Nicotine Gum for NRT - Nicotine Replacement Therapy

Nicotine chewing gum is one of the “youngest” nicotine containing products, which started to get wide-spread recognition in early 1990's. Nicotine gum is actually a type of chewing gum that delivers nicotine to the body with primary target to assist nicotine addicts with nicotine replacement therapy (NRT), a process for smoking cessation and quitting smokeless tobacco. The nicotine is administrated to the bloodstream via absorption by the tissues of the mouth.

Nicotine gum is currently generally available over-the-counter over the World, however it’s availability varies extensively from one area to another. Different countries, states and even counties may have their own unique rules regulating the sale of nicotine chewing gum. In many areas it is sold over the counter but its sale to minors is usually closely regulated. In some other places, however, a prescription from a medical doctor is required to purchase nicotine replacement product of any kind, including nicotine chewing gum.

The pieces are usually available in individual foil packages and come in various flavors. Nicotine content is usually either 2 or 4 mg of nicotine, roughly the nicotine content of 1 or 2 cigarettes, with the appropriate content and dosage depending on the smoking habits of the user. Popular brands include Nicoderm/Nicorette, Nicogum, and Nicotinell.

How does it work?

Nicotine is the addictive substance present in tobacco. Smokers who try to give up often experience unpleasant withdrawal symptoms and cravings for cigarettes, because they are dependent on the nicotine in tobacco. Withdrawal symptoms can include irritability, headaches, restlessness, insomnia and difficulty concentrating. These, combined with cigarette cravings, are why it is difficult for some people to give up smoking.

Nicotine replacement therapies work by giving you a small amount of nicotine, but without the dangerous effects of inhaling tobacco smoke. This helps relieve the withdrawal symptoms and cravings for a cigarette that you get when you stop smoking, and allows you to get on with breaking the psychological habit of smoking. If you are physically addicted to nicotine, using NRT has been shown to almost double your chances of successfully quitting smoking.

The nicotine released from chewing Nicotine gum is absorbed into the bloodstream from the lining of your mouth and provides quick relief from cravings.

Nicotine gum is available in two strengths. The 2mg gum is suitable for people who smoke less than 20 cigarettes a day, or whose first cigarette of the day is more than 30 minutes after waking. The 4mg gum provides a larger dose of nicotine for people who are more dependent on nicotine, i.e. people who smoke more than 20 cigarettes a day, or whose first cigarette is within 30 minutes of waking.

Before using Nicotine gum

Some medical conditions may interact with Nicotine Gum. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have chest pain (e.g., angina), heart problems (e.g., coronary artery disease, irregular heartbeat), a history of heart attack, high blood pressure, an overactive thyroid, an ulcer, a tumor on your adrenal gland (pheochromocytoma), diabetes, a jaw problem (temporomandibular joint disorder [TMJ]), or blood vessel problems (e.g., Buerger disease, Raynaud phenomena)
• if you take medicine for asthma or depression, or if you are using another medicine to stop smoking

Some MEDICINES MAY INTERACT with Nicotine Gum. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Acetaminophen, adrenergic antagonists (eg, prazosin), asthma medicines (e.g., theophylline), beta-blockers (e.g., labetalol, propranolol), caffeine, insulin, oxazepam, pentazocine, or tricyclic antidepressants (e.g., imipramine) because the risk of their side effects may be increased when you stop smoking
• Adrenergic agonists (e.g., isoproterenol, phenylephrine) because their effectiveness may be decreased when you stop smoking

This may not be a complete list of all interactions that may occur. Ask your health care provider if Nicotine Gum may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use it?

• Stop smoking completely prior to using nicotine gum.
• Follow the instructions provided with the gum.
• This gum is not to be chewed in the same way as normal chewing gum. Instead you should chew the gum slowly, until the taste becomes strong (usually requires 15-30 chews), and then rest it between your gums and your cheek. This should be repeated every time the taste starts to fade, until the gum has lost its strength (after about half an hour). This chewing technique allows the nicotine to be absorbed into the bloodstream from the lining in your mouth. It stops the nicotine being released too quickly and being swallowed.
• To minimize withdrawal symptoms, use the nicotine gum on a fixed schedule (1 piece every 1-2 hours, initially) rather than “as needed”. Most people use about 10 to 12 pieces of gum per day during the first month of therapy. As the urge to smoke decreases you will chew less gum.
• Reduce the dosage at the recommended intervals and stop using the gum after 12 weeks of treatment.  Do not chew more than 30 pieces per day.
• Avoid food and acidic beverages (coffee, juices, wine, and soft drinks) 15 minutes before and while chewing the gum.
• The nicotine gum is more viscous than ordinary chewing gum and is more likely to adhere to fillings, bridges, dentures, crowns and braces.  If excessive sticking or damage to dental work occurs, stop using the gum and consult a dentist.
• Chewing the gum too rapidly can lead to increased release or nicotine and side effects such as nausea, throat irritation, light-headedness, and hiccups.
• At all times, carry or have a least one full sleeve of nicotine gum (12 pieces) readily available.  Keep the gum in the same place where you previously kept your cigarettes (e.g., shirt pocket, purse, desk).

Warning!

• Nicotine gum should be chewed in the special way explained above and in the instructions in the package leaflet. If you chew the gum continuously, the nicotine is released too quickly and may be swallowed. This can cause side effects such as throat and stomach irritation, indigestion or hiccups.
• Do not exceed the recommended dose of this medicine, which will be stated in the product packaging or information leaflet supplied with the medicine.
• Acidic drinks such as coffee, sodas and fruit juices can reduce the amount of nicotine that is absorbed from the mouth if you drink them in the 15 minutes prior to chewing nicotine gum.
• Smokers who wear dentures may experience problems chewing Nicotine gum. The chewing gum may stick to, and may in rare cases damage dentures. These people may find that other forms of nicotine replacement, such as nasal sprays, sublingual tablets or lozenges, are more suitable.
• Make sure you do not leave unused or used Nicotine gum where children can reach it. Doses of nicotine that are tolerated by adult smokers during treatment can produce severe symptoms of poisoning in small children and may prove fatal. Dispose of Nicotine gum carefully.

Side Effects

·         Because this gum contains nicotine, it has a peppery-like taste and may cause a tingling sensation when chewed.

·         You may experience mouth sores, jaw muscle aches, increased saliva production, indigestion, or headache during the first few days of using this medication. These effects should diminish as use of the gum is continued.

·         Lightheadedness, dizziness, hiccups, nausea, vomiting, or insomnia may occur if the gum is chewed too rapidly. Is these effects occur, chew the gum more slowly.

·         Excessive nicotine may result in cold sweats, fainting, confusion, or rapid heartbeat. Notify your doctor is you develop these symptoms.

·         If you experience allergic reactions which may include symptoms of rash, itching, swelling, dizziness, or trouble breathing while using this product then stop using the product immediately and seek immediate medical attention.

·         If you notice other effects not listed above, contact your doctor or pharmacist.

Overdose

• If overdose is suspected contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222.
• Symptoms of overdose may include nausea, vomiting, excessive saliva, stomach pain, seating, headache, dizziness, confusion, weakness, fainting, difficulty breathing, seizures, rapid/weak or irregular heartbeat, blurred vision, diarrhea, and hearing problems.

Is it safe to consume on regular basis?

Scientists have discovered a link between mouth cancer and exposure to nicotine, which may indicate that using oral nicotine replacement therapies for long periods could contribute to a raised risk of the disease. A study funded by the Medical Research Council, led by Muy-Teck Teh, of Queen Mary, University of London, has found that the effects of a genetic mutation that is common in mouth cancer can be worsened by nicotine in the levels that are typically found in smoking cessation products.

The results raise the prospect that nicotine, the addictive chemical in tobacco, may be more carcinogenic than had previously been appreciated. “Although we acknowledge the importance of encouraging people to quit smoking, our research suggests nicotine found in lozenges and chewing gums may increase the risk of mouth cancer,” Dr Teh said. “Smoking is of course far more dangerous, and people who are using nicotine replacement to give up should continue to use it and consult their GPs if they are concerned. The important message is not to overuse it, and to follow advice on the packet.”

Most nicotine replacement products have labels advising people to cut down after three months of use and to stop completely after six months.

Sources and Additional Information:

http://www.ehow.com/about_4605092_nicotine-chewing-gum.html

http://en.wikipedia.org/wiki/Nicotine_gum

http://www.netdoctor.co.uk/medicines/100003542.html

http://www.nmcphc.med.navy.mil/downloads/tobacco/pted.nicotine%20gum.ep.doc

http://www.drugs.com/cdi/nicorette-gum.html

http://www.timesonline.co.uk/tol/life_and_style/health/article6143744.ece

What to expect when you plan to quit smoking?

Nicotine addiction is really strong. So, for most smokers, especially for the long-time smokers, quitting is not an easy and smooth process. However, if you know what you are doing this step for, and what to expect, you may be ready for the temporary unpleasant consequences.

The expectation highlights are as follows:

• Have realistic expectations - quitting isn't easy, but it's not impossible either. More than 3 million Americans quit every year.
• Understand that withdrawal symptoms are TEMPORARY. They usually last only 1-2 weeks.
• Know that most relapses occur in the first week after quitting, when withdrawal symptoms are strongest and your body is still dependent on nicotine. Be aware that this will be your hardest time, and use all your personal resources - willpower, family, friends, and the tips in this booklet - to get you through this critical period successfully.
• Know that most other relapses occur in the first 3 months after quitting, with situational triggers - such as a particularly stressful event - occur unexpectedly. These are the times when people reach for cigarettes automatically, because they associate smoking with relaxing. This is the kind of situation that's hard to prepare yourself for until it happens, so it's especially important to recognize it if it does happen. Remember that smoking is a habit, but a habit you can break.
• Realize that most successful ex-smokers quit for good only after several attempts. You may be one of those who can quit your first try. But if you're not, DON'T GIVE UP. Try again.

Let’s review different aspects of the nicotine physical withdrawal in more details.

The Effects of Physical Withdrawal

Anxiety, anger, irritability, impatience and restlessness; these are common, normal, and most importantly, temporary effects of physical withdrawal from nicotine. The never-ending cycle of falling nicotine levels and self-medication to offset these withdrawals is called 'smoking'. Our body can adjust, sometimes easier than we imagine. After just 72 hours without a smoke, most withdrawals will have significantly decreased. Nicotine, being water soluble, will be largely gone form our body. However, it will be 10 to 20 days before the body becomes accustomed to the absence of nicotine. We will refer here to people who are quitting smoking as 'starters' rather than quitters, and the first week as 'Glory Week'.

A detailed study of withdrawal effects by Marcia Ward - "Self-reported abstinence effects in the first month after smoking cessation", is full of relevant findings. The average starter peaks in withdrawals on Day 1. After two weeks withdrawal symptoms return to manageable levels.

Anger peaks for the average 'starter' on Day 2, leveling out to manageable levels by Day 5. Before you quit, plan ways to vent this unavoidable frustrations without hurting family, friends, co-workers, or your boss. Walk, run, swim, shoot baskets, shout into a pillow, shout over a valley, punch the wall, this non-source anger is finite, in other words, it’s normal and will pass. Remember, you have to ride the cycle of withdrawals to get past it. The mind does not remember details of extreme pain or bad times. Your fierce memories of 'Glory Week' will fade as you journey past the hump.

Occupy your time, keep a positive attitude, keep your reasons for beginning this quest in the forefront of your mind, clear your mind of negative thoughts and prattle, especially excuses. Stand up straight, look the devil in the eye, and tell him to go to hell.

Inability to Concentrate

2 out of 3 'starters' experience reduced or crippled concentration. This will improve only with time. Be patient with yourself, quitting smoking is a big life move. Forgive yourself the side effects of the whole thing, you are moving forward in ways you cannot comprehend now.

Poor concentration and focus could also be due to low blood sugar. Nicotine releases huge amounts of fatty sugars into our blood, by triggering the brain to release adrenaline, which in turn causes the body to revert to 'fight or flight mode', releasing the fatty sugars. This is why many smokers skip breakfast or lunch without feeling hungry, they are taxing their bodies into constant 'alert mode'.

When we stop smoking, the fat-feeding frenzies triggered by adrenaline are halted. Continuing to skip meals will plummet your blood sugars along with your concentration. Spread your food out more evenly over a day's time. Strong fruit juices like 100% cranberry or purple grape will stabilize blood sugar, and help your body heal.

Give yourself down time to heal, grieve, rest, and recover. 'Glory Week' consumes a huge amount of energy. Exercise will only boost your stamina and energy levels.

Trouble Sleeping

Nicotine is a powerful stimulant affecting brain waves, sleep patterns, sleep quality, subconscious, and even dreams. You are returning to your true levels of sleep need. You may find you need more sleep or less.

Bad breath or Nasty mouth

Drink lots of water to aid the flushing of your lungs, esophagus, throat, nasal and mouth tissues. Your senses of smell and taste are recovering and will reveal to you the extent of your tobacco soaked tissues.

Stomach Pain, Nausea, or Constipation

Nausea was examined in the Ward study, with 1 out of 6 'starters' reporting significant nausea. The bowel and intestines are also adjusting to the absence of the powerful stimulant nicotine. This nausea decreases to manageable levels in 2 weeks. Again, drinking lots of water can speed up the transition time and reduce severity of symptoms. Green leafy vegetables will also mitigate the symptoms. If the symptoms do not go away, an underlying condition, even cancer, may be present and you should go in for a full exam.

Psychological Withdrawal Symptoms

Cravings, urges, yearnings, and desires are powerful signals from our mind that it knows what we are trying to do! Not giving in to these primary cues results in the secondary symptoms: nervousness, anxiety, irritability, frustration, anger, rage, tension, jitters, shaking, shakiness, inability to concentrate, add yours here...

Take Pavlov's famous dog experiment, the dog was conditioned to salivate whenever the bell was rung. In the same way, the smokers mind is conditioned to expect nicotine as soon as it begins to feel any discomfort associated with the onset of physical withdrawal. In response to falling nicotine levels, the addicted mind has been conditioned to 'desire', compelling us to take more nicotine and avoid withdrawal discomfort. This cycle has played out for every single cigarette you have ever smoked. Most smokers felt compelled to smoke every 20 to 30 minutes, on average. If not satisfied, the desire might escalate to the point of urges or cravings. Our mind works against us to prompt us in subtle ways to take a hit, take a break, reward ourselves. Pathetic, isn't it? This counter-productive mindset works against us for weeks, we must recondition our brain to accept this new life.

Time Triggers

The conscious mind has conditioned the subconscious to act at that time when blood nicotine levels are dropping. Through habit, the subconscious quickly realizes that withdrawal discomfort can be avoided with more nicotine. When we feel a craving, it is simply our subconscious turning up the volume to make us act. But the subconscious mind is a peculiar product, like Pavlov's dog, of conditioning and NOT independent reasoning. The theory here is, if the subconscious is not fed nicotine, it will turn up the volume to maximum, and then simply shut off!

'Starters' must realize that any craving, no matter how strong it seems or is, will not last, period. This has been proven. It may seem the craving lasts forever; this may be the subconscious desperately making us believe it will last forever, before it shuts off, as it must. Time a craving, and you will discover for yourself this is true. Many 'starters' fail under the false belief at the moment that the only way to end the screaming urge is to light up.

Over the next 4-7 days as the nicotine is flushed out of our body, our mind and subconscious will keep revisiting the time trigger. When all the nicotine is gone, only then does solid, complete reconditioning of this time trigger occur. Any introduction of nicotine during this period will re-establish this time trigger and we must battle it all over again.

Withdrawal symptoms peak on Day 3. On average, the 'starter' will suffer 6 episodes on this day. The average number of strong withdrawals falls to 4 by Day 4. Withdrawal frequencies WILL and DO continue to fall. If you focus on nothing else during 'Glory Week', you poor bastard, focus again and again on the heartfelt reasons you took up this quit in the first place, the heart will not fail you. By Day 10, average withdrawals episodes lowers to a manageable 2.

The time trigger is stacked upon physical withdrawals from nicotine, the 'starter' is battling both these fundamentals at the same time. Add habit triggers on top of the stack, and the 'starter' is battling on three fronts. Many 'starters' are overwhelmed by the experience, and light up before reaching the place on Day 4 when physical withdrawals begin to clear, and psychological cravings drop by half.

Nicotine replacement therapies (NRT), the patch, gum, or lozenges, are touted as powerful medicine to get through 'Glory Week'. The shortfalls of this approach is realized when we understand that NRT works to alleviate only the habit triggers. NRT can also have a positive effect on confidence. The two remaining fronts, subconscious time triggers and physical withdrawals, are somewhat altered by NRT and rearranged, but not confronted directly. This re-arrangement may weaken the two fronts for a direct assault, shortly after "Glory Week', but continued use of NRT after breaking the habit triggers results in dismal success rates. The question whether NRT gradual nicotine reduction helps smokers quit for a significant period of time can be answered in part by NRT industries own studies, 8 of 10 NRT users will relapse fully within one year. Gradual reduction has not worked with alcohol, cocaine, or heroin. NRT can be somewhat likened to Jim Beam selling the cure to alcoholics by packaging Jim Beam in IV bags. Cold-turkey in hand with other support methods and products have the strongest chance of success overall.

Habit Triggers

Our brain is also conditioned it to expect nicotine before, during, or after certain events. Specific activities, even emotions, trigger the impulse to smoke. Waking up, breakfast, coffee, driving, break-time, meetings, lunch, dinner, rain, snow, cold, dusk, book chapters, visits, bills, phone calls, Fridays, bedtime, others smoking, ball-games, weddings, funerals, graduations, births, loneliness, sadness, romance, celebration are some examples. Even specific locations can call on the habit; garage, porch, garden, bar, fishing, camping out. These may seem overwhelming, but remember, habit triggers are driven by the subconscious, which is not capable of thinking on its own. Our conscious effort to reset and wipe clean these habit triggers can be achieved after a few or even one episode. After tackling the major habit triggers, the 'starter' will have an easier time kicking the lesser habit triggers.

At the 3 month mark, cravings once mighty are reduced to manageable 'thoughts'. Just like the thought of a 'hot, juicy steak' can be discarded after you have looked in your refrigerator and found no steak, so can the thought of 'just one cigarette' be discarded when you have considered your recent progress. 'Starters' at the 4 to 5 month mark often talk about cravings, but they admit these cravings are of the 'Hot fudge sundae' type, they come and go like normal desires.

'High Stress Trigger'

The most dangerous trigger for the 'starter' is the 'High Stress Trigger' The 'starter' should be extremely aware, and alert, during 'High stress' situations, and they WILL happen. Bankruptcy, foreclosure, serious illness, injury, or the death of someone close. You will lose someone close to you, this is unavoidable. 'Starters' need to prepare now for that eventuality. 'High stress' triggers are the perfect excuse to light up. Beware of these, be alert during these, be prepared, keep on your toes.

Psychological Relapse

Physical withdrawals have concrete symptoms, psychological withdrawals are a mind game which we can beat them through positive thinking and alertness. Understanding that negative thoughts will work against us is a powerful tool in itself for the 'starter'. Equally as important is for the 'starter' to realize that just one puff will reconnect all smoking memories and will viciously refresh the physical dependency cycle. The sobering truth to keep in mind; 9 out of 10 'starters' who break down and have just one will fail to quit. Feed the beast and you lose your hand.

Sadness or Depression

Giving up smoking is similar to the death of a loved one. It is a death of sorts, like the end of a marriage. Emotional loss associated with quitting smoking is documented. Mourning the loss is normal, grieve for grieving sake, and don’t forget to forgive yourself also. Heavy, long-term smokers are more likely to experience the stronger feelings of loss. Our mind knows that a close bond is being severed. Remember, however, that tobacco cannot return any of the love you give it, it is a weed. Saying goodbye to a fundamental member of our life often results in varying degrees of depression, the lightest of which is normal sadness. Severe depression can occur, and requires medical assistance. Seek the help you need if you find yourself down for the extended count. Low self-esteem, loss of sex drive, hopelessness, fatigue, or loss of appetite are warning signals to deepening depression. For the majority of 'starters' thank God, the onset of depression is temporary, and lifts to reveal your bright road ahead of you. Gratefulness and relief often follow on the heels of depression.

By Week 3, on average, the cloud begins to lift. It was once believed that depressed people smoked to self medicate, but now research is asking, "Which came first? This person's depression, or the nicotine addiction? Honesty is the most effective way to deal with these feelings of depression. The 'starter' has not really lost a loved one, the 'starter' has quit smoking cigarettes. Don't turn grief into an excuse to light up. The truth shall set us free. Wellbutrin and Zyban are two anti-depressants commonly used to alleviate quit smoking depression. Both contain 'bupropion', the active ingredient. Side effects are documented, so ask your doctor.

Loneliness or Cabin Fever

For too long we have refused or eliminated activities incompatible with smoking. Blow off the dusty chapters of long forgotten lifestyles, cheer up and dive in. The 'starter' has been in a dark, deep rut which will only become clear with time and healthy choices. Don't talk yourself into returning to that dark world of nasty butts, lighters, smoke, coughs, and limited choices.

Ravenous Appetite or Constant Hunger

Consuming large quantities of food seems the natural alternative to smoking. After all, everything tastes better and I can smell so much more! Without a doubt most 'starters' spend lots of time inspecting their refrigerator. Watch out that you don't overdo it. Weight gain will happen, weight loss will come in time, not yet mind you, but make it easier on yourself for the future and keep an eye on it. "Thou shall not weigh more than thy refrigerator!" Drink lots and lots of water and dark fruit juices. This will add some pounds which are just water, the easy kind to lose when you feel like it. The 'starters' metabolism will slow down to a degree, partly due to the absence of nicotine stimulant, largely due to the heart not having to work as hard to pump blood through constricted blood vessels. Quitting smoking does not cause weight gain, but eating more food does. Enjoy it, you have plenty of time to adjust down the road away. Only if you gain 100 pounds will you be inflicting damage similar to one pack of cigarettes!

Sources and Additional Information:

http://www.hoptechno.com/book43.htm

http://www.quit-smoking.net/what-to-expect.html

http://www.ways-to-quit-smoking.com/what-to-expect-when-you-quit-smoking-cigarettes.html

http://www.stopsmoking.net/what-expect.html