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Articles - Smoking Cessation Aids
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Which Nicotine-replacement Treatment Works Best?

There are four different nicotine-replacement treatments available over-the-counter or by prescription: nicotine gum (polacrilex), patch, spray and inhaler. They all have been shown to be safe and effective. The treatments decrease severe withdrawal discomfort, increase a smoker’s chances of stopping smoking and help him to stay smoke-free for one year after cessation.

Because the nicotine is delivered faster using the spray or inhaler, reports sometimes show these methods to be superior to the gum or the patch in relieving urges to smoke or behaviors of smoking. But, if this is true, why are people less likely to stick with these prescription nicotine-replacement medications than with the patch?

Quitters more likely to stick with the patch

Scientists now have a randomized and controlled study to answer this. The study directly compared the four nicotine-replacement products in the treatment of 504 patients on the basis of acceptability, nicotine levels, rated helpfulness, withdrawal-symptom relief and abstinence rates for three months. Compliance was very high for the patch, lower for the gum and very low for the spray and inhaler.

The patch was rated as the easiest to use, and the inhaler and spray as the most embarrassing to use. Lack of compliance for the spray and inhaler means that the level of nicotine replacement was inadequate compared to the patch or gum. All products were equal in terms of withdrawal symptoms, weight gain at week 12 or abstinence rates at three months. When the gum is provided free, its rate of use and effectiveness are higher than when patients have to pay for them.

The study’s subjects paid for their treatments in order to mimic the role that cost might play in outcomes. Products other than the patch encourage patient economizing and low compliance. This may explain in part why participants used the spray and inhaler less than recommended.

Source:Hajek, P., West, R., Foulds, J., Nilsson, F., Burrows, S., Meadow, A., “Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray and an inhaler,” Archives of Internal Medicine, 159:2033-2038, 1999.

By Mark S. Gold, MD, and Rena A. Prevette
© 2000 University of Florida McKnight Brain Institute