Two is better than one. A rule that is true in many cases and remains true when it comes to quitting smoking. No small feat, which is rarely successfully accomplished without serious determination and the support of nicotine replacement preparations, which help reduce the withdrawal symptoms typical of the first few weeks.
The substitutes for the nicotine on the market are now many, allowing each person to choose the one that is most comfortable and best tolerated among slow-release transdermal patches, lozenges to dissolve in the mouth, chewing gum, nasal or oral sprays, some freely available from pharmacies without a prescription, others to be arranged with the doctor as part of a more structured cessation plan.
Generally, especially when using them spontaneously, only one type of nicotine replacement is used at a time, in view of the fact that the amount of active ingredient released is believed to be sufficient to lessen the desire to smoke, without inducing significant side effects.
According to the results of a review by the Cochrane Group, however, using two nicotine replacement preparations at the same time instead of just one would increase the likelihood of sustained, if not permanent, success in quitting smoking. The reviewers arrived at their conclusion by analyzing the results obtained in the 63 most robust studies that tested the effects of different nicotine substitutes and their combinations, on a total of more than 41,500 smokers with an average consumption of at least 15 cigarettes per day and eager to quit.
In particular, the most effective approach to abandoning the smoke appears to be one based on a combination of a slow-release patch to be applied to the skin and a second, fast-acting substitute, such as lozenges, chewing gum, or nasal spray, to be taken as needed, adhering to the timing and dosages indicated on the packages or recommended by the physician.
Lozenges and chewing gum with higher nicotine dosage (4 mg) were more effective than those with lower dosage (2 mg), while for patches it is unclear whether higher (21-25 mg) or lower (14-15 mg) nicotine dosage results in significantly different outcomes. Conversely, it would seem to be advantageous to start applying the transdermal patch and/or taking fast-acting substitutes not on the day set for quitting cigarettes, but the day before (this evidence, however, requires further verification).
“Nicotine substitutes are safe, effective and well-tolerated preparations,” said Nicola Lindson of the University of Oxford (UK), lead author of the review, “but to derive maximum benefits in smoking cessation, they must be used properly so as to maximize their potential, which is often not the case. The combined use of a slow-release patch and a fast-acting nicotine substitute offers greater chanches to quit smoking: many people fear that using two nicotine substitutes at the same time may pose risks, but clinical evidence informs that this is not the case.”
To be even safer, if you decide to quit smoking, the advice is to contact a specialized Smoking Cessation Center or your medical professional and identify a personalized plan, taking into account your age, gender and any medical conditions you have. In addition to nicotine substitutes, psychological support can further increase the likelihood of success.
Source
Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019; Issue 4; Art. No. CD013308 (https://www.cochrane.org/news/featured-review-different-doses-durations-and-modes-delivery-nicotine-replacement-therapy)
