What are alternatives for nicotine replacement therapy in individuals with an adhesive allergy?

From the Guidelines

For individuals with adhesive allergies, nicotine gum, lozenges, inhalers, and nasal sprays are effective alternatives to nicotine patches for nicotine replacement therapy (NRT), as they bypass skin contact entirely. These alternatives can be used in various forms and dosages, such as nicotine gum (2mg or 4mg) chewed every 1-2 hours for up to 12 weeks, nicotine lozenges (2mg or 4mg) that dissolve in the mouth over 20-30 minutes, nicotine inhalers (Nicotrol) that deliver 4mg of nicotine per cartridge with 6-16 cartridges recommended daily for 12 weeks, and nicotine nasal spray (Nicotrol NS) that provides 0.5mg per spray with 1-2 sprays per hour recommended 1. Some key points to consider when choosing an alternative to nicotine patches include:

• The effectiveness of NRT in doubling cessation rates compared to controls, irrespective of the intensity of adjunctive support 1
• The safety and low risk of long-term use of NRT 1
• The importance of considering personal preference, smoking habits, and specific health considerations when selecting an NRT product 1
• The availability of oral medications like bupropion (Zyban, 150mg twice daily) or varenicline (Chantix, titrated to 1mg twice daily) as non-nicotine approaches 1 It is essential to note that the choice between these alternatives depends on individual factors, and a healthcare professional should be consulted to determine the best course of treatment. According to the most recent and highest quality study, nicotine gum, lozenges, inhalers, and nasal sprays are all effective options for individuals with adhesive allergies who cannot use nicotine patches 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Alternatives for Nicotine Replacement Therapy

For individuals with an adhesive allergy, there are alternative forms of nicotine replacement therapy (NRT) that do not involve the use of adhesive patches. These alternatives include:

• Nicotine gum 2, 3
• Nicotine lozenges 2, 4
• Nicotine inhalers 2, 4
• Nicotine nasal sprays 2, 4
• Nicotine oral sprays 4

Effectiveness of Alternative NRT Forms

Studies have shown that these alternative forms of NRT can be effective in aiding smoking cessation. For example:

• Nicotine gum has been shown to increase smoking cessation rates by approximately 1.5- to 2-fold after 12 months 5
• Nicotine lozenges have been found to be more effective than placebo in achieving abstinence from cigarettes 2
• Nicotine inhalers have been shown to be effective in achieving abstinence from cigarettes, with a risk ratio of 1.90 (95% CI 1.36 to 2.67) compared to placebo 2

Considerations for Individuals with Adhesive Allergy

When choosing an alternative form of NRT, individuals with an adhesive allergy should consider the following:

• The type and severity of their adhesive allergy
• The potential for skin irritation or other adverse effects from alternative NRT forms
• The level of support and guidance they need to successfully quit smoking
• The availability and accessibility of alternative NRT forms in their area 6, 2, 4