Nicotine Replacement Therapy – Frequently Asked Questions by HCP
General Questions
Within1:
20 minutes: Their blood pressure and pulse rate return to normal
8 hours: Oxygen levels in their blood return to normal.
48 hours: Carbon monoxide has been eliminated from their body. Their lungs start to clear out mucus and other smoking debris and their ability to taste and smell is greatly improved.
72 hours: Breathing becomes easier. Their bronchial tubes begin to relax and their energy levels increase.
2-12 weeks: Circulation improves throughout the body, making walking and running a whole lot easier.
3-9 months: Coughs, wheezing and breathing problems get better as their lung function is increased by up to 10%.
1 year: Heart attack falls to about half that of a smoker.
10 years: Risk of lung cancer falls to half that of a smoker. Risk of heart attack falls to the same as someone who has never smoked.
How will patients feel when they stop smoking and start using a NICODERM® and/or NICORETTE® product?
NICODERM® and NICORETTE® products help reduce cravings and withdrawal symptoms, but your patients should be prepared for some lingering withdrawal symptoms. After they stop smoking, symptoms can begin almost at once and are normally at their strongest during the first three or four days. For some people, any of the following may occur2-6:
- Unexpected craving or urges for cigarettes
- Anxiety, irritability, restlessness, mood changes, nervousness
- Drowsiness, trouble concentrating, increased appetite
No. Learn about pre-cessation treatment and the REDUCE TO QUIT® program. Not everyone is ready to quit right away. These programs enable your patients to ease into reducing their cigarette use.
Combination Therapy is the use of more than one Nicotine Replacement Therapy (NRT) product concomitantly. For example, usage of the NICODERM® patch along with NICORETTE® gum.
Combination Therapy is7-8:
- Over 1.3X more effective vs NRT Patch monotherapy
- Nearly 3X more effective vs cold turkey
Completing the full treatment program is important. The step-down treatment period allows your patients to gradually reduce the amount of nicotine they get, rather than stopping suddenly, and will increase their chances of quitting successfully. For most people, treatment will take about 3 months, although some people may require up to six months It is important to complete treatment — do not rush. If your patients feel they need to use NICORETTE® or NICODERM® for longer than 6 months or if the amounts of NICODERM® or NICORETTE® your patients are taking do not help them stop smoking, discuss using more than one type of nicotine replacement therapy at the same time.2-6
Your patients should carry NICORETTE® with them at all times for up to three months after they stop smoking in case they feel the urge to smoke again. One cigarette is enough to start smoking again.2-6
If your patients are using NICODERM® or a NICORETTE® product while trying to quit smoking but slip up and have a cigarette, they should not stop using NICODERM® or your NICORETTE® product. They should keep using it and keep trying to quit.2-6
Most relapses occur within the first week or within the first three months after quitting, especially during situations patients used to associate with smoking, like stress, or when drinking alcohol. Knowing that these situations can be difficult can help patients prepare for them or, better yet, avoid them in the first place. It’s important to have support from friends and family.2-6
The dosages of medications (including medicines obtained without a prescription) your patients are taking may need to be changed. Discuss with your patients what medications they are on and any new medicine they may take while using NICODERM® and/or NICORETTE® products. If your patients have diabetes, they may need to monitor their blood sugar levels more closely than normal when they stop smoking and start using this product.2-6
Signs include, but are not limited to: headaches, dizziness, nausea/upset stomach, drooling, abdominal pain, vomiting, diarrhea, cold sweat, blurred vision, difficulty hearing, mental confusion, weakness, fainting, rapid heartbeat or difficulty breathing. At high doses, these symptoms may be followed by low blood pressure, weak and irregular pulse, breathing difficulties, extreme exhaustion, circulatory collapse and general convulsions.2-6
If your patients experience any of these symptoms, they should stop using this product and consult you or local Poison Control Centre immediately.2-6
Signs of a nicotine underdose include, but are not limited to: strong cravings, increased appetite, depressed mood, restlessness, trouble concentrating, irritability/anger, and difficulty sleeping.9
If the amounts of NICODERM® or NICORETTE® products your patients are taking do not help them stop smoking, discuss remaining at the higher dose for longer or using more than one type of nicotine replacement therapy at the same time with your patients.2,4,6
Each province has their own program for smoking cessation.
View a map of coverage in Canada here.
Smoking Treatment for Ontario Patients (STOP) Program:
The STOP Program is a province-wide initiative that delivers smoking cessation treatment and counselling support to eligible Ontario smokers who wish to quit smoking. Their approach is to use the existing healthcare infrastructure as well as new and innovative means to reach smokers from all parts of the province.10
Since its inception in 2005, the STOP Program has provided free smoking cessation medication and counselling support to over 100,000 Ontarians who wanted to quit smoking.11
Well-validated research studies have shown that using medications such as Zyban® (bupropion), Champix® (varenicline), and Nicotine Replacement Therapy (NRT) patch, gum, lozenge, and inhaler can double the chances of quitting smoking.12 In addition to reaching smokers directly, the STOP Program works in partnerships with community and regional healthcare organizations to make smoking cessation medication and behavioural support available free of charge to patients and clients of these organizations.10
For more information visit: https://www.nicotinedependenceclinic.com/en/stop/home
Call a doctor or Poison Control Centre. Nicotine can cause serious illness in children and pets, even in very small amounts, and may be fatal. After a product is used throw it away out of reach of children and pets. Even used products contain enough nicotine to seriously harm children and pets.2-6
The packaging for these products does not include a DIN number. NRT products fall under the Natural Health Product Regulations and are issued Product Licenses and a Natural Health Product Number (NPN). All existing DIN products that met the NHP regulations were converted to NPN numbers by December 31, 2009.
NICODERM® Patch
Most smokers should start with the STEP 1 Patch (21 mg/day).
But, if one or more of the following apply to your patients, they should start with the STEP 2 Patch (14 mg/day):
- they smoke fewer than 10 cigarettes a day
- they weigh less than 45 kg (100 lb)
- they have heart disease and you recommended NICODERM®.6
The amount of nicotine varies depending on the stage of the 10-week quit plan. Step 1 boxes contain patches that deliver 21 mg of nicotine each. Step 2 boxes contain patches that deliver 14 mg of nicotine each. Step 3 boxes contain patches that deliver 7 mg of nicotine each.6
The NICODERM® patch, when used as directed, poses little risk of becoming dependent. With Nicotine Replacement Therapy, blood concentrations of nicotine peak more slowly, reaching much lower levels than when someone smokes. Users don't experience the nicotine "rush," but they also don't experience the painful cravings and withdrawal symptoms associated with quitting.
As with any medication, there are precautions to take. It's very important to read the package and the insert that comes with the NICODERM® product.7
When first applying the NICODERM® patch, some people experience mild itching, burning or tingling. These symptoms are normal and should go away within an hour. After a patient removes a NICODERM® patch, the skin under the patch might be somewhat red. Their skin should not stay red for more than one day.
If they get a skin rash after using a NICODERM® patch, or if the skin under the patch becomes swollen or very red, they should remove the patch, wash the area with water (do not use soap) and see you. Do not put on a new patch. They may be allergic to one of the components of the NICODERM® patch.6
Patients should remove the NICODERM® patch two (2) hours before engaging in prolonged, strenuous exercise, as this may increase nicotine absorption through the skin.6
Water won't harm the NICODERM® patch when worn. Patients can bathe, shower, swim or use a hot tub for short periods while they’re wearing the NICODERM® patch.6
NICODERM® patches generally stick well to most people's skin. However, if a patch falls off, patients should put on a new one, making sure they select a non-hairy, non-irritated area of skin that is clean and dry.
If the soap they use has lanolin or moisturizer, the patch may not stick well. Using a different soap may help. Body creams, lotions and sunscreens can also cause problems with keeping the patch on. Patients should not apply creams or lotions to the skin where they will put the patch. If their skin is oily, or if they have trouble getting the patch to stick, they should try cleaning their skin with rubbing alcohol first.
If they have followed the directions and the patch still doesn't stick, try using medical adhesive tape over the patch.6
If they want to change the time, they can do so. At the new time, just remove the NICODERM® patch they are wearing and put on a new one. After that, apply the NICODERM® patch at the new time each day.6
Store each patch in its protective pouch until they are ready to use it, because the patch will lose nicotine into the air if it is outside the pouch, Store the patch at room temperature (between 15–30°C).6
Fold the used patch in half with the stick sides together. After patients put on a new patch, they should take the opened pouch from the new patch and place the used folded patch inside it. Throw the pouch in the trash away from children. Even used patches have enough nicotine to poison children and pets. Wash hands with water (do not use soap).6
NICODERM® is available from their pharmacist, online at Nicoderm.ca and at most major retailers nationwide.
NICODERM® is available without a prescription. Patients should check with their healthcare professional or on their employer benefits plan to see if they can be reimbursed for NICODERM®.
See the list of provincial formulary coverage.
Our live support line is available from 8:00 am to 8:00 pm EST, Monday to Friday, at 1-866-311-5659.
NICORETTE® Products
All 4 products (QuickMist®, Gum, Lozenge, & Inhaler) can be used in combination with the NICODERM® patch. NICORETTE® and NICODERM® are the first and only brands in Canada authorized for use in combination. Discuss with your patients about which product is right for them.7
NICORETTE® products, when used as directed, pose little risk of becoming dependent. With Nicotine Replacement Therapy, blood concentrations of nicotine peak more slowly, reaching much lower levels than when someone smokes. Users don't experience the nicotine "rush," but they also don't experience the painful cravings and withdrawal symptoms associated with quitting.
As with any medication, there are precautions to take. It's very important to read the package and the insert that comes with the NICORETTE® product.7
Do not drink acidic beverages (coffee, tea, soft drinks, alcohol, citric juices) 15 minutes prior to using gum, mouthspray, lozenge or inhaler or during use as they will interfere with the effectiveness.9
NICORETTE® is available from their pharmacist, online at Nicorette.ca and at most major retailers nationwide.
NICORETTE® is available without a prescription. Patients should check with their healthcare professional or on their employer benefits plan to see if they can be reimbursed for NICORETTE®.
See the list of provincial formulary coverage.
The faster absorption of nicotine from NICORETTE®QuickMist® has been verified through pharmacokinetics studies. The primary reason for faster absorption of nicotine from the QuickMist® is the dosage format. QuickMist® contains nicotine in liquid format that it is delivered instantly as a mist or spray compared with the gum or lozenge format where it has to first either be released from the gum matrix or dissolve from a lozenge. The patient’s chewing technique could affect the release of nicotine which would affect the amount of nicotine available for absorption.
Absorption: Nicotine is a weak base and is easily soluble in both water and lipids depending on the degree of ionization. Its movement across cell membranes is highly pH dependent. By delivering the nicotine in a liquid where the pH is controlled, more consistent delivery of nicotine is achieved as variables associated with release of nicotine from other dosage formats like the gum or lozenge are controlled.15
Keep out of reach and sight of children and pets.
Do not use the spray after the expiry date (which can be found on the spray and on the blister card). The expiry date refers to the last day of that month,
Do not use if the blister card has been torn or opened.
Do not store above 25°C.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.3
Store the gum in its original packaging at room temperature (between 15–30°C) and protect from light.4
Store between 15–30°C.2
When not in use, always store mouthpiece and cartridges out of reach of children and pets. Store cartridges at room temperature (between 15–30°C) and protect from light and humidity. If cartridges are kept in the car, be careful since car interiors can heat up quickly.5
Our live support line is available from 8:00 am to 8:00 pm EST, Monday to Friday, at 1-866-311-5659.