Help and advice to stop smoking

Tag: nicotine dose

  • 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.

    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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