2023-11-27 14:05:06
The third message is fundamental: the dose of nicotine via nicotine substitutes must correspond to your dependence. It is the one which allows the absence of withdrawal symptoms and removes the desire to smoke. There is no limitation; the main thing is that you have the dose that allows you to not smoke and regain control over nicotine addiction.
How long should nicotine substitutes be used?
The time required for the dose – gradually decreasing – to allow smokers to no longer feel the desire to smoke in the long term and therefore to achieve cessation. This can be quite long, sometimes many months. The time for your body to disaccustom itself to tobacco and for the brain to become desensitized over the course of these dosages which gradually decrease. Generally, patches are rarely kept beyond 6 months, but it can happen. In contrast, oral absorption forms, such as nicotine lozenges and gums, can be used for a much longer period of time. Some smokers even find themselves obliged to use it over the long term in order to avoid the risk of relapse. The duration of use of nicotine substitutes is not defined, contrary to what you may sometimes hear from your pharmacist.
Is the majority of smoking cessation failures with nicotine substitutes due to underdosing?
Yes, and this observation is unanimous among the tobacco community. Most smoking cessation patients are under-dosed with nicotine and therefore, unsurprisingly, most of them fail to quit. It has now been demonstrated that the use of nicotine replacement at an effective dosage, with several patches if necessary and over a sufficiently long period adapted to each smoker, makes it possible to limit the risk of returning to smoking and to improve the rate of stopping at 12 months.
We often hear the following equation regarding the dosage of nicotine substitutes: 1 cigarette = 1 mg of nicotine. What is it worth?
If the equivalence – 1 cigarette = 1 mg of nicotine – constitutes a good starting point, it generally underestimates the necessary dose. The average smoker absorbs 1 to 2 mg of nicotine per cigarette, but some 10-cigarette-a-day smokers can absorb as much nicotine as very heavy smokers. In order to best adjust to needs, nicotine substitutes for oral absorption (gums, lozenges, nicotine tablets) must be prescribed systematically with the patches. This allows the smoker to adjust the nicotine dose themselves. When it is noted that they are consumed in large quantities, in addition to a 21 mg patch, it then makes sense to combine several patches to meet most of the nicotine needs. Oral absorption forms are always available, used in addition by the smoker, to further adjust the daily dose if necessary and/or ward off an occasional urge to smoke.
Why did you write a scientific article pleading for the revision of the rules governing the prescription and dispensation of nicotine substitutes?
So that all the advice that I have just explained to you is mentioned on the instructions and mainly the need to adjust the dose according to real individual nicotine needs, with if necessary the combination of several patches to achieve the necessary daily dose ( without necessarily being limited to a single patch of 21 mg/d). This need for adaptation is a rule that was already included in the HAS recommendations on smoking cessation from 2014!
The fear of overdose is very strong among candidates for withdrawal and even among doctors and pharmacists. What is its reality?
The risk of nicotine overdose, which worries smokers, is too often wrongly associated with cancer or myocardial infarction, even though nicotine is in no way involved in these complications of smoking. Its only role is to keep the smoker in a strong dependency. If the idea of overdose is approached in an alarming manner by the doctor or pharmacist, the smoker may be unnecessarily worried and not follow the prescriptions of his tobacco specialist. Furthermore, smokers still hear too often that the prescription and/or delivery of nicotine substitutes would be subject to the injunction “not to smoke while using the patch(s)”. On the one hand, it has been shown that there is no risk in using a patch while continuing to smoke and, on the other hand, continuing to smoke cigarettes on nicotine substitutes proves precisely that the person is on nicotine replacement therapy. -nicotine dosage. Instead of removing the patch, you need to adjust the substitution! By observing all these rules, many more smokers would be able to quit than currently.
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