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Nicorette-SEP2022-A
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    A combination of NRT is 25% more effective than
    using a patch alone¹
    		 
    NICORETTE® InvisiPatch
    A patch to provide continuous
    nicotine throughout the day
    NICORETTE®
    QuickMist
    MouthSpray
    		 
    		 
    NICORETTE®
    Cools Lozenge
    		 
    		 
    NICORETTE®
    Gum
    NICORETTE®
    Inhalator
    		 
    		 
    NICORETTE®
    Microtab
    		 
    		 
    NICORETTE®
    Nasal Spray
    One flexible format to relieve cravings whenever they strike
    Why Combination NRT?
    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 dependence6
    How combination NRT
    tackles 2 types of cravings?
    1. Background craving
    Due to reduced nicotine soon after quitting
    A patch to provide continuous nicotine throughout the day.
    		 
    2. Cue-Induced Craving
    Triggers such as stress or the smell of smoke, coffee or alcohol.
    A flexible format to relieve cravings whenever they strike.
    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 breakthrough cravings1,2

    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
    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
    Combination NRT is recognised by NICE & NCSCT
    Combination NRT is recommended by NICE and the National Centre for Smoking Cessation and Training (NCSCT) for smokers who want to quit.3,9
    Example scenarios
    Case 1: Tony
    Tony wants some advice. He has been smoking for 10 years, and tried to give up once before, about three years ago. He managed to stop for a couple of months using nicotine patches but started again when he started socialising with work more often. He found dealing with the cravings really difficult. His wife is expecting and he wants to stop for good. He smokes around 15-20 a days, and has cravings for an early morning cigarette.
    Recommendations:
    A combination of long-acting and short-acting NRT could be an appropriate option as Tony struggles with dealing with cravings (including early morning ones). A 25mg patch is suitable for those who smoke over 10 cigarettes a day while the QuickMist spray will help with breakthrough nicotine cravings.
    Case 2: Raminder
    Raminder is determined to give up smoking, but finds it really difficult to break the habit. She smokes socially when out with friends, and no more than 6 to 8 a day. She enjoys the social aspect and is worried about putting on weight if she stops. What product and advice from the below is most appropriate?
    Recommendations:
    Nicorette Inhalator is held like a cigarette and suitable for light and heavy smokers. Using NRT may also help control weight gain10, but also consider recommending an appropriate diet and increasing exercise if she is concerned about weight gain.
    Click here for Nicorette® (Nicotine) Product Information.
    NCSCT, National Centre for Smoking Cessation and Training; NICE, National Institute for Health and Care Excellence; NRT, nicotine replacement therapy.

    References
    1.   Lindson N et al. Cochrane Database Syst Rev 2019;4:CD013308.
    2.   Hartmann-Boyce J et al. Cochrane Database Syst Rev 2018;5:CD000146.
    3.   NICE Guidelines. Tobacco: preventing uptake, promoting quitting and treating dependence (2021). Available at: https://www.nice.org.uk/­guidance/ng209/chapter/­Recommendations-on-treating-­tobacco-dependence#stop-­smokinginterventions [Accessed September 2022].
    4.   West R and Shiffman S. Psychopharmacology 2001;155:115–122.
    5.   Wadgave U and Nagesh L. Int J Health Sci (Qassim) 2016;10(3):425–435.
    6.   Nicorette Invisi 25 mg Patch Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc. Accessed: January 2021.
    7.   Cahill K et al. Cochrane Database Syst Rev 2013;5:CD009329.
    8.   Kornitzer M et al. Prev Med 1995;24:41–47.
    9.   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.
    10.   Nicorette Inhalator Summary of Product Characteristics.
    UK-NI-2200780