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Smoking cessation with nicotine replacement products: cardiac adverse effects, often benign

When drug treatment is deemed necessary to assist smoking cessation, nicotine replacement products are the first-line drugs. They expose patients to benign palpitations but not to severe cardiovascular harms.

Smoking greatly increases the risks of cardiovascular disease. To assist smoking cessation, nicotine replacement products are prescribed to reduce the symptoms and increase the numbers of those quitting.

The analysis of 21 trials involving over 11,600 patients made it possible to evaluate the adverse effects of nicotine replacement products versus placebo. The risk of cardiac disorders, palpitations and cardiac arrhythmia in particular, is around twice as high as with the placebo but these are acceptable benign effects, and smokers are aware of them. There appeared to be no significant difference in terms of severe cardiac adverse effects, even in patients with a high cardiac risk.

Varenicline or bupropione are sometimes suggested to assist smoking cessation. Both drugs expose patients to disproportionate and severe adverse effects, especially severe neuropsychological and allergic disorders. They have not been as thoroughly evaluated as nicotine in cardiac patients.

When a smoking cessation drug is required, nicotine replacement products are the best choice since their adverse effects are benign and acceptable.  Given nicotine's cardiac effects, caution is advised when it comes to nicotine replacement products: it is better to adjust the dosage to the minimum effective dose and aim in the long term to halt nicotine replacement altogether after smoking cessation.

©Prescrire 1 December 2015

"Cardiac adverse effects of nicotine replacement therapy" Prescrire Int 2015; 24 (166): 292-293. (Pdf, subscribers only).

Download the full review.
Pdf, subscribers only

See also:

E-cigarettes: similar
efficacy to other nicotine
delivery devices, but
many uncertainties
(November 2015)

Smoking cessation
during pregnancy
(June 2015)

Smoking cessation:
varenicline has too many
adverse effects to be used
or... reused
(September 2014)