STOP SMOKING OR OPOID CONSUMPTION BY CARDIAC SAFE FAST ACTING NICOTINE REPLACEMENTS

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Smoking either in form of cigarettes,bidi,e-cigarette,Tambakoo ,Khainni,Zarda etc  are very dangerous for health as beside causing direct injury to lung and bronchial tree it causes heart diseases,peripheral arterial diseases,bbrain strokes and kidney diseases by causing hypertension etc.Fast acting nicotine replacement therapies (NRTs) include nicotine mouth spray, nicotine inhalers, nicotine nasal spray, nicotine nasal spray and nicotine sublingual tablet are being prescribed to get rid of such smoking or nicotine consumption and surprisingly it has been found by many studies enumerated below that these replacements are not harmful ffor lung or cardiac diseases . Here is a brief overview of each.Nicotine replacement is delivered by nicotine polacrilex gum, nicotine lozenges, nicotine nasal spray or transdermal nicotine.

Nicotine mouth spray: It delivers 1 mg nicotine per spray. Used as 1 to 2 sprays when craving occurs, up to 4 sprays per hour. Side effects occurring frequently with the oral spray include hiccups (occurring in more than 55% of those treated in one trial, throat irritation, and nausea (Eur Respir J. 2012;40:548).

Nicotine inhalers: They release nicotine vapor (not smoke). The ad lib use of the nicotine inhaler produces plasma nicotine levels that are roughly one-third of those that occur with cigarette smoking. Use 6 to 16 cartridges per day for the first 6 to 12 weeks and gradually reduce dose over the next 6 to 12 weeks. Commonly occurring side effects include localized irritation of the mouth or throat, particularly during the early stages of use. Because inhaled nicotine may cause bronchospasm, it may be less appropriate for smokers with a history of severe airway reactivity.

Nicotine nasal spray: It delivers an aqueous solution of nicotine to the nasal mucosa. The peak nicotine level occurs at 10 minutes. Dose is 1 or 2 sprays per hour for three months. The maximum dose is 10 sprays per hour, not to exceed 80 total sprays per day. Side effects include nasal and throat irritation, rhinitis, sneezing, and tearing. Nasal irritation is extremely common, occurring in 94% of patients during the first two days of use and continuing in 81% of patients after three weeks of therapy (Medical Economics, Montvale, NJ 1998).

Nicotine sublingual tablet: It is administered as 2 mg tablet sublingually (over 30 minutes) every one to two hours. Patients who are heavily nicotine-addicted can use 2 tablets sublingually (4 mg total) for each dose (Nicotine Tob Res. 2002;4:441). Side effects occurring commonly include sore mouth or throat and dryness or burning in the mouth.

The Lung Health Study cohort of 5887 middle-aged smokers with chronic obstructive pulmonary disease who were followed for five years compared smokers with those who quit with or without nicotine gum. There was no increase in hospital admission for cardiovascular events with nicotine gum treatment, regardless of the dose used. Participants who quit smoking successfully and used nicotine gum had a lower hospital admission rate for cardiovascular disease than subjects who did not quit smoking, regardless of whether or not they used the gum (fda.gov/Drugs/DrugSafety/ucm259161.htm).

The results of two other controlled trials of nicotine replacement and one population-based case-control study of patients with cardiovascular disease also provided no evidence for an increase in coronary events with replacement therapy (CMAJ. 2011;183:1359).
A randomized trial of 584 patients (almost all men) with at least one diagnosis of cardiovascular disease found no difference in the incidence of primary cardiovascular end points (death, myocardial infarction, cardiac arrest, and admission to the hospital for cardiovascular disease) at 14 weeks between the nicotine and placebo groups (5.4 vs 7.9 percent with placebo) (accessdata.fda.gov/drugsatfda_docs/label/2018/021928s045_046lbl.pdf). Overall, the evidence suggests that chemicals other than nicotine are responsible for the elevated risks of myocardial infarction and stroke in smokers. The risks of nicotine medication in patients with cardiovascular disease, if any, are much lower than those of smoking, and the benefits of nicotine medication far outweigh the risks of continued smoking in such patients.