• There is no difference in efficacy between different formulations of nicotine replacement therapy.
• Points to discuss with the smoker when choosing a product include:
• The number of cigarettes smoked per day.
• The time to the first cigarette of the day.
• Speed of nicotine delivery.
• Ease of use.
• Local irritant effects.
• Amount of behavioural replacement provided.
• Ability for the smoker to adjust and titrate the nicotine dose as required.
• Use of intermittent formulations as required to relieve cravings.

In depth

• Smokers must use sufficient nicotine replacement therapy (NRT) in order to achieve good success rates. To ensure a sufficient dose, several expert reviewers advise regular use of intermittent (non-patch) formulations of NRT, topping up as needed.
• NRT patches are available in two preparations (16-hour and 24-hour), each with three strengths prescribed in a programme of reducing dose, usually over 8–12 weeks:
• 16-hour patch: 15 mg, 10 mg, 5 mg (Nicorette^®).
• 24-hour patch: 21 mg, 14 mg, 7 mg (Nicotinell^®, NiQuitin^®).
• NRT gum is available in two strengths — 2 mg and 4 mg:
• People who smoke more than 20 cigarettes per day: start with the 4 mg gum.
• NRT lozenges are available in four strengths — 1 mg, 1.5 mg, 2 mg, and 4 mg:
• Nicotinell^®:
• People who smoke less than 20 cigarettes per day: start with 1 mg lozenges.
• People who smoke 20 to 30 cigarettes per day: start with 1 mg or 2 mg lozenges, depending on the person's characteristics and preference.
• People who smoke more than 30 cigarettes per day: start with 2 mg lozenges.
• Niquitin^®:
• People who have their first cigarette of the day more than 30 minutes after waking up: start with 2 mg lozenges.
• People who have their first cigarette of the day within 30 minutes of waking up: start with 4 mg lozenges.
• Nicopass^® 1.5 mg lozenges are not suitable for smokers who are heavily dependent on nicotine.
• NRT sublingual tablets — 2 mg:
• 20 cigarettes or more per day: start taking two tablets (4 mg) sublingually each hour.
• Fewer than 20 cigarettes per day: start taking one tablet (2 mg) sublingually each hour (increase to two tablets each hour if the person fails to stop smoking or has significant withdrawal symptoms).
• NRT nasal spray and inhalator — one strength only:
• All smokers: use when required, to relieve the urge to smoke.
• Duration of NRT in people maintaining abstinence from cigarettes is usually 8–12 weeks (depending on which form of NRT is used and which dose is initiated), followed by a gradual reduction in dose.
• Some people, in particular those who are more dependent on nicotine, may need higher doses of NRT for a longer duration to reduce the risk of relapse.

In depth

• Nicotine replacement products may be combined to gain better control of withdrawal symptoms.
• This is usually done by providing a steady delivery of nicotine using a patch, with an intermittent formulation to provide relief from breakthrough cravings.

In depth

• The most common adverse effects include local reactions (e.g. skin irritation with patches; irritation of the nose, throat, and eyes with nasal spray), sleep disturbances (e.g. vivid dreams), gastrointestinal disturbances, dizziness, and headache. If these are problematic, try a different formulation.
• In addition to the adverse effects above, the nasal spray can cause sneezing and watering eyes for a short time after use; advise people not to use it while they are driving.

In depth