very low-certainty evidence due to imprecision and risk of bias) 7.
• Varenicline: Varenicline increased vaping cessation rates at six months, but the evidence was low certainty due to imprecision 7.

Behavioural Interventions for Quitting Nicotine Vaping

• Text Message-Based Interventions: There was low-certainty evidence that text message-based interventions may have increased vaping cessation rates compared to control in 13- to 24-year-olds 7.

Overall, the evidence suggests that both nicotine replacement patches and inhalers can be effective in aiding nicotine vaping cessation, but the choice of intervention may depend on individual preferences and needs. Additionally, pharmacological interventions such as combination NRT and varenicline, as well as behavioural interventions like text message-based interventions, may also be effective in quitting nicotine vaping. However, more research is needed to fully understand the effectiveness of these interventions.