Father. The most common form of combination therapy is when you use the nicotine patch and supplement it with the occasional piece of nicotine gum or lozenge. This isn’t the most common combination method, but some heavier smokers utilize this method to quit smoking. The headaches will be worse when your blood pressure is high and may feel unbearable. Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction. 2009 Sep;31(9):1957-65. doi: 10.1016/j.clinthera.2009.08.029. If you’re wearing the nicotine patch together with the nicotine gum, lozenge, spray, or inhaler, you’ll want to use that additional NRT product sparingly. This isn’t the most conventional approach for combination therapy but if you have a desire to go this route talk over your plans with your doctor. Tobacco Cessation Specialist. The study was supported by NIH's National Cancer Institute (NCI), National Institute on Drug Abuse (NIDA) and National Center for Research Resources (NCRR). I wrote about this topic in another blog post here: Is It Safe To Wear More Than 1 Nicotine Patch At A Time?. Iva Gutowski is a practicing nurse with health care experience since 2001. You won’t follow the schedule that is outlined on the box or in the manufacturer’s directions. Prediction of abstinence at 10 weeks based on smoking status at 2 weeks during a quit attempt: secondary analysis of two parallel, 10-week, randomized, double-blind, placebo-controlled clinical trials of 21-mg nicotine patch in adult smokers. The rationale of this study is to evaluate the possible beneficial effects of adding nicotine gum to the routine of subjects using the nicotine patch. Nonsmoking status at each visit, as reported by the subjects, was verified by CO below 10 ppm in expired air. I’ve spoken to some Quitters using three quit smoking medications together in the nicotine patch, nicotine gum, AND Wellbutrin. 2008 Oct;30(10):1852-8. doi: 10.1016/j.clinthera.2008.09.016. If you smoke 11 or more cigarettes a day start with the 21 mg patch (step 1). Nicotine replacement therapy for smoking cessation. Bill, It’s Recommended To Use Nicotine Replacement Therapy For 8-12 Weeks. If you smoke 10 or less cigarettes a day start with the 14 mg patch (step 2). Several medications are available to help smokers kick the habit. Investigators looked at quit rates at several intervals, including the 1 week after the quit date, at the end of treatment and at 6 months. The success rates in the 4 other treatment groups were around 33% and about 22% in the placebo group. It’s important that you go about your #QuitPlan in a smart and safe manner. 8. You only use it when you’re hit with a strong urge or craving to smoke. Clin Ther. Writer. With the patch and nicotine gum/lozenge combination plan, you have more control over how much nicotine you put into your body. The patch will provide a steady stream of nicotine into your body throughout your day. However, few studies have compared the relative effectiveness of these therapies. Do not cut patch. Without medical attention, breathing and heart rate may cease altogether or you may fall into a coma.  |  When your Quit Date arrives and it’s time to put on the 21mg patch, the patch will be more effective. That’s a typical thing to experience when you’re quitting smoking especially early on in the process. Using logistic regression with adjustment for six baseline covariates, odds ratios for abstinence (with 95% CI) were computed. Please enable it to take advantage of the complete set of features! If you haven’t tried the combination therapy approach to quit smoking yet, I strongly recommend that you give it a shot. Those instructions are intended for if you plan to use the gum by itself, not while you’re also using the nicotine patch. Ellerbeck EF, Nollen N, Hutcheson TD, Phadnis M, Fitzgerald SA, Vacek J, Sharpe MR, Salzman GA, Richter KP. This may take some time but focus your energy on stopping one tobacco/nicotine product before you set your sights on the other. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. While experiencing a nicotine overdose, you will experience an increased heart rate. This isn’t the most common combination method, but some heavier smokers utilize this method to quit smoking. USA.gov. 6. You also won’t use the 2mg gum or 2mg lozenge on a fixed schedule like you would if you were using it by itself. It’s a similar situation if you’re a dual tobacco user. Avoid wearing patch on same area more than once per week. However, if you have a high addiction level and elect to go with the higher 4mg strength, that should be okay but please do so under the supervision of your doctor. Your pulse may feel very rapid and weak. You’re going to be under-dosed and this can be a big hurdle to quitting. Notably, they were most successful at achieving at least 1 smoke-free day in the first week after quitting, an important step toward long-term success. You’d simply be doubling your nicotine intake orally. There’s no switch or dial on the patch to turn down the nicotine if it starts to feel like you’re getting too much. Please talk over your plans with your doctor first if you decide that combination therapy is something you want to try. Editor: Harrison Wein, Ph.D. Assistant Editors: Erin Bryant and Tianna Hicklin, Ph.D. NIH Research Matters is a weekly update of NIH research highlights reviewed by NIH’s experts. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 7. National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 20892, U.S. Department of Health and Human Services, U.S. Department of Health & Human Services, NIH Institute and Center Contact Information, Get the latest public health information from CDC », Get the latest research information from NIH », NIH staff guidance on coronavirus (NIH Only) », Office of Communications and Public Liaison. If you add Quitline to the mix, you’ll have an even better chance. If you smoke cigarettes and chew tobacco, for example, switching over to the 21mg patch on your Quit Date won’t be enough nicotine for you. But it’s not outside the realm of possibility, either. To dispose of patch, fold the old patch in half with the sticky sides together and throw it in regular trash away from children or pets. The researchers did not look at other common smoking cessation aids, including nasal sprays, inhalers and nicotine gum. When you get a craving, or when you think you’ll get one, take a fast-acting nicotine product such as: mouth spray, lozenge, inhaler or gum. The headaches will be worse when your blood pressure is high and may feel unbearable. If so, please let us know how it worked out for you in the comments section below. The conversation regarding your nicotine reduction plan needs to take place with your doctor. You use the patch and the nicotine gum or lozenge at the same time. Coach. Tobacco Cessation Specialist. Patients in the medication groups received 8 to 12 weeks of treatment with either the nicotine patch, the nicotine lozenge, bupropion, a combination of the patch plus the lozenge or a combination of the lozenge plus bupropion. When using combination therapy, it’s clinically recommended to only use the nicotine gum or lozenge SPARINGLY. The group taking the patch-lozenge combination also tended to have other positive outcomes, such as more time before relapse. The patches don’t come any stronger than that strength. 5B52, MSC 2094 This site needs JavaScript to work properly. When you’re wearing the nicotine patch you only use the gum or lozenge on an as needed basis. This can be an unpleasant experience and it’s important that you’re careful to avoid it. Writer. I wrote about Wellbutrin and using it with NRT a bit more in this blog post here: Can I Use Chantix Or Wellbutrin At The Same Time That I Use Nicotine Replacement Therapy??? Based on how much you’re smoking and your addiction level, your doctor can collaborate with you on whether it’s best to start by wearing two 21mg patches, or wear one 21mg patch in combination with a 14mg or 7mg patch. You can use the nicotine spray or inhaler with the nicotine patch, however, as stated above, you’ll need to obtain a prescription from your doctor to use this combination type since you can’t walk into a store and purchase the nicotine spray or inhaler without one. For example, if you’re smoking 40 cigarettes per day, gradually work to cut down to 20 cigarettes per day. There is less nicotine in NRT products, compared to cigarettes, so it’s unlikely you’ll get too much nicotine. You don’t want to under-dose, but you also don’t want to overdose either. It’s more effective than using just one NRT product, and it more than doubles your chance of quitting. I wrote about this combination therapy approach in more depth in another blog post here: What Is “Combination Therapy” and Why Is It So Effective in Quitting Tobacco? Clipboard, Search History, and several other advanced features are temporarily unavailable. If you are continually smoking while wearing the nicotine patch or have been exposed to high levels of nicotine, your blood pressure will then begin to decrease. You might worry about whether it’s dangerous to use nicotine replacement therapy (NRT) products like the patches or gum. There may be a Quitter somewhere in the world who gave this nicotine spray or inhaler + gum or lozenge combo approach a shot. To learn more about combination therapy, request a Quitline callback. Writer. Nicotine is a stimulant that acts on the central nervous system. Gum use was not restricted during the first 6 months, with recommendations to use at least four pieces a day. A review of the efficacy of smoking-cessation pharmacotherapies in nonwhite populations. She has worked in the hospital setting on medical/surgical floors and critical care units. The Wellbutrin and NRT products complement each other quite well. That’s why doctors discourage people from smoking … The cravings and withdrawals won’t be as big if you cut down on your cigarettes first. Gutowski holds a License Practical Nursing degree from McDowell Technical Community College, Copyright © 2020 Leaf Group Ltd., all rights reserved. The patch is easy to use but some may find two products too tricky. The patch will be more effective if you take this step before your Quit Date. Healthy subjects (374) were randomized at their work-setting in a 1-year double-blind placebo-controlled trial: 149 subjects to active nicotine patch + active gum (group 1), 150 to active nicotine patch + placebo gum (group 2), and 75 to placebo patch + gum (group 3). In the November 2009 issue of the Archives of General Psychiatry, the scientists reported that about 40% of those in the patch-plus-lozenge group were still smoke-free 6 months after their quit dates. Leung MKW, Bai D, Yip BHK, Fong MY, Lai PMH, Lai P, Lai ISY, Lam ZHW, Leung ATF, To DKY, Wong MT, Wong TK, Chao DVK. To help fill this gap, scientists at the University of Wisconsin-Madison led by Dr. Megan E. Piper studied more than 1,500 smokers. Put patch on clean, dry, healthy skin on the chest, back, belly, or upper arm. If you decide to use the nicotine patch plus the gum OR lozenge combination therapy approach, it’s recommended to go with the lower strength 2mg gum or 2mg lozenge. Recap: With your doctor’s supervisor, wearing two nicotine patches at the same time can be an effective strategy for highly addicted tobacco users to quit smoking. There’s five nicotine replacement therapy products: the nicotine patch, gum, lozenge (which also comes in the mini-lozenge), spray, and inhaler.