Are smoking cessation lozenges effective?

Nicotine Lozenges Are Effective for Smoking Cessation

Nicotine lozenges are effective aids for smoking cessation, doubling the chances of successful quitting when used properly as part of a comprehensive smoking cessation strategy. 1 Lozenges are one of six effective forms of nicotine replacement therapy (NRT) that help reduce withdrawal symptoms and cravings associated with quitting smoking.

Efficacy of Nicotine Lozenges

• Nicotine lozenges, like other NRT products, effectively reduce urges to smoke and withdrawal symptoms following cessation 1
• There appears to be little difference in effectiveness between different types of NRT (including lozenges, gum, patch, nasal spray, inhaler, and sublingual tablets) 1
• NRT in all forms approximately doubles the chance of successful smoking cessation compared to placebo 1
• The FDA recognizes that nicotine replacement products like lozenges reduce withdrawal symptoms associated with quitting smoking 2

How Nicotine Lozenges Work

Nicotine lozenges work by:

• Providing controlled doses of nicotine that are absorbed through the oral mucosa
• Reducing withdrawal symptoms and cravings while avoiding the harmful toxins found in cigarette smoke
• Delivering nicotine in a slower, less satisfying, but safer and less addictive way than cigarettes 1
• Allowing the user to control the dose and how quickly it is obtained, similar to gum and inhalator products 1

Optimal Use of Nicotine Lozenges

For best results:

• Use lozenges for a minimum of 12 weeks during the initial quit attempt 3
• Consider extending therapy up to 6 months or 1 year to promote continued cessation 3
• Follow the instructions in the package and seek advice from a pharmacist if more information is needed 1
• Understand that the nicotine must be absorbed through the mouth - any nicotine that is swallowed is wasted 1

Combination Therapy

• Combining different forms of NRT may be more effective than using a single product alone 1, 3
• Particularly effective is combining the nicotine patch (providing steady background nicotine levels) with a short-acting form like lozenges (for breakthrough cravings) 3, 4
• The JAMA review from 2022 confirms that combining a nicotine patch with other NRT products is more effective than using a single NRT product 4

Who Should Use Nicotine Lozenges

• Adult smokers of 10 or more cigarettes per day have the strongest evidence for NRT effectiveness 1
• NRT can be used by most smokers, including lighter smokers (though most research has been done with people who smoke at least 15 cigarettes a day) 1
• NRT appears safe for patients with cardiovascular disease, though package inserts may advise consulting with a healthcare provider first 1

Cautions and Contraindications

• Pregnancy is generally considered a contraindication for most NRT products in the UK, though NRT is likely safer than continued smoking 1
• Some products may not be recommended for people under 18, though this restriction varies by product 1
• Very few people become addicted to NRT products 1

Success Rates and Expectations

• NRT alone increases quit rates to 15-16% at 6 months compared to placebo (9.4%) 4
• When combined with behavioral support, success rates can increase further 4, 5
• Patients should understand that NRT is not a "magic cure" and does not completely replace the need for willpower 1
• Multiple quit attempts may be required - smokers make an average of approximately 6 quit attempts before achieving long-term abstinence 4

Nicotine lozenges represent an effective, accessible option for smokers attempting to quit. When used properly and for an adequate duration, they significantly improve the chances of successful smoking cessation and reduce the associated morbidity and mortality of continued smoking.