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Its use is only contraindicated in smokers with ischaemic heart disease of less than 4 weeks duration and in subjects with severe cardiac arrhythmias.41 A recent meta-analysis found that using standard dose nicotine patches for the 15 days prior to D-day was accompanied by an increase in their efficacy compared to when they were used with the usual regimen (OR: 2.17 [95% CI: 1.463.22).43 Nevertheless, this is a consistent recommendation with low quality evidence

Furthermore, nicotine interferes with REM sleep, the most restorative phase of sleep, causing users to wake up feeling less refreshed and more fatigued

But these controls, Freeman says, will make enforcement far easier for authorities because, unlike cigarettes, only pharmacists will be able to legally sell vapes once the legislation passes

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