Information about Nicotine Replacement Therapy on this website is based on data on adults only. The safety and efficacy of NRT for teens has not been sufficiently evaluated in order for the FDA to approve it for use for those under 18. However, clinical practice guidelines by the U.S. Public Health Service advise that physicians can consider prescribing NRT to those under 18 'when there is evidence of nicotine dependence and a desire to quit tobacco use.'(6) Before receiving a prescription for NRT, a teenager must be carefully evaluated by a doctor in order to determine whether they may benefit from using NRT, and whether the potential benefits of using it outweigh the potential risks.
Regardless of your age, it is always wise to consult a health care provider before beginning a smoking cessation program.
the bottom line
The use of approved medications can increase the chance of long-term abstinence from tobacco in adults, specifically when they have a desire to quit smoking. Adult smokers trying to quit should consider the use of medications discussed on this site and should discuss their options with a physician. The safety and efficacy of these druges hasn't been evaluated much for teens and the U.S. Food and Drug Administration (FDA) therefore does not approve them for use by those under the age of 18. Teens trying to quit smoking must be evaluated by their doctors in order to determine if and how they should use these drugs, and those under 18 will need a prescription in order to legally obtain any of these drugs (even ones that adults can get over the counter). In addition, those smoking fewer than 10 cigarettes per day and women who are pregnant or breastfeeding may use the approved therapies but may require alterations in treatment or close monitoring by a physician.(6)
definition
There are currently six first-line medications considered safe and effective and approved by the U.S. Food and Drug Administration (FDA) for tobacco dependence treatment in adults. These include five forms of nicotine replacement therapy -- gum, inhaler, lozenge, nasal spray, and patch -- as well as the non-nicotine medication bupropion. These first-line medications have an established scientific record of efficacy. Most adult smokers can and should use them; however, special precautions may be needed for smokers with certain medical problems or for pregnant women. These medications have few side effects (fewer than 5% of users stop using the medications due to side effects), are considered equally effective, and can nearly double the chances of quitting smoking successfully. There is no method to scientifically match a patient to a specific treatment. Therefore, choice of treatment depends on individual preference, what is appropriate for a particular lifestyle, and how helpful the individual smoker finds the medication to be.
The concept behind nicotine replacement therapy is to address nicotine dependence and minimize withdrawal symptoms by replacing the nicotine from cigarettes with an alternative nicotine source. This helps the smoker to adapt to not smoking and to develop behavioral techniques to break the cigarette habit while still receiving the nicotine "fix" in a controlled manner. As smokers progress with cessation, they can then slowly taper the nicotine dose until it is no longer needed.
explanation
The idea of using a potentially harmful drug -- nicotine -- as a medical treatment may seem strange at first, but it makes sense because smokers are already being exposed to nicotine -- in the very dangerous form of cigarettes. In addition to nicotine, cigarettes contain numerous poisons such as carbon monoxide and cyanide, a large number of cancer-causing agents, and other harmful substances. Nicotine replacement therapy (NRT) products contain nicotine and only nicotine, so they expose the user to just one potentially dangerous substance, unlike smoking. Although high doses of nicotine may have some harmful effects on the body, it does not appear to be a cancer-causing agent, and it does not play a major role in the development of heart disease.(1,21) Thus, when people stop smoking and start to use NRT, they are already reducing their health risks.
However, since nicotine is the addictive agent in cigarettes, some public health officials are concerned that NRT medications themselves will cause dependence.(22) The nicotine levels in NRTs are much lower than those in cigarettes, though, and the nicotine in some NRTs is absorbed more slowly than it is from cigarettes. Therefore, the potential for dependence is rather small.
For all NRTs, caution should be taken for pregnant and lactating women, individuals who have recently had a heart attack (within two weeks), and those with serious cardiovascular disease including arrhythmias or angina.(6) Pregnant and lactating women should be encouraged to quit first without NRT, as it is not completely clear to what extent nicotine causes harmful effects on the fetus or nursing infant.(23) However, NRTs produce lower levels of nicotine in the body than cigarettes do, and they do not expose the user to carbon monoxide (which is thought to be harmful to the fetus) the way that smoking does. Thus, some experts suggest that pregnant women can use NRT if the likelihood of abstinence without it is minimal.(6,24) For people with cardiovascular disease, studies have shown that it is possible to use NRT with little risk; however, it is very important that patients are monitored closely and that cigarettes are not used along with NRT.(25)
The FDA and manufacturers of NRT products strongly advise against smoking while using any form of NRT. Smoking while using NRT can lead to a harmful overload of nicotine in the body. In the case of the nicotine patch, users also should not smoke within a few hours after removing a patch because the nicotine from the patch remains in the bloodstream for several hours after the patch is removed. NRT users should remember that NRT does not work equally well for everyone and does not completely eliminate the withdrawal symptoms associated with smoking cessation. Further, it will not magically allow or motivate the smoker to quit. What it does do, however, is add another weapon to the arsenal of techniques that can help people quit.
