NICOTINE REPLACEMENT THERAPHY

Nicotine replacement therapies (NRTs), such as nicotine gum and the transdermal nicotine patch, were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. NRTs are used (in conjunction with behavioral support) to relieve withdrawal symptoms — they produce less severe physiological alterations than tobacco-based systems and generally provide users with lower overall nicotine levels than they receive with tobacco. An added benefit is that these forms of nicotine have little abuse potential since they do not produce the pleasurable effects of tobacco products — nor do they contain the carcinogens and gases associated with tobacco smoke. Behavioral treatments, even beyond what is recommended on packaging labels, have been shown to enhance the effectiveness of NRTs and improve long-term outcomes.

The FDA's approval of nicotine gum in 1984 marked the availability (by prescription) of the first NRT on the U.S. market. In 1996, the FDA approved Nicorette gum for over-the-counter (OTC) sales. Whereas nicotine gum provides some smokers with the desired control over dose and the ability to relieve cravings, others are unable to tolerate the taste and chewing demands. In 1991 and 1992, the FDA approved four transdermal nicotine patches, two of which became OTC products in 1996. In 1996 a nicotine nasal spray, and in 1998 a nicotine inhaler, also became available by prescription, thus meeting the needs of many additional tobacco users. All the NRT products — gum, patch, spray, and inhaler — appear to be equally effective.