Only in the necessary cases it is necessary to raise a support with substitute therapies of the nicotine, with will without much ado there is 8 % of successes to the first one, it raises 10 % and up to 18 % in the fifth frustrated attempt. If nicotine patches collaborate or nicotine chewing gums these successes can improve 22 %.
Indications:
Just it will be necessary in patients with high physical dependency.
There must begin the same day in which one stops smoking, on having got up, or in the previous hours.
It will be supported every day, reducing periodically the dose, without overcoming 3 months of treatment.
Several forms of administration exist, being the most secondhand: the cutaneous patch and the chewing gum or chewing gum. The first one offers the safety of a constant liberation of the nicotine, and avoids the unesthetic aspect of chewing chewing gum. The chewing gum is alike more the fluctuations of concentration of nicotine in blood that causes the cigaret, although it is necessary to bear in mind his contraindications and his special use conditions.
Sometimes it is useful to combine both methods in those smokers who in spite of using the patch, throughout the day experience episodes of intense desire to smoke, being able to associate then the chewing gum.
The nicotine transdérmica presents to itself in patches of 16 ó 24 hours of continued liberation of the substance, and in three sizes different from 10, 20 and 30 square cm of surface, with a liberation of 5 ó 7, 10 ó 14 and 15 ó 21 mgr. of nicotine respectively, as it is a question of the patch of 16 ó 24 hours.
Sufficient scientific evidence does not exist to choose for a type of patch or for other. In any case it seems logical to recommend the patch of 24 hours in those smokers who already experience intense desire to smoke to
to wake up. The patch must not be used in areas with hair because it diminishes the absorption, not in areas recently shaved by the risk of increasing it.
The treatment with patches usually begins with those of higher doses, always bearing in mind the consumption previous to tobacco, to be diminishing the doses progressively, approximately every 3 ó 4 weeks, or even earlier, according to the evolution.
Other routes of administration or substitute methods of nicotine like the aerosols, the nasal sprays, etc., are still in experimentation phase.
It is an antidepressant that produces an inhibition of the absorption neuronal of norepinefrina, serotonina and dopamina, increasing his concentration in the sinapsisneuronal. This mediators' deplección seems to be the cause of the withdrawal symptoms of the nicotine. With which his activity would be to replace this absence and making to disappear, or diminish, the symptoms of the absence of nicotine.
In well controlled different studies, the percentage of patients who stopped smoking was 44 % at the age of six weeks of treatment and 23 % a year.
Associating substitute nicotine treatments simultaneously of the bupropion does not seem to improve the percentage of successes.
As side effects appear the mouth dryness in 12 % of the cases, and the insomnia in 34 % of the cases. It is used to dose of 300 mg for day.
SUBSTITUTE THERAPIES 
SUBSTITUTE THERAPIES OF NICOTINE
