Researchers at Queen Mary University of London followed 50 smokers in a tobacco dependence clinic in Argentina, as they tried to quit smoking. This is the first study to tailor nicotine dosing according to smokers’ choices as they try to quit, and the results suggest that most smokers using stop-smoking medications can tolerate doses that are up to four times higher than the ones recommended.
“Our findings should provide reassurance to smokers that it is okay to use whatever nicotine doses they find helpful.”
Study author Dunja Przulj said that when they are smoking, smokers are able to control the amount of nicotine they obtain, and that having levels restricted when they are trying to quit is counterproductive. “Smokers determine their nicotine intake while they smoke, but when they try to quit, their nicotine levels are dictated by the recommended dosing of the treatment. These levels may be far too low for some people, increasing the likelihood that they go back to smoking.”
“Medicinal nicotine products may be under-dosing smokers and could explain why we’ve seen limited success in treatments, such as patches and gum, helping smokers to quit. A change in their application is now needed. Our findings should provide reassurance to smokers that it is okay to use whatever nicotine doses they find helpful,” added Przulj.
The participants of this study, started on one daily 21mg nicotine patch four weeks prior to their quit date. The dose was increased weekly by another 21mg patch unless participants reported adverse effects or did not wish to increase the dose, and finally up to a maximum of four patches, totaling 84mg/day.
After the quit date, the dose was reduced by 21mg/day each week from one week after their quit date, until it reverted back to the standard dose (21mg/day) four weeks later. The participants were also advised to continue smoking as they pleased throughout the pre-quit period, and were offered additional oral nicotine replacement therapies.
The majority of participants managed to abstain from smoking, with no withdrawal symptoms
Through their observations the researchers observed the following trends:
Of the 50 participants, 90 per cent progressed to at least three patches, while 72% progressed to four patches.
82% of participants achieved four weeks validated abstinence from smoking, and experienced no significant increase in withdrawal symptoms, including urges to smoke.
Cigarette consumption, smoke intake and enjoyment of smoking declined significantly during the pre-quit period, and the intervention was rated as helpful and easy to adhere to.
During the pre-quit period, the number of cigarettes smoked per day reduced significantly from 20/day at the start to 6/day by the quit date.
The number of adverse effects increased as patch dose increased. The most common of these were nausea, followed by vomiting, but were mainly mild and well tolerated.
Two participants rated their adverse effects as ‘severe’, both at the 63mg dose. One reported headaches, nausea and feeling faint; the other experienced nausea and blurry vision. Both reduced their dose back to 42mg/day.
Only 6% of participants dropped out of treatment and none dropped out because of patch side effects.
These results highlight another reason why smokers prefer e-cigs over other cessation tools
Renowned stop-smoking researcher Professor Peter Hajek also from Queen Mary University of London, pointed out that these results indicate why e-cigarettes may be preferred by smokers. “Smokers are perfectly capable of determining which doses of nicotine they find helpful. There is no risk of dangerous overdose, because nicotine includes an effective safety valve in the form of nausea.”
“Our results also suggests that one of the reasons e-cigarettes are so much more popular and potentially more effective than other nicotine replacement treatments is that smokers can adjust their nicotine intake according to their needs,” he added.