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New developments in NRT
Karl Fagerström

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NRT was developed in the early 70s. The first product was the gum in strengths of 2 and 4 mg, approved first in CH 1978 and in UK 1979. The skin patches were introduced in the early 90s. Thereafter, with the exception of the nasal spray, a number of me-to-products, in terms of efficacy and pharmacokinetic profile, have been introduced (sublingual tablet, inhalator and lozenges).
More recently some new products (gum, lollipop and mouth spray) with a faster delivery of nicotine that somewhat better mimics what the smoker is used to from the cigarettes have been developed. Very recently a nicotine pill for swallowing has also been tested pharmacokinetically.

However also new ways of using NR are emerging. Introducing NR 1 to 3 weeks before actual quitting seem to boost success rates and combining several NR products is also likely to increase success rates, particularly for more dependent smokers. For smokers failing a quit attempt or for those unable or unwilling to make a quit attempt using NR as an aid to reduce smoking may increase motivation and self efficacy and finally produce cessation.


Karl Fagerström studied at the University of Uppsala and graduated as a licensed clinical psychologist 1975. At that time he started to run a smoking cessation clinic. In 1981 he got his Ph.D. on a dissertation about nicotine dependence and smoking cessation.
In the end of the seventies and early eighties he served as the editor-in-chief for the Scandinavian Journal for Behaviour Therapy.
From 1983 through 1997 he worked for Pharmacia and Upjohn as Director of Scientific Information for Nicotine Replacement Products. He has worked with the nicotine gum Nicorette since 1975 and has been contributing to NRT developments such as patch, spray and inhaler. Ever since 1975 he has been working clinically part-time.

Currently he works with his own private consultancy (Fagerström Consulting and the Smokers Information Center). He is a founding member of the Society for Research on Nicotine and Tobacco.
He started the European affiliate in 1999 of which he has been the president up to 2003. In 2003 he also became president elect of the mother SRNT. His main research contributions have been in the fields of Behaviour Medicine, Tobacco and Nicotine with over 100 peer reviewed publications of which he is the first author of 75. The current main interest is on reducing harm and exposure to tobacco toxins among all those who can not give up smoking. He has given the name to a nicotine dependence scale (The Fagerström Test For Nicotine Dependence) and was awarded the WHO medal 1999 for outstanding work in tobacco control.

Karl Fagerström
The Smokers' Information Centre, Helsingborg, Sweden