Quitting smoking is not won solely by willpower, but largely through a correctly calibrated nicotine replacement strategy (NRT). For thousands of smokers NRT represents invaluable help, provided the correct dose is used—one that will extinguish the compelling urge to light a cigarette and other nicotine withdrawal symptoms. The equation is simple: the stronger the dependence, the greater the initial nicotine intake must be.
Determining the Right Dose: The Fagerström Test as a Guide
Assessing dependence is essential before starting effective treatment. Specialists often rely on two simple indicators: the number of cigarettes smoked per day and, most importantly, the time elapsed between waking up and the first cigarette.
A smoker who consumes fewer than 10 cigarettes per day or waits more than an hour after waking up for their first puff is considered weakly dependent. For them, lower doses of oral substitutes will often suffice, possibly combined with a low-dose patch.
Conversely, if consumption exceeds 15 cigarettes or if the first cigarette is smoked within 30 minutes of waking up, the dependence is judged to be strong to very strong. In this case, it is imperative to start with a high-dose patch (often 21 mg/24h or 25 mg/16h) and systematically combine it with a fast-acting oral form to manage unexpected craving spikes. For heavy smokers (more than 15 cigarettes), it is sometimes necessary to use two patches simultaneously to reach the required replacement dose.
Forms of Substitution
Each type of substitute delivers nicotine according to a different kinetic, justifying their combined or targeted use:
- Patches: They ensure continuous, slow diffusion of nicotine into the body over sixteen or twenty-four hours. They constitute the background treatment, aiming to maintain stable nicotine levels and prevent constant withdrawal. Dosing typically ranges from 7 to 21 mg (or 10 to 25 mg for 16h), with a gradual weaning protocol over about eight to twelve weeks, reducing the dose in stages.
- Gums, Micro-Tablets, and Lozenges: These oral forms deliver nicotine through the oral mucosa. They are essential for managing craving peaks. They are generally available in 2 mg doses for moderate dependence and 4 mg for strong dependence. They are taken on demand, typically eight to twelve times a day.
- Mouth Sprays and Inhalers: These devices offer very rapid absorption, with the mouth spray being the quickest to counter a sudden urge, closely resembling the effect of a cigarette puff. They are used at a rate of one to two sprays per craving.
The duration of this replacement treatment should be maintained for at least three months, with the goal of stabilizing the cessation, and then gradually reducing the nicotine intake over several weeks, or even months, depending on the comfort of the ex-smoker. Treatment can extend up to six or even twelve months if necessary, to prevent relapse.
The Fear of Overdose: A Myth for the Smoker
The key point, often misunderstood by the general public, is that it is rarely possible to overdose on nicotine replacement therapy.
Healthcare professionals point out that the nicotine delivered by an NRT is absorbed more slowly and does not create the abrupt cerebral concentration peak of a cigarette. If the dosage is too high, the symptoms are generally mild and temporary: slight nausea, headaches, or palpitations. These signs are easily identifiable and simply call for a reduction in dose.
Conversely, it is under-dosing that represents the true pitfall of quitting. An insufficient dose fails to satisfy the nicotine deficiency, leaving the door open to withdrawal symptoms (irritability, anxiety, hunger, difficulty concentrating) and, inevitably, to relapse. The message is clear: it is better to start with a strong dose and adjust downwards, rather than condemning oneself to failure through timid dosing.
It is crucial not to stop treatment prematurely under the pretext of feeling “cured.” A hasty cessation, often after only a few weeks, exposes the former smoker to persistent craving and other nicotine withdrawal symptoms which can undermine efforts and lead to a return to smoking. Lasting success lies in this measured and fully dosed approach, taking the time for gradual reduction.
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