, Volume 111, Issue 3, pp 271–277

Effectiveness of nicotine patch and nicotine gum as individual versus combined treatments for tobacco withdrawal symptoms

  • K. O. Fagerström
  • N. G. Schneider
  • E. Lunell
Original Investigations


Nicotine gum and transdermal nicotine have been shown to relieve withdrawal and double success rates over placebo in trials of smoking cessation. This study tested whether combining the two methods would relieve withdrawal more effectively compared to either treatment alone. Twenty-eight smokers served as their own controls in each of four conditions: active gum + active patch (double active), active gum + placebo patch (gum only active), placebo gum + active patch (patch active) and placebo gum+placebo patch (double placebo). This “double placebo” design controls sensory, psychological and ritual variables associated with each drug form. Withdrawal symptoms were rated four times daily for 3 days in each condition. Total baseline (smoking) withdrawal scores using visual analogue scales (VAS) averaged 101.1. During cessation, total withdrawal increased to 187.0 for the double placebo condition, 142.2 for the active gum/placebo patch treatment and 128.3 for the active patch/placebo gum treatment. The double active condition equalled smoking with score 99.2. All pairwise comparisons were significant (P<0.001) except between the two single active conditions and between smoking versus the double active condition. Significant time-of-day effects by treatment on withdrawal were observed for the double placebo condition (P<0.05) with less withdrawal in the morning. The findings suggest: 1) combining nicotine gum with transdermal nicotine may be superior to either treatment alone, 2) more symptoms may be nicotine specific (relieved by replacement) than previously thought.

Key words

Nicotine withdrawal Smoking cessation Nicotine gum Nicotine path Nicotine dependence 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Benowitz NL, Jacob III P, Savanapridi C (1987) Determinants of nicotine intake while chewing nicotine polacrilex gum. Clin Pharmacol Ther 41 [4]:467–473PubMedGoogle Scholar
  2. Covey LS, Glassman AM, Stetner F (1990) Depression and depressive symptoms in smoking cessation. Comp Psychiatry 31:350–354CrossRefGoogle Scholar
  3. Cummings S, Hansen B, Richard RJ, Stein MJ, Coates TJ (1988) Internists and nicotine gum. JAMA 260:1565–1569CrossRefPubMedGoogle Scholar
  4. Fagerström KO (1988) Efficacy of nicotine chewing gum: a review. In: Pomerleau O, Pomerleau C (eds) Nicotine replacement in the treatment of smoking. Liss, New York, pp 109–128Google Scholar
  5. Fagerström KO, Schneider NG (1989) Measuring nicotine dependence in tobacco smoking: a review of the Fagerström Tolerance Questionnaire. J Behav Med 12:159–182CrossRefPubMedGoogle Scholar
  6. Fagerström KO, Lunnel E, Molander L (1991) Continuous and intermittent transdermal delivery of nicotine: blockade of withdrawal symptoms and side effects. J Smok Rel Disord 2:173–180Google Scholar
  7. Fagerström KO, Säwe U, Tönnesen P (1992) Therapeutic use of nicotine patches: efficacy and safety. J Smok Rel Disord 3:247–261Google Scholar
  8. Fiori MC, Jorenby DE, Baker TB, Kenford SL (1992) Tobacco dependence and the nicotine patch: clinical guidelines for effective use. JAMA 268:2687–2694CrossRefPubMedGoogle Scholar
  9. Gritz ER, Jarvik ME (1973) Preliminary study: forty-eight hours of abstinence from smoking. Proceedings, 81st Annual Convention, American Psychological Association, pp 1039–1040Google Scholar
  10. Hajek P, Jackson P, Belcher M (1988) Long-term use of nicotine chewing gum: occurrence, determinants and effect on weight gain. JAMA 260 [11]:1593–1596CrossRefPubMedGoogle Scholar
  11. Henningfield JE, Jasinski DR (1988) Pharmacologic basis for nicotine replacement in the treatment of smoking. In: Pomerleau O, Pomerleau C (eds) Nicotine replacement in the treatment of smoking. Liss, New York, pp 35–61Google Scholar
  12. Henningfield JE, London ED, Benowitz NL (1990) Arterial-venous differences in plasma concentrations of nicotine after cigarette smoking. JAMA 263 [15]:2049–2050CrossRefPubMedGoogle Scholar
  13. Hughes JR (1992) Tobacco withdrawal in self-quitters. J. Consult Clin. Psychol 60 [4]:689–697CrossRefPubMedGoogle Scholar
  14. Hughes JR, Hatsukami DK, Pickens RW, Krahn D, Malin S, Luknic A (1984) Effect of nicotine on the tobacco withdrawal syndrome. Psychopharmacology 83:82–87CrossRefPubMedGoogle Scholar
  15. Hughes JR, Higgins ST, Hatsukami D (1990) Effects of abstinence from tobacco. In: Kozlowski LT, Annis HM, Cappell HD, Glaser FB, Goodstadt MS, Israel Y, Kalant H, Sellers EM, Vingilis ER (eds) Research advances in alcohol and drug problems, vol 10. Plenum, New YorkGoogle Scholar
  16. Jarvik ME, Schneider NG (1992) Nicotine. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG (eds) Substance abuse: a comprehensive textbook, 2nd edn. Williams & Wilkins, New York, pp 334–356Google Scholar
  17. Rose JE, Herskovic JE, Trilling Y, Jarvik ME (1985) Transdermal nicotine reduces cigarette craving and nicotine preference. Clin Pharmacol Ther 38 [4]:450–456PubMedGoogle Scholar
  18. Russell MAH (1988) Nicotine replacement: the role of blood nicotine levels. Their rate of change and nicotine tolerance. In: Pomerleau O, Pomerleau C (eds) Nicotine replacement: a critical evaluation. Liss, New York, pp 63–94Google Scholar
  19. Russell MAH, Merriman R, Stapleton J, Taylor W (1983) Effect of nicotine chewing gum as an adjunct to general practitioners' advice against smoking. BMJ 287:1782–1785PubMedGoogle Scholar
  20. Sachs DPL (1991) Advances in smoking cessation treatment. Curr Pulmonol 12:139–198Google Scholar
  21. Sachs DPL, Leischow SJ (1991) Pharmacological approaches to smoking cessation. Clin Chest Med 12:769–791PubMedGoogle Scholar
  22. SAS Users Guide (1990). Vol. 2, General linear models Chapter 24, and SAS Procedures guide, Univariate procedures, Chapter 42. SAS Institute, Cary, North CarolinaGoogle Scholar
  23. Schneider NG (1987) Nicotine gum in smoking cessation: rationale, efficacy and proper use. Comp Ther 13:32–37Google Scholar
  24. Schneider NG (1992) Nicotine therapy in smoking cessation: pharmacokinetic considerations. Clin Pharmacokinet 23:169–172PubMedGoogle Scholar
  25. Schneider NG, Jarvik ME (1984) Time course of smoking withdrawal symptoms as a functions of nicotine replacement. Psychopharmacology 82:143–144CrossRefPubMedGoogle Scholar
  26. Spilker B (1984) Types of blinds. Guide to clinical studies and developing protocols. Raven Press, New York, p 15Google Scholar
  27. Tönnesen P, Fryd V, Hansen M, Helsted J, Gunnersen AB, Forchammer H, Stockner M (1988) Effect of nicotine chewing gum and group counselling in smoking cessation. N Engl J Med 318 [1]:15–18PubMedGoogle Scholar
  28. West R, Hajek P, Belcher M (1989) Time course of cigarette withdrawal symptoms while using nicotine gum. Psychopharmacology 99:143–145CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • K. O. Fagerström
    • 1
    • 2
  • N. G. Schneider
    • 3
  • E. Lunell
    • 2
  1. 1.Smoking Cessation Clinic. Medical SchoolUniversity of LundLundSweden
  2. 2.Kabi Pharmacia Research LaboratoriesHelsingborgSweden
  3. 3.VA Medical Center, Brentwood DivisionUCLA School of Medicine Los Angeles CALos AngelesUSA

Personalised recommendations