Trying to quit smoking? Nicotine replacement therapy may help

Smoking has detrimental effects on our health and can cause myriads of chronic diseases such as lung cancer, mouth cancer, throat cancer and cardiovascular disease.

There are over 7000 chemicals present in cigarette smoke, more than 250 of them are harmful and at least 70 are known to be carcinogenic.

These include tar, ammonia, arsenic, carbon monoxide, formaldehyde, methanol as well as heavy metals such as lead and cadmium.

Among these chemicals, it is nicotine that is responsible for the addictive effect of cigarettes, which is attributable to its ability to stimulate the brain. When gas exchange takes place within the lungs, nicotine enters the blood and it can reach the brain within ten seconds.

Nicotine triggers a cascade of chemical reactions in the brain, causing pleasure, excitement, and a sense of well-being.

However, this effect is fleeting and once nicotine concentrations in the blood falls, the smoker will then feel tense and anxious, resulting in withdrawal syndrome.

Consequently, nicotine is highly addictive, making it very hard to quit smoking.

Nicotine Replacement Therapy (NRT) is a commonly used pharmacological treatment for smoking cessation.

NRT contains nicotine, and it can alleviate withdrawal symptoms and cravings as it provides a small dose of nicotine without the other hazardous chemicals present in cigarette smoke.

An extensive review by Cochrane in 2018 involving 136 different studies concluded that NRT can increase the rate of smoking cessation by 50 per cent - 60 per cent. However, it is not a “magic bullet” that guarantees you will quit smoking.

Counselling from trained healthcare professionals and support from family and friends are also important.

There are several NRT products in the market, with different methods of nicotine delivery.

Two of these are registered with the Health Ministry, which are the nicotine gum and transdermal patch.

The type of NRT product recommended by doctors and pharmacists may differ based on the smoker’s needs, smoking habits and nicotine dependency.

Fagerström test can be used to assess smokers’ nicotine dependence and determine the most suitable form and dose of NRT. All NRT products are effective if taken correctly.

How to use Nicotine Gum:

1. Chew the gum slowly until a peppery taste is released

2. Stop chewing and place the gum between gums and cheek. Let it stay for about a minute to let the nicotine absorbed into your body.

3. After the taste has faded and tingling has reduced, resume chewing the gum until the taste and tingling returns.

4. Repeat steps 2 and 3 for about 30 minutes.

5. Avoid eating or drinking for 15 minutes before or during use. Acidic food and drinks such as soda and coffee can stop the nicotine gum from working properly. Do not swallow the nicotine gum or your nicotine-soaked saliva.

How to use Nicotine Transdermal Patch:

1. Apply one patch to clean, dry, hairless skin of the thigh, arm, chest, or hip.

2. Remove the patch from the foil package, peel off the protective strips, and immediately apply the patch to skin

3. Leave it on for 16 hours or 24 hours before removing the patch

4. Apply patch to a new body part every day. Allow 5 days gap before applying it on the same area

Side effects may occur due to the use of NRT products, and they are usually caused by improper use and the nicotine itself.

For example, chewing the nicotine gum too fast can release too much nicotine at once, causing dizziness, hiccups, or nausea. Incorrect technique may also cause mouth ulcer.

Some people may get skin redness due to the use of nicotine patches. If the skin irritation does not disappear after four days, or if the skin starts swelling, seek doctor’s advice.

Make sure to follow the dose given by the doctor or pharmacist, and avoid smoking cigarettes while using NRT products as too much nicotine can lead to insomnia, vivid dreams, increased blood pressure and rapid heartbeat.

It is never too late to quit smoking.

It will improve your health and reduce your risk of heart and lung diseases, cancer, and many other smoking-related illnesses.

It will also improve the well-being of the people around you by reducing health risks related to passive smoking.

Individuals wishing to quit smoking may visit any Smoking Cessation Clinics that are available in many government healthcare facilities throughout the nation.

Counselling and treatment will be provided from highly trained healthcare professionals. You can also sign up for the Jomquit program through jomquit.com.

If there are any inquiries about medicines, call the National Pharmacy Call Centre (NPCC) at the toll-free line 1800-88-6722 on weekdays from 8am to 5pm.

Izzati Yussof is a pharmacist from the Pharmaceutical Services Department, Federal Health Department Kuala Lumpur and Putrajaya.