NRT
Advantages
Disadvantages
Side Effects
Precautions
Nicotine Lozenges
Use it regularly; do not eat/drink for 15 minutes before using or when the mouth; can cause dyspepsia.
Nausea; hiccups; insomnia; headache; cough.
MI within 2 weeks of starting; arrhythmia, angina; pregnant or breastfeeding; age < 18 years.
Can be used regularly with withdrawal symptoms or urges; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth; over the counter (OTC). Can be used regularly with withdrawal symptoms or urges; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth; OTC. Can be used regularly with withdrawal symptoms or urges with patches; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth. Can be used regularly; delivers nicotine most rapidly of all NRTs.
Nicotine Gum
Mouth/jaw soreness; stomach; hiccups; nausea/vomiting.
MI within 2 weeks of starting; arrhythmia, angina; pregnant or breastfeeding; age < 18 years; temporomandibular joint (TMJ) disease. MI within 2 weeks of starting; asthma and chronic lung disease; arrhythmia, angina; pregnant or breastfeeding; age < 18 years; TMJ disease. MI within 2 weeks of starting; sinus issues; asthma; arrhythmia, angina; pregnant or breastfeeding; age < 18 years; TMJ disease. History of seizures; do not taking bulimia/ anorexia; taking MAO inhibitor; liver disease, pregnant or breastfeeding; < age 18 years.
Use it regularly; do not eat/drink for 15 minutes before using or when the mouth; can cause dyspepsia; may be hard to use with dentures/ dental work. Use it regularly; do not eat/drink for 15 minutes before using or when the mouth.
Nicotine Oral Inhaler
Mouth and throat irritation; runny nose; cough, headache, hiccups.
Nicotine Nasal Spray
More addictive than other forms of NRT; some do not prefer nasal spray; requires prescription.
Nasal irritation; tearing; runny nose, sneezing or cough headache.
Bupropion SR
Nausea, dizziness; insomnia; constipation, dry mouth, rash, seizures, changes in mood or behavior; anxiety.
Simple to use; may help with depression; combined with patches.
More possible side effects than other medicines; cannot be used if history of bulimia/anorexia; or recently took monoamine oxidase (MAO) inhibitor; requires a prescription.
E-cigarettes/vaping Vaping was introduced to the U.S. market in 2007, containing both nicotine and tetrahydrocannabinol (TCH), which are poorly regulated (Werner et al, 2020). Unfortunately, there is not enough data to determine short- term or long-term effects or the type of components to blame (Broderick, 2023). Vaping is a delivery system similar to a nebulizer; however, the vaping system coats the lungs in harmful chemicals masked in a variety of flavorings and aromatic additives. Vitamin E is often used as part of the delivery system and thickening agent in the e-liquid, which is thought to be an irritant to the lungs. Other common substances found in the e-liquid include (1) diacetyl, which is a food additive (buttery taste in microwave popcorn) known to damage small passages in the lungs; (2) formaldehyde, which contributes to lung and heart disease; and (3) acrolein, which is used as a weed killer and can also damage lungs (Broderick, 2023). Several lung diseases are associated with vaping. Bronchiolitis obliterans (popcorn lung) is a rare condition resulting from damage of the small airways from diacetyl. Inhaling this additive causes coughing, wheezing, chest pain, and shortness of breath. Symptomatic treatment is
available; however, there is no lasting treatment (Broderick, 2023). Vaping-related lipoid pneumonia develops when fatty acids enter the lungs from the oily substances found in the e- liquid. This induces inflammatory responses in the lungs, demonstrated by chronic cough, shortness of breath, and blood- tinged mucus. The most important treatment is eliminating vaping while the lungs heal themselves (Broderick, 2003). Primary spontaneous pneumothorax . Those who develop a collapsed lung due to vaping often develop air blisters on the top of the lungs that rupture and create tiny tears (Broderick, 2003). Rapid growth found in adolescence are prone to blisters that create a weak point. The blisters do not produce symptoms but smoking and vaping increase the risk for pneumothorax (Broderick, 2003). Signs of a pneumothorax include sharp chest or shoulder pain and dyspnea. Immediate treatment includes oxygen and chest radiograph (CXR) confirmation with supportive treatment. E-cigarette/vaping-associated lung injury (EVALI) is strongly associated with vitamin E, which is found in lung fluid of individuals with EVALI but not in those without EVALI (CDC, 2021). EVALI is a diagnosis of exclusion, but rapid
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