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At the beginning of the quit day , start to use nicotinell chewing gum before any cigarettes have been smoked.

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Stopping smoking is the single most effective intervention for improving the health of both the pregnant smoker and her babyand the earlier abstinence is achieved the betterHoweverif the mother cannotor is considered unlikely toquit without pharmacological supportNRT may be used as the risk to the fetus is lower than that expected with smoking tobaccoStopping completely is by far the best option but Nicotinell patches may be used in pregnancy as a safer alternative to smokingBecause of the potential for nicotine-free periodsintermittent dose forms are preferablebut patches may be necessary if there is significant nausea and/or vomitingIf patches are used they shouldif possiblebe removed at night when the fetus would not normally be exposed to nicotine.

When using Nicotinell Step 1 patchchew one piece of Nicotinell chewing gum 2 mg if you get a cravingUse at least 4 pieces of gum and not more than 12 pieces in a dayContinue for 12 weeks.

In principlethe Nicotinell TTS can cause adverse reactions similar to those associated with nicotine administered by other meansincluding smokingand these are mainly dose dependentSince the maximum plasma concentrations of nicotine that are produced by the patch are lower than those produced by smoking and fluctuate lessnicotine-related adverse reactions occurring during treatment with the patch can be expected to be less marked than during smoking.

Clinical trial experience has shown that skin reactions at the application sites are the most frequent adverse reactionsThis led to the premature discontinuation of Nicotinell transdermal patch in approximately 6of clinical trial participantsThese reactions include application site burningoedemaerythemairritationpruritusrashurticaria and vesiclesThe majority of these reactions were mildMost of the skin reactions resolved within 48 hoursbut in more severe cases the erythema and infiltration lasted from 1 to 3 weeksThe time of onset of significant skin reactions was between 3 and 8 weeks from the start of therapyIn isolated cases the skin reactions extended beyond the application sitesIsolated cases of urticariaangioneurotic oedema and dyspnoea were reported.

Transferred dependence is rare and is both less harmful and easier to break than smoking dependence.

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