• Combination NRT has been shown to be more effective than the use of a single NRT product¹

• Combination NRT is the use of a nicotine patch, which provides a steady supply of nicotine, along with a fast-acting flexible format to help with immediate cravings^1,3

Data from a Cochrane review showed that compared with the use of a single NRT product, combination NRT can increase long-term quit rates by 25%¹.

1 RR: 1.25, 95% CI: 1.15–1.36; anticipated absolute effects: quit rates with monotherapy 139 per 1000, quit rates with combination NRT 174 per 1000.¹

• • The safety profile of combination NRT is comparable to monotherapy^7,8 and even with combination NRT, the levels of nicotine received are unlikely to be higher than those received from smoking⁹

• • The efficacy of combination NRT for smokers who want to quit is recognised by NICE and the National Centre for Smoking Cessation and Training (NCSCT):^3,9

“There is good evidence to show that combination NRT is more effective than single product use.” – NCSCT⁹

• NRT has been shown to be an effective pharmacotherapy²

• It provides a temporary substitute for the nicotine that smokers receive from cigarettes and delivers nicotine without the other harmful toxins that are found in tobacco^2,3

• The use of NRT aims to assist smokers who want to quit by helping to relieve the urge to smoke along with nicotine withdrawal symptoms, such as irritability, low mood and restlessness^2,4

• Absorption of nicotine from NRT is either mucosal (oral and nasal formats) or transdermal (patch)⁵

• While transferred nicotine dependence from cigarettes to NRT is rare, it is both less harmful and easier to break than smoking dependence^3,6

In a Cochrane review, NRT was found to increase quit rates by 55% compared with the use of placebo or no NRT.²

RR: 1.55, 95% CI: 1.49–1.61; illustrative comparative risks: quit rates with control 105 per 1000, quit rates with NRT 162 per 1000.²

Tony wants some advice.

He has been smoking for 10 years, and tried to give up once before, about three years ago. He managed to stop for a couple of months using nicotine patches, but started again when he started socialising with work more often.

He found dealing with the cravings really difficult. His wife is expecting and he wants to stop for good. He smokes around 15-20 a day, and has cravings for an early morning cigarette.

Recommendations:

A combination of long-acting and short-acting NRT could be an appropriate option, as Tony struggles dealing with cravings.

A 25mg Invisipatch is suitable for those who smoke over 10 cigarettes a day, delivering nicotine throughout the day to help reduce background withdrawal symptoms. A faster acting format such as QuickMist mouthspray, can then be used to help tackle cravings when they strike during the day. A combination of a long acting patch with a shorter, faster acting NRT is more likely to be successful than either long or short acting alone.

16 hour daily patch +

maximum daily dose of 2 sprays per dosing episode, 4 sprays per hour and 64 sprays per day

Raminder is determined to give up smoking, but misses the hand to mouth action of smoking.

She enjoys the social aspect of smoking and smokes when out with friends, no more than 6 to 8 a day.

What product and advice is most appropriate?

Recommendations:

Nicorette Inhalator is held like a cigarette and suitable for light and heavy smokers.

It should be used whenever the urge to smoke is felt or to prevent cravings in situations where these are likely to occur.

Up to 6 cartridges can be used daily. Each cartridge lasts for approximately 40 minutes of intense use, which can be used in divided doses (e.g. 8x 5 minute sessions)