Nicotine replacement therapy, which should be used in conjunction with an educational support program, has been proved to be effective and is available as chewing gum or transdermal patches (the preferred method). Ideally the nicotine should not be used longer than 3 months.
This is available as 2 mg and 4 mg.
• Low dependence (less than 10 cigarettes per day): use non-pharmacological methods rather than replacement
• Moderate dependence (10-14 cigarettes per day): 2 mg
• High dependence (> 15 per day): 4 mg initially, changing to 2 mg after 4-6 weeks. Useful points
• Chew each piece slowly for about 30 minutes.
• Ensure all the nicotine is utilised.
• Chew at least 6 pieces per day, replacing at regular intervals (not more than 1 piece per hour)
• Use for 3 months, weaning off before the end of this period.
Transdermal nicotine 3
• Moderate dependence: 14 mg patch; change to 7 mg patch after 4-6 weeks
• High dependence: 21 mg patch; change to 14 mg patch after 4-6 weeks
Apply to non-hairy, clean, dry section of skin on upper outer arm or upper chest and leave in place for
24 hours. Rotate sites with a 7-day gap for reuse of a specific site.
These are pregnancy and breast-feeding, children, severe myocardial ischaemia, arrhythmias or recent CVA.
General Practice, Chapter 18
• Gum: hiccoughs, orodental problems, jaw pain, gastrointestinal including exacerbation of peptic ulcer
• Patches: local reaction, sleep disturbances (use 16-hour patch for this)
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Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.