Higher dose 24 hour nicotine patches and nicotine tablets are both effective at reducing cravings for smokers
- Harris, Kari Jo PhD MPH
- Ahluwalia, Jasjit S. MD MPH MS
Paper 1
BACKGROUND People attempting to quit smoking often suffer withdrawal cravings, especially in the morning when nicotine has cleared from the system overnight. Nicotine replacement therapy patches are applied once a day and they release nicotine slowly to reduce withdrawal symptoms. The 16 hour (day) patches and 24 hour (overnight) patches are available over the counter in the United States.
OBJECTIVE To compare the effectiveness of over-the-counter 24 and 16 hour patches for reducing nicotine craving and withdrawal symptoms, especially after waking.
SETTING One smoking cessation research clinic in the United States.
METHOD Double-dummy randomised controlled trial.
LITERATURE REVIEW No explicit strategy; 27 references.
PARTICIPANTS Two hundred and twenty-two adults who smoked for at least 3 years; were attempting to quit; recruited using local media; paid $150; age 18-65 (mean 39); 69% female; 82% Caucasian. To be eligible, participants had to report greater cravings for cigarettes in the morning; smoke within 30 minutes of waking; be consuming 15 or more cigarettes per day; and want to quit. Exclusion criteria: any characteristics which might confound assessments of morning cravings or drug dosing.
INTERVENTION The 16 hour (15 mg; Nicotrol) or 24 hour (21 mg; NicoDerm CQ) patches. Participants wore one of each patch during the day (one of which was a placebo) and removed the active 16 hour or placebo 24 hour patch during the night. Palm top computers prompted participants to record cravings and withdrawal at random times for 1 week at baseline and 2 weeks after quitting.
OUTCOMES Participants reported withdrawal and cravings.
MAIN RESULTS The 24 hour users experienced greater reductions in cravings, anxiety, and restlessness during the morning and throughout the day for the entire 2 week period (P all < 0.05); they were tempted to smoke half as often as those using the 16 hour patch (P < 0.05), and stopped smoking for a greater number of days (P < 0.02).
CONCLUSIONS Higher nicotine dose 24 hour patches are more effective than 16 hour (15 mg) patches for reducing cravings and morning withdrawal symptoms.
Paper 2
BACKGROUND Nicotine replacement therapy effectively reduces smoking withdrawal symptoms. A range of different administration methods exist, including a tablet containing 2 mg of nicotine.
OBJECTIVE To assess the effectiveness of the nicotine tablet for assisting smoking cessation.
SETTING Smoking cessation programme in Swedish university department.
METHOD Random double-blind controlled trial.
LITERATURE REVIEW No explicit strategy; 25 references.
PARTICIPANTS Two hundred and forty-seven smokers aged 20+ consuming at least 10 cigarettes per day for three or more years recruited through newspaper advertising.
INTERVENTION Placebo or nicotine sublingual tablets for 3-6 months. Dosage was one tablet an hour for those smoking up to 20 cigarettes per day (maximum 20 tablets/day) and two tablets an hour for those up to 40 cigarettes per day (maximum 40 tablets/day).
OUTCOMES Self-reported smoking abstinence; measures of exhaled carbon monoxide up to 12 month follow-up.
MAIN RESULTS After 2 weeks, 50% of the nicotine tablet group and 29% of the placebo group had complete smoking abstinence (P < 0.0001). This effect lasted till 6 months (33 versus 18%; P < 0.005) but by 12 months, the difference between groups was not statistically significant. These results were driven mainly by smokers heavily dependent on nicotine; results were statistically insignificant when comparing only smokers with low nicotine dependence. There were few adverse effects of the tablet, the most common being nausea and vomiting (24 versus 7%; P < 0.001); dyspepsia (18 versus 9%; P < 0.04); hiccups (11 versus 0%; P < 0.001); and gastritis (11 versus 5%; P < 0.1).
CONCLUSIONS The nicotine tablet is well tolerated and helps smokers with high nicotine dependence quit for longer periods (up to 6 months).