Nicotine concentrations with concurrent use of cigarettes and nicotine replacement: A review

Abstract

This paper reviews the data on blood nicotine or saliva cotinine concentrations with concomitant smoking and use of nicotine replacement (NR) products. Eleven studies that provided data on blood nicotine concentrations, carbon monoxide in exhaled air, and number of cigarettes smoked were reviewed. At least one day had to be spent on concurrent use of cigarette and NR products. With simultaneous use of smoking and acute NR products (gum and inhaler) the nicotine concentrations were unchanged, whereas they increased (+54%) with nicotine patches. With both types of NR products, the number of cigarettes smoked per day was reduced by approximately 50% and carbon monoxide (CO) by 30%. Where smokers had the intention or received instructions to reduce smoking, a greater reduction in cigarettes smoked and exhaled CO was observed. Despite substantially increased nicotine concentrations (e.g., up to 3 times the approved dose) there were no significant adverse reactions. Concurrent use of NR products and cigarette smoking appears to be safe.

Adherence to and Reasons for Premature Discontinuation From Stop-Smoking Medications: Data From the ITC Four-Country Survey

“…Most former smokers progressed through a number of attempts before achieving long-term abstinence (U.S. Department of Health and Human Services, 1990). Current labeling of NRT products in which smokers are advised to stop using the product following relapse is inconsistent with this reality and with the evidence that concurrent use of NRT and cigarettes is safe (Fagerstrom & Hughes, 2002). Rather than recommend discontinuation of the product, it may be fruitful to advise smokers to continue using NRT after relapse, particularly if the relapse occurred within the first couple of weeks of cessation when withdrawal symptoms are most acute.…”

Nicotine preloading for smoking cessation: the Preloading RCT

“…This raises the possibility that NRT, which is usually started on the quit day, may be effective if used in this way, as it too reduces satisfaction from smoking when used concurrently with cigarettes. 8 Using nicotine in this way is termed 'nicotine preloading'. The reason that this may help achieve smoking cessation is because nicotine from NRT desensitises the nicotinic receptors and blocks the effects of further nicotine from cigarettes.…”

“…Smoking while using a short-acting NRT tends not to raise the concentration of nicotine in the blood, whereas smoking and using a patch does. 8 It may be this higher concentration of nicotine that undermines the reward from cigarettes. Indeed, there was some evidence of this, with patches having a RR of 1.26 (95% CI 1.03 to 1.55) for longer-term abstinence.…”

Effects of high dose transdermal nicotine replacement in cigarette smokers

“…Nicotine replacement therapies (NRTs) have been evaluated as a tool to facilitate reduced cigarette intake (Bolliger et al, 2000;Carpenter et al, 2004;Etter et al, 2002;Fagerstrom et al, 1997;Wennike et al, 2003). Although NRTs have led to greater reduction in smoking than placebo, the extent of reduction in number of cigarettes smoked does not necessarily correspond to the extent of reduction in exposure as assessed by biomarkers (Fagerstrom & Hughes, 2002;Hughes & Carpenter, 2005;Hurt et al, 2000). For example, Hecht and coworkers (2004b) found that smokers reduced their daily smoking by over 70% with the use of NRT, yet only reduced their levels of 4-(methylnitrosamino)-l-(3 pyridyl)-l-butanol (NNAL) and its glucoronides (NNAL Glucs) or total NNAL, a biomarker for the tobacco-specific lung carcinogen, 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NNK), by slightly over 30%.…”