Prescribing combination nicotine replacement therapy (NRT) rather than a single NRT can improve your patients’ chances of quitting
- NRT has been shown to be an effective pharmacotherapy2
- It provides a temporary substitute for the nicotine that smokers receive from cigarettes and delivers nicotine without the other harmful toxins that are found in tobacco2,3
- The use of NRT aims to assist smokers who want to quit by helping to relieve the urge to smoke along with nicotine withdrawal symptoms, such as irritability, low mood and restlessness2,4
- Absorption of nicotine from NRT is either mucosal (oral and nasal formats) or transdermal (patch)5
- While transferred nicotine dependence from cigarettes to NRT is rare, it is both less harmful and easier to break than smoking dependence3,6
In a Cochrane review, NRT was found to increase quit rates by 55% compared with the use of placebo or no NRT.2
RR: 1.55, 95% CI: 1.49–1.61; illustrative comparative risks: quit rates with control 105 per 1000, quit rates with NRT 162 per 1000.2
What is the benefit of combination NRT?
- Combination NRT has been shown to be more effective than the use of a single NRT product1
- Combination NRT is the use of a nicotine patch, which provides a steady supply of nicotine, along with a fast-acting flexible format to help with immediate cravings1,3
Data from a Cochrane review showed that compared with the use of a single NRT product, combination NRT can increase long-term quit rates by 25%.1
RR: 1.25, 95% CI: 1.15–1.36; anticipated absolute effects: quit rates with monotherapy 139 per 1000, quit rates with combination NRT 174 per 1000.1
- The safety profile of combination NRT is comparable to monotherapy7,8 and even with combination NRT, the levels of nicotine received are unlikely to be higher than those received from smoking9
- The efficacy of combination NRT for smokers who want to quit is recognised by NICE and the National Centre for Smoking Cessation and Training (NCSCT):3,9,10
“Advise them that using more than one product is more likely to be successful, particularly for more dependent smokers” – NICE3
“There is good evidence to show that combination NRT is more effective than single product use.” – NCSCT9
CI, confidence interval; NCSCT, National Centre for Smoking Cessation and Training; NICE, National Institute for Health and Care Excellence; NRT, nicotine replacement therapy; RR, risk ratio
- Lindson N et al. Cochrane Database Syst Rev 2019;4:CD013308.
- Hartmann-Boyce J et al. Cochrane Database Syst Rev 2018;5:CD000146.
- NICE public health guideline PH45. Smoking: harm reduction. June 2013.
- West R and Shiffman S. Psychopharmacology 2001;155:115–122.
- Wadgave U and Nagesh L. Int J Health Sci (Qassim) 2016;10(3):425–435.
- Nicorette Invisi 25 mg Patch Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc. Accessed: January 2021.
- Cahill K et al. Cochrane Database Syst Rev 2013;5:CD009329.
- Kornitzer M et al. Prev Med 1995;24:41–47.
- National Centre for Smoking Cessation and Training (NCSCT). Briefing: 3. Combination nicotine replacement therapy 2012. Available at: https://www.ncsct.co.uk/usr/pub/Briefing%203.pdf. Accessed: January 2021.
- NICE guideline NG92. Stop smoking interventions and services. March 2018.