Nicotine replacement therapy

In clinical trials, patients who use NRT products are
1.77 times as likely to quit smoking than are those
who receive placebo [7]. The main mechanism of
action of NRT products is thought to be a stimula-
tion of nicotine receptors in the ventral tegmental
area of the brain, which results in dopamine release
in the nucleus accumbens. The use of NRT is to re-
duce the physical withdrawal symptoms and to al-
leviate the physiologic symptoms of withdrawal, so
the smoker can focus on the behavioral and psy-
chological aspects of quitting before fully abstaining
nicotine. Key advantages of NRT are that patients
are not exposed to the carcinogens and other toxic
compounds found in tobacco and tobacco smoke,
and NRT provides slower onset of action than nico-
tine delivered via cigarettes, thereby eliminating the
near-immediate reinforcing effects of nicotine ob-
tained through smoking (Figure 1.3). NRT products
are pregnant if these patients are under medical su-
pervision [112]. Patients with temporomandibular
joint disease should not use the nicotine gum, and
patients smoking fewer than 10 cigarettes daily
should initiate NRT with caution and generally at
reduced dosages [112]. The safety and efficacy of
NRT have not been established in adolescents, and
currently none of the NRT products are indicated
for use in this population [112,115].