Help to stop smoking

Tag: nicotine

  • Nicotine: health effects

    Nicotine: health effects

    Here is what experts consider to be the current evidence regarding the health effects of nicotine. The main message is that nicotine is addictive, but poses few direct health risks when separated from tobacco smoke. People who do not already smoke should not use nicotine.

    • Addiction is the Main Risk: Nicotine is the chemical in tobacco that causes addiction (dependence) by triggering pleasure and making people want to avoid withdrawal symptoms (cravings).
    • Tobacco Smoke is the Danger: The thousands of toxic and cancer-causing chemicals in tobacco smoke—not the nicotine—are what make smoking lethal.
    • Aids to Quitting Smoking: Nicotine-containing products like Nicotine Replacement Therapy (NRT: patches, gum) and vapes (e-cigarettes) are effective tools to help people quit smoking by managing cravings without the severe harm of tobacco.
      • Vaping is recommended as a quit aid and is considered significantly less harmful than smoking.
      • Evidence shows people using nicotine vapes are almost twice as likely to quit successfully compared to those using NRT.
    • Who Should Use Nicotine: Nicotine products are primarily for people who already smoke and are trying to quit. They should not be used by non-smokers.

    Specific Health Impacts of Nicotine (Separate from Smoking)

    The evidence suggests that many of the severe health problems linked to smoking are not caused by nicotine alone:

    • Heart Health: Nicotine can cause a temporary, short-term rise in heart rate and blood pressure. However, long-term evidence of harm is lacking. Smokers who completely switch to vapes or NRT often see significant and early improvements in their vascular health.
    • Cancer: The research consensus is that nicotine does not cause cancer.
    • Brain Development: There is limited evidence that nicotine significantly impacts cognitive function in humans, and separating its effects from smoking is difficult. Pre-existing factors may also play a role.
    • Mental Health: While smoking is linked to conditions like depression, nicotine itself does not appear to be the main driver; other chemicals in tobacco smoke play a larger role.
    • Toxicity: At very high levels, nicotine can cause acute side effects like nausea and dizziness, but users quickly learn to avoid these toxic doses.

    Reference: ASH. Evidence summary: The health effects of nicotine. November 2025. ASH-evidence-brief-on-nicotine-V6-Nov25.pdf

  • The amount of nicotine in cigarettes

    The amount of nicotine in cigarettes

    How much nicotine is in a cigarette?

    Many people know that nicotine makes cigarettes addictive, but few know how much nicotine is actually in a cigarette, or how much nicotine your body absorbs when you smoke. Understanding these numbers can help you choose an alternative product that does not involve burning tobacco or inhaling smoke.

    The total amount of nicotine in a cigarette varies, but most commercial cigarettes contain between 10 and 15 milligrams (mg) of nicotine. This is the amount present in the tobacco before the cigarette is lit, but this figure does not reflect the whole picture. Most of the nicotine in a cigarette is destroyed by combustion or remains in the sidestream smoke that you do not inhale. What really matters is the amount of nicotine that enters your bloodstream.

    ‘Light’ or ‘low-nicotine’ cigarettes:

    Don’t be fooled by these labels! Studies have shown that cigarettes marketed as ‘light’ or ‘low-nicotine’ contain about the same amount of nicotine as regular cigarettes. The real difference lies in their design (air holes around the filter), which can affect how you smoke.

    How much nicotine do you actually inhale?

    You do not inhale all of the 10 to 15 mg of nicotine contained in a cigarette. When you light a cigarette and take a puff, a significant amount of nicotine is destroyed by heat or escapes as sidestream smoke. The amount of nicotine that enters your lungs and is absorbed in your blood (bioavailability) depends on many factors, including how the cigarette is manufactured and, most importantly, how you smoke it. A person who smokes one cigarette absorbs approximately 1 to 2 mg of nicotine. Although this amount may seem small compared to the total 15 mg, it is enough to deliver a powerful dose to your brain and satisfy your addiction.

    The smoker’s behavior matters

    The way a person smokes is the most important variable in the actual dose received. Each person behaves differently, and two people smoking the same cigarette may absorb different amounts of nicotine. Your brain acts like a thermostat that determines how much nicotine you need to feel good and avoid nicotine withdrawal symptoms. As a result, people who smoke “low nicotine” or “light” cigarettes do so differently than normal cigarettes. This is called compensatory smoking:

    Deeper puffs: If you use a low-nicotine cigarette, your body compensates by taking deeper, longer puffs to get the amount of nicotine your brain needs.

    Smoking more often: You may also simply smoke more cigarettes throughout the day.

    Blocking the vents: Some ‘light’ cigarettes have ventilation holes near the filter. Smokers often cover these with their fingers or lips, either unconsciously or intentionally, which increases the concentration of smoke inhaled and, consequently, the dose of nicotine.

    This means that a heavy smoker can easily absorb 25 mg of nicotine per day by smoking a pack of 20 cigarettes, whether these are regular, low-nicotine or light cigarettes.

    Why it is important to understand nicotine levels and the speed of delivery:

    Nicotine is the main addictive chemical in tobacco, it is what drives you to smoke one cigarette after another. When you inhale smoke, nicotine quickly enters your bloodstream and reaches your brain. This rush causes the release of a chemical that makes you feel good (dopamine), which is why smoking can be enjoyable or soothing. But this feeling is temporary, as the nicotine level in your blood drops quickly, leading to withdrawal symptoms.

    When you smoke, nicotine reaches your brain within 10 to 20 seconds of inhalation. This rapid effect is one of the reasons why cigarettes are so addictive. Your brain learns to anticipate this rapid rush, and cravings develop when nicotine levels drop. Nicotine replacement therapies (patches, gum, tablets) release nicotine at a much slower rate and therefore do not create addiction, even though the molecule is the same.

    Understanding how nicotine works helps to understand why nicotine replacement therapies (such as patches, gum or lozenges) are designed in this way: to provide controlled, lower doses of nicotine at a slower rate of delivery and without the toxic chemicals found in cigarette smoke.

    Knowing all this can make it easier to quit smoking.

    Knowing these figures can help you understand how cigarettes are designed to make you addicted. The tobacco industry adjusts the chemical composition so that nicotine reaches your brain quickly and reliably, not only by controlling the amount of nicotine in cigarettes with the same precision used by drug manufacturers to produce prescription drugs, but also by using chemical additives.

    To quit smoking without experiencing nicotine withdrawal symptoms, you need to replace the “dirty” nicotine you currently get from smoking with “clean” nicotine from nicotine replacement therapy (NRT): products such as patches, gum and lozenges deliver a controlled and steady dose of nicotine without the thousands of other toxic chemicals found in cigarette smoke. Nicotine-based medicines release nicotine at a much slower rate than cigarettes, which is why these products are not addictive. They help you manage withdrawal symptoms when you quit smoking.

    Behavioural support from a healthcare professional increases the effectiveness of nicotine replacement therapy. Peer support groups and quit-smoking helplines can also help you manage the psychological and behavioral aspects of quitting smoking.

    If you do not want to use NRT, you can also get nicotine from e-cigarettes or nicotine pouches, these products deliver sufficient amounts of nicotine but no smoke, and are therefore much less dangerous than cigarettes.

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  • Nicotine patch

    Nicotine patch

    An effective tool for quitting smoking

    The nicotine patch is a small, bandage-like patch that you apply directly to your skin, typically on your arm or torso. It’s designed to deliver a controlled, steady dose of nicotine into your bloodstream throughout the day. It provides you with nicotine in a controlled manner, without the harmful substances (tar, carbon monoxide) found in cigarette smoke.

    It is designed to alleviate the discomfort associated with cigarette withdrawal symptoms (craving for cigarettes, irritability, bad mood, depression, anxiety, difficulty consentrating, trouble sleeping, increased appetite and weight gain).

    How Does the Patch Work?

    The nicotine patch slowly releases nicotine through your skin, which is then absorbed by your body.

    The patch can be used by smokers who wish to quit smoking, but also by those who are not yet ready to quit and who continue to smoke while wearing the patch:

    • After you quit smoking, the patch relieves cravings and other nicotine withdrawal symptoms, so that you suffer less during the first days, weeks and months after quitting.
    • The patch increase your chances of successfully quitting smoking.
    • Smokers who are not ready to quit immediately can use nicotine patches for a few weeks before quitting smoking, in addition to cigarettes. This way, most of their nicotine needs will be met by the patch, they will smoke fewer cigarettes, and it will be easier for them to quit after a few weeks of combined use.
    • Smokers who do not wish to quit smoking, or feel unable to do so, can use nicotine patches to reduce their cigarette consumption. This means that part of their nicotine requirement will be satisfied by the patch, and they will smoke fewer cigarettes, thereby inhaling less smoke and fewer toxic components present in cigarette smoke. This dual use can be continued in the long term, over several months or years.

    Is the patch effective to quit smoking?

    In smokers willing to quit, a synthesis of 51 high-quality studies involving 25,754 participants concluded that nicotine patches increase their chances of quitting smoking by a factor of 1.64 (i.e. +64%), compared to a control group that did not use patches. However, it is difficult to quit smoking, and the median quit rate in the control group was only xx per cent after 6 months, while the quit rate in the group using the patch was xx per cent. This shows that the patch is effective, but that it only increases your chances of quitting smoking by a few percentage points.

    To increase your chances of quitting smoking, you can combine two nicotine medications, e.g. patch and gum, or patch and inhaler, or patch and tablet. This will further increase your chances of quitting by a factor x1.27 (i.e. +27%).

    There is evidence that higher-doses patches (21-25 mg) are more effective than lower doses patches (14-15 mg), and that patches with 42-44 mg are as effective as patched with 21-22 mg.

    The Importance of compliance and of not smoking after you quit, not even a puff

    For the treatment to be effective, you must follow the instructions. It is essential that you use the patch every day, at the recommended dosage, for 3 months after quitting smoking, without stopping the treatment prematurely. If you do not do so, you increase the risk of relapse.

    You can smoke while wearing the patch; it is not dangerous. However, it is best not to smoke at all after quitting, even a single puff, as this increases the risk of relapse.

    Consulting a healthcare professional (doctor, psychologist, pharmacist) can significantly increase your chances of success.

    How to Use the Patch?

    Some brands of patches are designed to be worn for 16 hours a day, from morning until bedtime. The idea is to simulate the fluctuations in nicotine levels experienced by a smoker without supplying nicotine during sleep, which could disrupt sleep. Other brands are designed to be worn for 24 hours. The idea is to reduce the urge to smoke and withdrawal symptoms in the morning.

    With the 16-hour patch that you remove before going to bed, you may wake up with very low nicotine levels in your blood and experience cigarette cravings and other nicotine withdrawal symptoms in the morning. The patch slowly releases nicotine through the skin, and you will not feel its full effects until two hours after applying it. Therefore, you should use the patch in combination with a faster-acting product, such as nicotine gum or lozenges, to avoid withdrawal symptoms in the morning.

    Dosage depends on your initial cigarette consumption:

    Heavy smokers (more than 15 cigarettes/day): Start with the highest dose (25 mg/16h) for 8 weeks, then reduce (15 mg/16h for 2 weeks, then 10 mg/16h for 2 weeks).

    Moderate/light smokers (fewer than 15 cigarettes/day): Start directly with the medium dose (15 mg/16h) for 8 weeks, then switch to the low dose (10 mg/16h) for 4 weeks.

    Treatment lasts 3 months. It is very important not to stop treatment prematurely, as this would increase the risk of relapse.

    Practical Tip: Change the application site every day to minimize skin irritation.

    Precautions and Contraindications

    The nicotine patch should not be used by non-smokers or non-users of tobacco or e-cigarettes, children under 12, and in principle, adolescents, unless there are already addicted to cigarettes or e-cigarettes.

    Health Conditions:

    If you suffer from recent or severe heart problems (recent heart attack, unstable or worsening angina, uncontrolled high blood pressure), or other conditions such as diabetes, kidney/liver diseases, or epilepsy, you must consult your doctor before starting treatment.

    Pregnancy and Breastfeeding:

    Nicotine, even in the form of a medication, can harm the fetus or infant. Pregnant or breastfeeding women should only use the nicotine patch after consulting a healthcare professional. If smoking cessation is not achieved, flexible-dose nicotine products (like gum or lozenges) are preferred.

    What Side Effects Can You Expect?

    Side effects of the patch are often confused with cigarette withdrawal symptoms.

    Common side effects of the patch: Itching at the application site, headache, nausea, or vomiting. Not to be confused with cigarette withdrawal symptoms: Irritability, depression, anxiety, bad mood, difficulty concentrating, sleep disturbances, increased appetite, or smoking cravings.

    Most skin reactions are mild and disappear quickly after removing the patch. If you experience severe effects (chest pain, irregular pulse), stop treatment and seek medical advice.

    If you absorb too much nicotine, you may feel nauseous, dizzy or weak, and have a bad taste in your mouth, similar to the feeling you get when you smoke too much. If this happens, remove the patch immediately and the effect will disappear after a few minutes. There is no risk of nicotine overdose with nicotine patches in former smokers or tobacco users.

    The nicotine patch is a valuable tool, but ultimate success depends on your willingness to quit smoking, your ability to avoid places where you used to smoke and the presence of other smokers, and, ideally, medical supervision.

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  • Questionnaire : how much nicotine do you need?

    Questionnaire : how much nicotine do you need?

    Answer these 5 questions to assess how much nicotine you consume as a smoker (or consumed when you smoked). We will then use this information to calculate the optimal nicotine concentration in your e-liquids, your nicotine medications (patch, gum, tablet, inhaler), or your nicotine pouch. Our statistics show that these 5 questions provide twice as accurate an estimate of your nicotine need as using only the number of cigarettes smoked per day.

    1- How many cigarettes do (did) you usually smoke(d) per day?

    • 1-5 cig./day = 1 point
    • 6-10 cig./day = 2 points
    • 11-15 cig./day= 3 points
    • 16-20 cig./day= 4 points
    • 21+ cig./day = 5 points

    2- Usually, how long after waking up do (did) you smoke your first cigarette of the day?

    • 0-5 minutes = 5 points
    • 6-15 minutes = 4 points
    • 16-30 minutes = 3 points
    • 31-60 minutes = 2 points
    • Over 1 hour = 1 point

    3- On a scale of 0 to 100, indicate how heavily you smoke(d):

    • 0 = 0 point
    • 1-20 = 1 point
    • 21-40 = 2 points
    • 41-60 = 3 points
    • 61-80 = 4 points
    • 81-100 = 5 points

    4- On a scale of 0 to 10, how much smoke do you inhale each day (or inhaled when you smoked)? This amount depends on the number of cigarettes you smoke, how deeply you inhale, and the number of puffs.
    0: I do not inhale any smoke.
    10: I smoke so much that even if I tried, I could
    not inhale any more smoke.

    • 0 = 0 point
    • 1-2 = 1 point
    • 3-4 = 2 points
    • 5-6 = 3 points
    • 7-8 = 4 points
    • 9-10 = 5 points

    5- Indicate the number of milligrams of nicotine listed on your cigarette packet:

    • 0.1-0.5 mg = 1 point
    • 0.6-0.7 mg = 2 points
    • 0.8 mg = 3 points
    • 0.9 mg = 4 points
    • 1.0 mg or more = 5 points

    Now, add up and calculate your total number of points (maximum = 25 points)

    Data from our studies indicate that if your total is:

    • 0-4 points, you aborb between 0 and 7 mg of nicotine per day (mean = 3.4 mg / day)
    • 5-9 points, you aborb between 7 and 14 mg of nicotine per day (mean = 10 mg / day)
    • 10-14 points, you aborb between 14 and 21 mg of nicotine per day (mean = 17 mg / day)
    • 15-19 points, you aborb between 21 and 28 mg of nicotine per day (mean = 24 mg / day)
    • 20-25 points, you aborb over 30 mg of nicotine per day.

    After you stop smoking, you must continue to absorb the same amount of nicotine in order to avoid withdrawal symptoms and not start smoking again because you cannot tolerate these symptoms. Consume enough nicotine from e-cigarettes or from nicotine medications or nicotine pouches for at least 3 months after quitting smoking.

    Dosage for nicotine medications

    Nicotine replacement medications release approximately 70% of the nicotine they contain. For example, a patch containing 21 mg of nicotine releases approximately 15 mg of nicotine.

    Use this factor (x0.7) to calculate the optimal dose of your nicotine medication. For example, if you scored 12 points on our questionnaire, you need 17 mg of nicotine per day, and a 21 mg patch plus two 2 mg gums should provide you with the necessary dose.

    Dosage for nicotine pouches

    Use the same rule (x0.7) as for nicotine medications.

    Dosage for e-cigarettes

    For e-cigarettes, the amount of nicotine aborbed by the user depends on many factors, in addition to the nicotine concentration in the e-liquid:

    • the other characteristics of the e-liquid (flavor, nicotine salt or freebase nicotine),
    • the characteristics of the device (battery, coil, wick)
    • your own level of nicotine addiction, your personal way on inhaling (number and depth of puffs), your social environment (whereas you are around smokers and vapers).

    Nevertheless, our previous studies conducted among former smokers who successfully quit smoking using e-cigarettes, and who responded to the above questionnaire offer some insights.

    Vapers who obtained :

    • 0-4 points used e-liquids containing 10 mg / mL
    • 5-9 points used e-liquids containing 10-12 mg / mL
    • 10-14 points used e-liquids containing 12 mg / mL
    • 15-19 points used e-liquids containing 16 mg / mL
    • 20-25 points used e-liquids containing 18 mg / mL

    Use these results as a guide to choose your e-liquid, and do not underdose your e-liquids, because if you do, you risk unnecessarily:

    • using too much liquid
    • exposing your lungs to too much vapour
    • spending too much money on e-liquids
    • experiencing nicotine withdrawal symptoms and running the risk of relapsing into smoking.

    Remember: the right dose of nicotine is the one that eliminates nicotine withdrawal symptoms.
    Your brain acts like a thermostat, regulating the amount of nicotine you need. If you use e-liquids that do not contain enough nicotine, you will need more liquid to feel satisfied.

    There is no risk of nicotine overdose in regular smokers, as they can tell when they are consuming too much nicotine (specific taste in the mouth, sensation similar to that felt when you have smoked too much).

    4 important points to remember

    • To successfully quit smoking and avoid nicotine withdrawal symptoms, you need a sufficient amount of nicotine. Do not underdose your nicotine products.
    • You need a sufficient concentration of nicotine in your e-liquids (at least 10 mg/mL). Do not listen to retailers who insist that you buy 3 mg/mL liquids, they do this because they want to sell you more liquid.
    • Purchase your electronic cigarettes and e-liquids from a specialist shop rather than a kiosk or online, as the sales staff in these shops can advise you and allow you to try and taste different products until you find the one that best suits your needs.
    • The advice provided here does not replace that of a doctor or psychologist specialising in the treatment of nicotine addiction.

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  • 10 rules to stop smoking

    Here are the 10 golden rules for quitting smoking:

    1. Make a firm commitment in writing, set a date to stop smoking in the next few days, and stick to it.
    2. Once you quit, do not touch a cigarette, not even one puff.
    3. Throw away all your tobacco, ashtrays, and lighters.
    4. Ask your family, friends, a doctor or a specialist clinic for help and support, or call a helpline.
    5. Follow a treatment programme: nicotine replacement therapy, bupropion, varenicline or cytisine, and use these medicines in conjunction with medical supervision.
    6. Or switch to another source of nicotine (e-cigarettes, nicotine pouches) or a tobacco product that is not burned (snus, heated tobacco).
    7. Avoid smokers and places where you used to smoke.
    8. If you have a strong urge to smoke, wait a few minutes—it will pass after 5 minutes—and take nicotine to relieve the urge (e.g., a patch or e-cigarette).
    9. Ask people to avoid smoking in your presence.
    10. Persevere, try again if you fail. You may need several attempts to succeed, but you will eventually get there.