Nicotine Replacement Therapy

Nicotine substitutes treat the difficult withdrawal symptoms and cravings that 70 to 90 percent of smokers say is their only reason for not giving up cigarettes. By using a nicotine substitute, a smoker’s withdrawal symptoms are reduced. Now available by prescription, nicotine replacement therapy (NRT) is clinically proven to be twice as effective as the cold-turkey method.

NRT eases withdrawal symptoms while the smoker gets used to not smoking and the dose is gradually reduced. NRT only deals with the physical aspects of addiction. It is not intended to be the only method used to help you quit smoking. It should be combined with other smoking cessation methods that address the psychological component of smoking, such as a smoking cessation program.

Studies have shown that an approach pairing NRT with a program that helps to change behavior can double your chances of successfully quitting. NRT is available in many forms, allowing you to choose which will suit you best.


Discreet and easy to use, patches work by releasing a steady dose of nicotine into the bloodstream via the skin. Patches should be applied to a hairless part of your body such as your upper arm but don’t use in the same place 2 days running. The 16-hour patch works well for light-to-average tobacco users.

It is less likely to cause side effects like skin irritation, racing heartbeat, sleep problems, and headache, but it does not deliver nicotine during the night, so it is not helpful for early morning withdrawal symptoms. The 24-hour patch provides a steady dose of nicotine, avoiding peaks and troughs. It helps with early morning withdrawal. However, there may be more side effects such as disrupted sleep patterns and skin irritation.


Nicotine gum is a fast-acting form of replacement that is absorbed through the mucous membrane of the mouth. It can be bought over the counter without a prescription and comes in 2 mg and 4 mg strengths. Nicotine gum allows you to control your nicotine dose. Learning to chew the gum properly is important.

The idea is to chew gently until you get the flavor and then “park” the gum in your cheek so that nicotine is absorbed through the lining of the mouth. Long-term dependence is one possible disadvantage of nicotine gum. In fact, research has shown that 15 percent to 20 percent of gum users who successfully quit smoking continue using the gum for a year or longer.

Nicotine Gum and The Patch Together

The use of nicotine gum and nicotine patches together has not been widely researched and has not yet been approved by the FDA. However, existing studies appear promising. Smokers in most of these studies use the nicotine patches routinely (over 24 hours) and the nicotine gum as a “rescue” of up to four pieces a day without significant side effects.

Nasal Spray

This is the strongest form of NRT and is a small bottle of nicotine solution, which is sprayed directly into the nose. Absorbed faster than any other kind of NRT, this can help heavier smokers, especially where other forms of NRT have failed.

The nasal spray delivers nicotine quickly to the bloodstream because it is absorbed through the mucous membranes in the nasal passages. It is available only by prescription. However, the FDA cautions that because this product contains nicotine, it can be addictive. It recommends the spray be prescribed for 3-month periods and should not be used for longer than 6 months.


The microtab is a small white tablet that you place underneath your tongue. It works by being absorbed into the lining of the mouth.


The lozenge is like a sweet or piece of candy that you suck slowly. It gives you nicotine in a similar way to the microtab. These are the newest forms of NRT on the market. After undergoing the appropriate testing, the FDA recently approved the first nicotine-containing lozenge as an over-the-counter aid in smoking cessation.

As with nicotine gum, the Commit TM lozenge is available in two strengths: 2 mg and 4 mg. Smokers determine which dose is appropriate based on how long after waking up they normally have their first cigarette.


This is a plastic device shaped like a cigarette with a nicotine cartridge fitted into it. Sucking on the mouthpiece releases nicotine vapor, which gets absorbed through your mouth and throat. Inhalators are useful for people who miss the hand-to-mouth action of smoking.

NRT is generally safe for everyone to use and certainly much safer than smoking. The U.S. Agency for Healthcare Research and Quality (AHRQ) clinical practice guideline on smoking cessation recommends nicotine replacement therapy for all smokers except pregnant women and people with heart or circulatory diseases.

If a health care provider suggests nicotine replacement for people in these groups, the benefits of smoking cessation must outweigh the potential health risks. As you can see from this section, there are many types of NRTs. When choosing which type of nicotine replacement you will use, think about which method will best fit your lifestyle and pattern of smoking.

Issues you may want to consider when choosing a type of nicotine replacement are:

  • How much am I smoking now? Do I need a high dose of nicotine?
  • Are my cravings worse in the morning when I first get up?
  • Do I need quick relief from cravings?
  • Do I want or need something to chew or occupy my hands?
  • Am I looking for once-a-day convenience?
  • Do I need a rescue medication for “breakthrough” urges?
  • Is my skin sensitive? Have patches in the past given me a rash?

Some important points to consider:

  • Nicotine gums, lozenges, and inhalers are oral substitutes that allow you to control your dosage to help keep cravings at bay.
  • Nicotine nasal spray works very quickly 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.

Other Smoking Cessation Aids

Bupropion hydrochloride (bupropion, Zyban), also marketed as an antidepressant, was approved for use as a stop-smoking medication in the form of a sustainedrelease (SR) tablet. It works by desensitizing the brain’s nicotine receptors and has shown promising results in clinical trials.

The course of treatment lasts around 8 weeks. In one study, Zyban helped 49 percent of smokers quit for at least a month. In the same study, 36 percent of nicotine patch users were able to quit for a month. When both the Zyban tablet and nicotine patch were used together, 58 percent of smokers were able to remain smoke free for over a month.

It is only available by prescription under medical supervision. Zyban is safe for most healthy adults but there are side effects, the most serious of which is the risk of seizures (convulsions). Therefore, bupropion should not be used for patients with seizure disorders and is not recommended for those with a cur-rent or prior diagnosis of bulimia or anorexia nervosa.

This risk is estimated to be less than 1 in 1000 but other less serious side effects such as insomnia, nightmares, dry mouth, and headaches are more common. An independent review by a consumer’s rights organization found that when buproprion was used in conjunction with regular counseling, it was at least twice as effective as placebo in helping patients to stop smoking.