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Two is better than one when quitting

Smokers have a better chance of quitting if they use nicotine gum or another short-acting nicotine replacement therapy (NRT) together with a patch, rather than just one or the other.

‘Pre-quitting’ – starting NRT a week or two before actively trying to stop smoking, also probably helps, though more evidence is needed.

These are the key conclusions from a new Cochrane review – a systematic review of the best evidence available by a panel of international experts, including Professor Chris Bullen from the University of Auckland.

The Cochrane review covered 63 clinical trials with a total of 41,509 participants, who typically smoked at least 15 cigarettes a day at the start of the study. The review authors found that just over 17 percent of people who combined a patch with another type of NRT were able to quit for six months or longer, compared with about 14 percent of people who used a single type.

NRT is available as long-acting skin patches, and short-acting chewing gum, nasal and oral sprays, inhalers, lozenges and tablets that deliver nicotine through the body to the brain. The aim is to replace nicotine that smokers get from cigarettes, lessening the urge to smoke.

“The review shows a clear advantage of using a combination of a long-acting and short-acting NRT compared with single therapy alone,” says Professor Bullen, in the School of Population Health at the Faculty of Medical and Health Sciences, and director of the National Institute for Health Innovation.

“Importantly, the Cochrane review found no evidence that using two NRT products together increases the risk of harms, which are rare and minor – such as skin irritation from patches, or mouth ulcers from lozenges.”

He says the guidelines in Aotearoa New Zealand line up with these latest findings. “But one potential barrier to smokers wanting to use combined NRT is that you have to pay a separate pharmacy dispensing fee for each type – that’s something worth reviewing on the basis of this evidence. However, if people go to their local ‘stop smoking’ provider, they can get NRT products for free.”


• Cochrane Library: Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation (Review)


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