What are the pros and cons of using nicotine (nicotine replacement therapy) for smoking cessation?

From the Guidelines

Nicotine replacement therapy (NRT) is a highly effective tool for smoking cessation, and its benefits far outweigh its drawbacks, making it a recommended treatment for smokers trying to quit. The main advantage of NRT is that it reduces withdrawal symptoms like irritability, anxiety, and cravings, making it easier to quit smoking. According to a study published in the Journal of the National Comprehensive Cancer Network, combination NRT incorporating long-term and fast-acting NRT offers the greatest potential benefits for smokers, with odds of quitting nearly three times higher than those using single forms of NRT 1.

Benefits of NRT

• Reduces withdrawal symptoms, making it easier to quit smoking
• Can nearly double the chances of quitting successfully compared to placebo
• Available in various forms, including patches, gum, lozenges, inhalers, and nasal sprays
• Can be used for 8-12 weeks, gradually reducing the dosage as dependence decreases

Drawbacks of NRT

• Only addresses nicotine dependence, not the behavioral aspects of smoking
• Can cause side effects like skin irritation from patches, mouth/throat irritation from gum or lozenges, and potential sleep disturbances
• Not recommended during pregnancy without medical supervision
• Some people may develop dependence on the NRT products themselves

Safety and Efficacy

A meta-analysis of safety data from clinical studies with the transdermal patch and a recent review of NRT safety in patients with cardiovascular disease found no evidence of an increased risk of cardiac events associated with NRT treatment 1. Additionally, evidence suggests that NRT is safe and few become long-term users, making it a recommended treatment for smokers trying to quit 1.

Recommendation

Based on the strongest and most recent evidence, combination NRT is the most effective treatment for smoking cessation, and its benefits far outweigh its drawbacks. Therefore, it is recommended that smokers trying to quit use combination NRT, under the guidance of a healthcare professional, to increase their chances of quitting successfully.

From the FDA Drug Label

Use reduces withdrawal symptoms, including nicotine craving, associated with quitting smoking. The pros of using nicotine replacement therapy for smoking cessation include:

• Reduction of withdrawal symptoms
• Reduction of nicotine craving The cons are not explicitly stated in the drug label. 2

From the Research

Pros of Nicotine Replacement Therapy (NRT) for Smoking Cessation

• NRT can help people increase their chances of successfully stopping smoking by 50% to 70% 3, 4
• All licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator, and sublingual tablets/lozenges) can aid in smoking cessation 3, 4
• NRT can reduce motivation to smoke and nicotine withdrawal symptoms, easing the transition to complete abstinence 3, 4
• The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual 3, 4
• Combining a nicotine patch with a rapid delivery form of NRT can be more effective than a single type of NRT 4

Cons of Nicotine Replacement Therapy (NRT) for Smoking Cessation

• Adverse effects from using NRT are related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets 3, 4
• NRT can cause minor irritation of the site through which it is administered, and in rare cases can cause non-ischaemic chest pain and palpitations 3
• Some smokers may discontinue NRT due to mild adverse effects, despite the fact that these effects are rarely severe 5
• The cost of NRT can be a barrier to access for some smokers, although this is not a direct con of the therapy itself

Comparison of NRT to Other Pharmacotherapies

• NRT is as effective as bupropion for smoking cessation, with some studies suggesting that a combination of NRT and bupropion may be more effective than bupropion alone 6, 4
• Varenicline, a partial agonist at nicotinic alpha4beta2 receptors, may be as effective as or more effective than NRT for smoking cessation, although more research is needed to fully understand its effects 6