Nicotine replacement therapy

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Nicotine replacement therapy (NET also NRT for engl. Nicotine replacement therapy "NRT") is the measured delivery of nicotine by means of preparations nicotine as a substitute for the elimination of nicotine delivery in the smoking cessation . Thus with nicotine patch , nicotine chewing gum , nicotine lozenges pastilles nicotine patches or nicotine spray nicotine was added. Maintaining the nicotine level is intended to avoid or mitigate the symptoms of tobacco withdrawal in order to facilitate or enable permanent cessation of smoking.

Nicotine is partly responsible for the dependence on tobacco products . Comparisons of animal studies and studies of human drug use show that pure nicotine is only slightly addictive, while tobacco cigarette smoke is very addictive. In combination with other substances in tobacco smoke, nicotine has an extremely high potential for dependence and can very quickly lead to dependent behavior . According to a paper by D. Nutt et al. Published in 2007. the addiction potential of tobacco smoke lies somewhere between alcohol and cocaine. More precisely, the physical addiction potential is that of alcohol or barbiturates and the psychological addiction potential that of cocaine. A comparison with addiction to opiates such as heroin is not indicated because this is much more complicated to treat and the withdrawal symptoms are more severe. A few cigarettes or a few days with small cigarette consumption are enough to become physically dependent. The addiction potential of orally ingested nicotine is significantly lower, patches have almost no addiction potential.

The nicotine preparations listed are presentation drugs and, with the exception of the nicotine nasal spray, are only available in Germany without a prescription in pharmacies .

Mode of action

Nicotine replacement supplements are designed to help subdue tobacco smoke cravings by slowly releasing nicotine into the body. Unlike cigarettes, they only emit nicotine and no other toxins such as carbon monoxide , formaldehyde , acrolein , hydrocyanic acid , arsenic or the carcinogenic polycyclic aromatic hydrocarbons contained in cigarettes. Nicotine substitutes come in different strengths. The appetite suppressing effect of the products and the minimization of weight gain during weaning are heavily advertised. The effects of nicotine as an anorectic were described in the journal Science in 2011.

Chances of success

The likelihood of relapse among smokers who quit tobacco without aids is 97% within six months of quitting. Until 2012, it was assumed that nicotine replacement preparations with the correct dosage and further professional guidance could increase the chances of success by three percent. On the other hand, more recent studies after 2013 indicate that the relapse rate in those who used nicotine replacement supplements to quit was just as high as in those who quit without aids.

Over-the-counter NET products

Nicotine patches

The following products are available in pharmacies in Germany in various strengths without a prescription. There is no general pharmacy obligation for nicotine in Germany.

Nicotine patches

Nicotine patches are placed on the skin and changed daily. Recommended for medium to heavy smokers who smoke relatively evenly throughout the day. The nicotine dose applied to the patch varies between 8.3 mg to 52.5 mg, although only between 7 mg and max. 21 mg of the active ingredient can be absorbed at approx. 5 mg / h through the depot function of the skin. The potential for addiction is close to zero.

Nicotine chewing gums

Recommended for less to moderately strong smokers or "social smokers". Nicotine chewing gum is chewed like normal chewing gum and can also be used to supplement nicotine patches when the need for a cigarette is particularly strong. Nicotine chewing gum is available in different flavors and strengths (2 mg and 4 mg). There is little potential for addiction.

Nicotine lozenges

Recommended for medium to heavy smokers who smoke unevenly throughout the day. They release the nicotine when sucking and - like nicotine chewing gum - are used when necessary and are available in three strengths (1 mg, 2 mg and 4 mg). The oral availability is 50%. Part of the nicotine is swallowed, this part is subject to a first-pass effect .

Nicotine inhaler

With the nicotine inhaler you suck the nicotine into your mouth through a mouthpiece, similar to smoking a cigarette. One cartridge contains 10 or 15 mg of nicotine. In addition to nicotine, flavorings such as B. contain menthol .

Nicotine spray

Nicotine spray (e.g. nicorette spray ) is recommended for medium to heavy smokers and is suitable for short-term / spontaneous use during smoking cessation in order to avoid relapse. The nicotine is released from the can into the mouth via spray and absorbed through the oral mucosa.

NET Prescription Products

The following products are available on prescription from pharmacies in Germany.

  • Nicotine nasal spray

Nicotine nasal spray is recommended for heavy smokers who are very dependent on tobacco. Nicotine-containing liquid is sprayed into the nose. A 10 ml bottle contains 100 mg of nicotine.

Individual evidence

  1. ↑ Guideline tobacco dependence from recommendations for the therapy of tobacco addiction. (PDF, 44 kB) Medicines Commission of the German Medical Association. In: Drug Ordinance in Practice , special issue, 1st edition, May 2001
  2. ↑ Determinants of Tobacco Use and Renaming the FTND to the Fagerström Test for Cigarette Dependence . Retrieved July 28, 2013.
  3. ↑ James D. Belluzzi et al .: Monoamine Oxidase Inhibitors Allow Locomotor and Rewarding Responses to Nicotine . December 14, 2005, accessed August 1, 2013.
  4. ↑ James D. Belluzzi et al .: Acetaldehyde Enhances Acquisition of Nicotine Self-Administration in Adolescent Rats . October 20, 2004, accessed August 1, 2013.
  5. ^ JE Rose, WA Corrigall: Nicotine self-administration in animals and humans: similarities and differences . March 1997, PMID 9089846 .
  6. ↑ SCENIHR : Questions about tobacco additives: Is the development of nicotine addiction dose-dependent?, (2010), accessed July 29, 2013.
  7. ↑ How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General, Nicotine Addiction: Past and Present . Surgeon General (US), 2010, accessed July 29, 2013.
  8. ↑ Development of a rational scale to assess the harm of drugs of potential misuse. (PDF; 127 kB) 2007, accessed on March 9, 2013 .
  9. ↑ Harm reduction on nicotin addiction - Helping people who can't quit . ( Memento of the original from April 29, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 1.9 MB) A report by the Tobacco Advisory Group of the Royal College of Physicians, October 2007, page 98/99. @1@ 2Template: Webachiv / IABot / www.sfata.org
  10. ↑ Hildegard Kaulen: Explosive appetite suppressants. In: FAZ.net . July 19, 2011, accessed October 13, 2018 .
  11. ↑ http://science.sciencemag.org/content/332/6035/1330
  12. ^ Lindsay F. Stead, Rafael Perera, Chris Bullen, David Mant, Tim Lancaster: Nicotine replacement therapy for smoking cessation. Cochrane Tobacco Addiction Group, 2008, doi : 10.1002 / 14651858.CD000146.pub3
  13. ↑ HR Alpert et al .: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation. Center for Global Tobacco Control, January 2013, doi: 10.1136 / tobaccocontrol-2011-050129 , PMID 22234781 .
  14. ↑ D. Kotz, J. Brown, R. West: 'Real-world' effectiveness of smoking cessation treatments: a population study Addiction, Vol. 109, No. 3, pp. 491–499, March 2014, doi: 10.1111 / add.12429 .
  15. ^ S. Zorin, F. Kuylenstierna, H. Thulin: In Vitro Test of Nicotine's Permeability through Human Skin. Risk Evaluation and Safety Aspects . British Occupational Hygiene Society, 1999
  16. ↑ J. Hukkanen, P. Jacob III, NL Benowitz: Metabolism and Disposition Kinetics of Nicotine . In: Pharmacological Reviews , March 2005.
  17. ^ A b Ontario Medical Association: Rethinking Stop-Smoking Medications: Treatment Myths and Medical Realities . ( Memento of May 24, 2012 in the Internet Archive ) (PDF; 296 kB; English). Toronto January 2008 ISBN 0-919047-60-2
  18. ^ Open drug Database, 2016, accessed February 22, 2016 .