Nicotine Replacement Therapies

Nicotine Replacement Therapies

When you smoke a cigarette, nicotine enters your body through your lungs and travels to your brain. Nicotine replacement therapy (NRT) works by substituting the source of nicotine to “replace” the nicotine you inhale when you smoke. For people who are quitting smoking, NRTs can help by delivering a safer alternative source of nicotine than cigarettes. They also can reduce or eliminate the symptoms of withdrawal, making it easier for some people to quit. NRTs have been extensively tested and used by millions of people, and considered safe and effective ways of quitting smoking.

To optimize your chances of success, medications should be a consideration in your quit day checklist.

Note: The content in this section is for informational purposes. Not all nicotine replacement therapies are right for everyone. Be sure to discuss the option of nicotine replacement therapy with your doctor or healthcare provider.

Types of NRTs

There are many different types of NRTs that are available either over-the-counter or from a prescription from your doctor. They vary in the dose of nicotine they supply and the way in which the nicotine is delivered into the body. As with any medication, talk to your doctor. Not all medications are safe for women who are pregnant and breastfeeding, or for people who may be taking other medications. Types of NRTs include:

  • Nicotine gum – Nicotine gum is an over-the-counter product that you can buy at your local pharmacy. A piece of nicotine gum is chewed briefly, allowed to rest in the mouth, then chewed again. This process enables nicotine to be absorbed into the body through the mouth lining. Nicotine gum is used for two to three months, up to a maximum of six months.
  • Nicotine lozenges – Nicotine lozenges come in the form of hard candy and release nicotine into the system as they dissolve in the mouth. Each lozenge lasts for about a half hour and can be used as needed for up to twelve weeks.
  • Nicotine patch – The nicotine patch is a medication applied to your skin each day. It delivers nicotine through the skin into your body. Some brands of the nicotine patch are available over-the-counter, while others require a prescription from your doctor. The nicotine patch is available in 16-hour and 24-hour doses, and is used for two to three months.
  • Nicotine nasal spray – Nicotine nasal spray is a prescription medication that you spray into your nostrils every couple of hours. Nicotine nasal spray is used for three months, up to a maximum of six months, and gradually tapered off.
  • Nicotine inhaler – The nicotine inhaler is a prescription medication that you hold to your mouth and inhale to combat cravings. The inhaler is used for three months, up to a maximum of six months. It is recommended that people use at least 6 cartridges per day in the first three to six weeks, then taper off as cravings become less severe or less frequent.
  • Bupropion hydrochloride (Zyban) – These prescription pills, which don’t contain any nicotine, are taken daily to combat cravings. The pills should be taken two weeks before quit day, then for seven to twelve weeks after. Doctors sometimes prescribe Bupropion pills along with use of the nicotine patch.
  • Varenicline (Chantix) – These prescription pills are taken twice each day. The medicine attaches to nicotine receptors in the brain, reducing the pleasurable effects of smoking and helping to reduce symptoms of withdrawal.

Using NRTs can double your chance of quitting smoking. Remember that medicine alone can't do all the work. Talk to your doctor about the option of NRT and consult other ways to help you be successful, such as quit smoking programs.

How NRTs Work

Unlike cigarettes, which contain thousands of harmful chemicals, nicotine medications contain small doses of nicotine alone to combat cravings and urges to smoke. The amount of nicotine is decreased gradually over that time until nicotine replacement is no longer needed. Because the dose of nicotine is much lower than what a person would receive by smoking a cigarette, becoming addicted to NRTs is rare. That’s why NRTs are considered an effective way to help someone who smokes quit for good.

Do I Need an NRT to Quit?

While you can go it alone, nicotine replacement therapy offers another option in helping some people to quit smoking. However, not everyone who decides to quit smoking will want or need to use them. The goal in using nicotine medication is to stop smoking completely. If you plan to take nicotine medications, you should begin using them on your quit day.

NRTs and Smokeless Tobacco

The Food and Drug Administration has not yet approved any nicotine replacement therapies specifically for quitting smokeless tobacco. However, using a NRT may help you quit, or at least deal with nicotine cravings. For smokeless tobacco users, some NRTs may help more than others. Nicotine gum and lozenges are oral substitutes that are the most like using smokeless tobacco, and so may be most effective from a behavioral standpoint. They also let you control your dosage to help reduce cravings. The nicotine inhaler may not be as useful for smokeless tobacco users, as it is designed to look and feel like a cigarette filter tip. The nicotine patch gives a steady dose of nicotine, but may not help with strong cravings.

Answer the following questions to help determine whether an NRT may be right for you:

  • Are you sure you want to quit smoking for good? Having one or two cigarettes while you use the gum, patch, nasal spray, inhaler, or lozenge is not dangerous, but your goal is to quit smoking for good. Use NRT only when you are ready to stop smoking.
  • Have you quit smoking before and relapsed since? NRTs may be a good option for you if you’ve tried to quit smoking before and have relapsed
  • Do you smoke 20 or more cigarettes each day? NRTs are usually recommended for people who smoke a pack a day or more.
  • Are you willing to be patient? Using NRT correctly can take some getting used to. Follow the instructions and give it some time.
  • Are you pregnant or breastfeeding? Not all NRTs are safe for pregnant or breastfeeding women. Talk to your doctor or other health care provider about your options.
  • Do you have allergies or asthma? Some NRTs are not recommended for people with these conditions. Ask your doctor, dentist, or pharmacist.

Which NRT is Right for You?

Nicotine replacement therapy offers an increased chance of success when it comes to achieving a smoke-free life. But not all NRTs are right for everyone. It’s important first to consider whether you need an NRT to quit, or if you can be successful with a method like cold turkey. If you decide that nicotine replacement therapy may play a role in your plan, use the table below to compare the benefits, drawbacks, and costs of each therapy. Then talk to your doctor about your plans for quitting and which NRT might be right for you.

When choosing a nicotine replacement therapy, think about which method best fits your lifestyle and pattern of smoking. The points below highlight the main differences between NRTs. Refer to the table that follows for a list of benefits and drawbacks of each therapy:

  • Nicotine gums, lozenges, and inhalers allow you to control your dosage of nicotine to help keep cravings under control.
  • Nicotine nasal spray works quickly to combat cravings when you need it.
  • Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler.
  • Nicotine patches are convenient and only have to be applied once a day.
  • Both inhalers and nasal sprays require a doctor’s prescription.
  • Some people may not be able to use patches, inhalers, or nasal sprays due to allergies or other conditions.
Note: The content in this section is for informational purposes. Not all nicotine replacement therapies are right for everyone. Be sure to discuss the option of nicotine replacement therapy with your doctor or healthcare provider.
Prescription or OTC* Potential Benefits Potential Drawbacks
Nicotine Gum
Approx. $120 for 2 weeks of use
  • Convenient
  • Delivers nicotine into the system more quickly than the patch
  • Can cause bad taste/ throat irritation
  • Cannot eat or drink while chewing
Nicotine Lozenge
Approx. $6 per day for average usage and $12 per day for maximum usage
  • Convenient
  • Lasts for 30 minutes or more
  • Can cause soreness of the teeth and gums, indigestion, and throat irritation
Nicotine Patch
Both available – Talk to your doctor.
Approx. $50 for 2 weeks of use
  • Easy to use
  • Few side effects
  • Delivers nicotine more slowly than other methods
  • Can cause skin irritation
  • Can cause racing heartbeat
Nicotine Nasal Spray
Prescription – Talk to your doctor.
  • Delivers nicotine quickly
  • Effective at reducing sudden cravings
  • Can cause nose and sinus irritation at first, but usually goes away
  • Not recommended for those with asthma and allergies
Nicotine Inhaler
Prescription – Talk to your doctor.
  • Few side effects
  • Delivers nicotine to the system as quickly as nicotine gum
  • Mimic the inhaling action of a cigarette
  • May cause coughing, mouth or throat irritation
  • Not recommended for people with asthma or chronic lung disease
Bupropion Hydrochloride
Prescription – Talk to your doctor.
  • Easy to use
  • Few side effects
  • Not recommended for people with seizures, eating disorders, who are pregnant or breastfeeding or taking an MAO (Monoamine oxidase) inhibitor, a class of anti-depressant drugs.
Varenicline (Chantix)
Prescription – Talk to your doctor.
  • Easy to use
  • Can more than double the chances of quitting smoking
  • May cause headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence (gas), and changes in taste

*OTC stands for over-the-counter. You can buy this medicine without a prescription at your local pharmacy.

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Smoking Fact

Cigarette smoking is currently at a lower rate than at any point since the start of World War II. However, an estimated 25 percent of men and 20 percent of women still smoke cigarettes.