Nicotine Replacement Therapy (NRT)

Nicotine is a stimulant alkaloid from the tobacco plant. It is used to alleviate nicotine withdrawal syndrome and as an aid to smoking cessation. Inhaled nasal, oral and transdermal administration.

Nicotine replacement therapy (gum, lozenges, skin patches, nasal spray, inhaler) may be a good option for the breastfeeding mother if she is unable to quit without pharmacological help  ^{(Le Lous 2020, Baraona 2017, ABM 2015, Rowe 2013, Sachs 2013, Einarson 2009, Myr 2004, Ilett 2003)}. Some authors disagree (Maritz 2011, Alm 2006).

Nicotine is excreted in breast milk in a moderate amount (RD: 5 - 10%) that could be significant. ^{(Ilett 2003)}

Plasma cotinine levels in infants born to mothers using nicotine patches for smoking cessation were 13% of maternal plasma levels. No developmental problems were observed in these infants. ^{(Ilett 2003)}

Patch: Nicotine serum levels in the mother (hence in the milk) may be similar to those of women who smoke if high concentration patches are used. Lowest effective concentration ones for treatment of tobacco dependency are recommended ^{(Ilett 2003)}. Patches should be taken off while sleeping. Short-acting products (chewing gum, lozenges) are more recommended during lactation. ^{(Sachs 2013, Molyneux 2004)}

Chewing gum and lozenges: Nicotine serum levels in the mother (hence in the milk) may be one-half than those in women who smoke but may arrive to be as high as in smokers. The fewer number of chewing gums effective for treatment of tobacco dependency is recommended, with a lapse of 2-3 hours before the next breast feed after taking a nicotine chewing gum.

Inhaler: Nicotine serum levels in the mother (hence in the milk) is usually one-eighth than those in women who smoke. The fewer number of inhalations that would be effective for treatment of tobacco dependency are recommended.

Offspring of women who smoke are at lower risk of harm to health when they are breastfed than formula fed. Breastfeeding minimizes risks originated by tobacco smoke exposure. Those risks are even lower with the use of Nicotine Replacement Therapy (patch, chewing gum, lozenges or inhaler)

See below the information of these related products:

• Electronic cigarette, E-Cigarette, Vape, Vaping (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
• Tobacco (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)