Optimising nicotine replacement therapy in clinical practice.

BACKGROUND: In spite of an established safety and efficacy record, nicotine replacement therapy (NRT) is frequently used incorrectly, suboptimally, or not at all.
OBJECTIVE: This article reviews practical evidence based strategies to optimise the use of NRT in clinical practice. The increasing role of combination therapies is explored and strategies to prevent relapse using NRT are examined. DISCUSSION: Misguided concerns about safety and efficacy undermine the use of NRT and should be addressed proactively with accurate information. It is also vital to give detailed instructions for the correct use of NRT products and to use an adequate dose to relieve symptoms. Quit rates can be increased further, by starting the nicotine patch 2 weeks before quitting, combining a patch with an oral form of NRT (such as gum or lozenges) and continuing to wear the patch after a lapse. Oral forms of NRT relieve cue induced cravings and this may help prevent relapse.