Combination Nicotine replacement therapy better than Monotherapy to quit smoking

People who want to quit smoking have more chances of being successful if they use a combination of nicotine patch plus a fast-acting form of nicotine replacement therapy (NRT), such as gum, lozenge, or nasal spray. New evidence has been published in the Cochrane Library.

Nicotine replacement therapy (NRT) aims to replace the nicotine from cigarettes to ease the transition from cigarette smoking to abstinence. It works by reducing the intensity of craving and withdrawal symptoms. In many countries, people can get NRT from healthcare professionals as well as over-the-counter, without prescriptions.

This review includes 63 trials covering 41,509 participants. All studies were conducted in people who wanted to quit smoking, and most were conducted in adults. People who enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. Studies lasted for at least six months.The evidence is up to date to April 2018.

The Cochrane authors found that using a nicotine patch and another type of NRT (such as gum or a lozenge) at the same time made it more likely that a person would successfully stop smoking than if they used one type of NRT alone. Just over 17% of people who combined a patch with another type of NRT were able to quit compared with about 14% people who used a single type of NRT.

People were also more likely to successfully quit if they used higher dose nicotine gum (containing 4mg of nicotine) in comparison to lower dose nicotine gum (containing 2mg of nicotine). Higher dose nicotine patches (containing 25mg or 21mg of nicotine) probably make it more likely that a person will quit smoking than lower dose nicotine patches (15mg or 14mg of nicotine), however, more evidence is needed to strengthen this conclusion.

When people quit smoking, they often set a quit day, which is the day when they plan to stop smoking entirely. There is evidence that starting to use NRT before a quit day may help more people to quit than starting using NRT on the quit day itself, but more evidence is needed to strengthen this conclusion.

Some studies looked at the safety of different types of NRT use and found that very few people experienced negative effects and those that were mentioned were minor, such as skin irritation with patches or mouth ulcers with lozenges. NRT is considered to be a safe medication, however, data on the safety of different types of NRT use in comparison to one another is sparse.

Lead author, Dr Nicola Lindson from the Nuffield Department of Primary Care Health Sciences, University of Oxford, UK said: “NRT is easy to access over the counter for people who would like to quit smoking, but many people don’t use it to best effect, so their chances of giving up smoking are reduced.”

This high-quality evidence clearly signposts that the most effective way to use NRT is to use a combination of two products at once, a patch and a fast-acting form such as gum, nasal spray or lozenge. Quitting this way increases the chances of you stopping smoking altogether. Some people are concerned about using two forms at the same time, but the evidence does not indicate an increased risk of harms

This review is published by the Cochrane Tobacco Addiction Group. This Group has also published other evidence for people considering giving up smoking, including systematic reviews on electronic cigarettes, behaviour therapies, and other medications for quitting smoking.