Nicotine Replacement Therapy (NRT)

What is nicotine replacement therapy (NRT)?

Nicotine replacement therapy (NRT) involves using products (like gum and patches) with low doses of nicotine to cut down on cravings and lessen withdrawal symptoms after you quit smoking. It’s a type of medication-assisted treatment (MAT) for people with nicotine dependence (tobacco use disorder).

The nicotine products for NRT don’t contain the other toxins (like carcinogens) that smoking exposes you to.

NRT can help with physical withdrawal and craving symptoms. But it doesn’t address every part of quitting smoking, like the mental, emotional and social aspects. Even with the help of NRT, quitting smoking can still be hard. Combining NRT with other strategies, like talk therapy or a quitting (smoking cessation) program, can increase your chances of quitting permanently.

Who is NRT for?

NRT is for people who have severe nicotine dependence and want to quit smoking. Researchers haven’t studied NRT as much for quitting smokeless tobacco.

Nicotine is a stimulant found in tobacco products. Nicotine addiction happens when your body gets used to having some level of nicotine in your system. In physical and psychological ways, your body “depends” on constantly having the chemical.

Signs of severe nicotine dependence include:

• Smoking more than one pack of cigarettes a day.
• Smoking within five minutes of waking up.
• Smoking even while you’re sick.
• Waking up at night to smoke.
• Smoking to ease symptoms of withdrawal.

Experts state that NRT is generally safe for almost all adults who want to quit smoking. But pregnant people and teens shouldn’t use NRT. Certain health conditions, like liver or kidney issues, may make NRT unsafe as well. Discuss NRT with a healthcare provider before starting it. They’ll help you understand if it’s right for you.

How does nicotine replacement therapy work?

During NRT, you use products with controlled, low doses of nicotine to keep cravings and withdrawal at bay after you quit smoking. NRT products contain lower amounts of nicotine than the average cigarette, and their impact on your body is more gradual.

NRT products include nicotine:

• Gum.
• Lozenges.
• Skin patches.
• Inhalers.
• Nasal sprays.

The U.S. Food and Drug Administration (FDA) has approved these products for smoking cessation. Using them too much or using them and continuing to smoke can lead to a buildup of toxic levels of nicotine in your body, resulting in nicotine poisoning.

Before you start using NRT, it’s a good idea to talk to a healthcare provider about the best — and most effective — way to approach NRT for you. Some things to keep in mind include:

• Experts recommend starting NRT products either one to two weeks before quitting or immediately after stopping cigarette use.
• Attending a smoking cessation counseling program alongside NRT will increase your chances of quitting successfully.
• The more often you smoked before quitting, the higher the dose of nicotine you may need to start with.
• You should slowly decrease the dose of nicotine during NRT.
• Be sure to store these products safely away from children and pets to prevent accidental nicotine poisoning.

How to use nicotine gum

Nicotine gum is an over-the-counter (OTC) product. You chew on the gum to release the nicotine. Once you get a tingling feeling or it develops a peppery taste, you position the gum between your cheek and gums for about 30 minutes.

Be sure to follow the instructions that come with the nicotine gum package. The gum comes in varying strengths (doses). Some general tips include:

• Wait at least 15 minutes after drinking caffeine-containing beverages (like coffee and tea) and acidic beverages (like orange juice) before chewing a piece of nicotine gum.
• You can typically use a piece of gum every one to two hours to manage craving symptoms for the first six weeks after quitting smoking.
• Following six weeks of use, you can reduce use to one piece every two to four hours, and then one piece every four to eight hours.
• Don’t use more than one piece of gum at a time.
• Plan to stop using the gum by 12 weeks. Talk with your provider before using the gum for a longer period.

How to use nicotine lozenges

Nicotine lozenges are OTC products that you put in your mouth between your cheek and gums (like hard candy or a cough drop). The lozenge slowly releases nicotine as it dissolves in your mouth. You may feel a warm or tingly sensation.

Follow the instructions that come with the nicotine lozenge package. The lozenges come in varying strengths (doses). Some general tips include:

• You can typically use one lozenge every one to two hours to manage craving symptoms for the first six weeks after quitting smoking.
• Following six weeks of use, you can reduce use to one lozenge every two to four hours, and then one lozenge every four to eight hours.
• Don’t use more than one lozenge at a time.

How to use nicotine patches

Nicotine patches are OTC products you place on your skin in the morning that give a small, steady dose of nicotine throughout the day. Nicotine patches come in different shapes and sizes.

Follow the instructions that come with the nicotine patches. Some general tips include:

• The nicotine patch comes in different strengths. The best dose for you depends on how often you currently smoke.
• You typically wear one patch for 16 or 24 hours. You can wear it while showering or bathing.
• Put the patch on clean, dry, healthy and hair-free skin on your upper body. You can put the patch on your upper chest, upper arm, shoulder, back or inner arm. Mix up where you put the patch each day.

How to use nicotine inhalers

Nicotine inhalers require a prescription from a healthcare provider. The cartridge contains nicotine, and you inhale on and off (“puff”) a controlled dose through a mouthpiece attached to the cartridge. The inhaler looks like a plastic cigarette holder. The back of your throat mainly absorbs the nicotine, not your lungs.

It’s important to note that nicotine inhalers aren’t the same as e-cigarettes (vaping). The FDA approves nicotine inhalers as a medically monitored method for quitting smoking. Vaping and e-cigarettes aren’t an FDA-approved method for quitting smoking.

Be sure to follow the packing instructions and your provider’s guidance for using a nicotine inhaler. General tips for using one include:

• How long you use each cartridge and how many cartridges you can use a day varies based on the brand.
• Take frequent short, shallow puffs from the inhaler. Don’t inhale deeply.
• Don’t eat or drink for 15 minutes before using the inhaler or while using it.

How to use nicotine nasal sprays

Nicotine nasal sprays require a prescription from a provider. They’re pump bottles that contain nicotine in liquid form that you spray into each of your nostrils. Levels of nicotine peak within five to 10 minutes after using the spray.

Carefully read the package instructions and follow your provider’s guidance for using a nicotine nasal spray. How often you can use it varies based on the brand and dose. Some things to note include:

• Providers typically recommend using at least eight doses per day for the first six weeks. Don’t use more than 40 doses per day.
• You shouldn’t use a nicotine nasal spray for longer than three months.

Providers usually only prescribe nicotine nasal sprays if you have a severe nicotine addiction. The spray works quickly and can be addictive, like cigarettes. So, it’s important to carefully follow the dosing instructions from your provider. Talk to your provider if you’re using the spray more than you should.

Combining NRT products

NRT products work differently, so you may benefit from using more than one product to help you quit smoking. Using a long-acting product (a nicotine patch) can help lessen withdrawal, while using a short-acting product can quickly relieve cravings as they happen.

More specifically, you can use one long-acting NRT product together with one short-acting product. For example, you may combine:

• Nicotine gum and a nicotine patch.
• Nicotine lozenges and a nicotine patch.
• Nicotine inhaler and a nicotine patch.
• Nicotine nasal spray and nicotine patch.

As always, talk to your healthcare provider about the best and safest way to combine NRT products for you.

What are the advantages of nicotine replacement therapy?

Using NRT effectively reduces the urge to smoke cigarettes by providing your body with nicotine through safer products. Studies show that using NRT helps increase the chances of quitting smoking by about 50% to 70%.

What are the side effects of NRT?

Each type of NRT product has potential side effects. Be sure to read the packaging and talk to a healthcare provider before you start using the product to know what to expect.

In general, due to their nicotine content, NRT products can cause:

• Nausea.
• Headache.
• Racing heart.

Other side effects of nicotine patches include:

• Skin irritation.
• Sleep problems or unusual dreams.

Other side effects of nicotine gum include:

• Throat irritation.
• Mouth sores.
• Hiccups.

Other side effects of nicotine lozenges include:

• Hiccups.
• Sore throat.
• Coughing.
• Heartburn.

Other side effects of nicotine nasal spray (which usually only last for one to two weeks) include:

• Nasal and/or throat irritation.
• Runny nose.
• Watery eyes.
• Sneezing.
• Coughing.

Other side effects of nicotine inhalers include:

• Coughing.
• Mouth and/or throat irritation.
• Runny nose.
• Upset stomach.

Nicotine poisoning

It’s essential to use NRT products as they’re intended. Using them too often or taking them while continuing to smoke can lead to nicotine poisoning (overdose). Children and pets can also develop nicotine poisoning from consuming small amounts of these products.

Early-phase symptoms of nicotine poisoning include:

• Nausea and vomiting.
• Increased salivation.
• Abdominal pain.
• Sweating.
• Increased heart rate.
• Rapid, heavy breathing (hyperpnea).
• Loss of control of body movements (ataxia), loss of balance and/or difficulty walking.
• Tremors.
• Headache.
• Dizziness.
• Seizures.

Go to the emergency room if you or your child have these symptoms.

How long does NRT last?

Nicotine replacement therapy (NRT) is meant to have a limited use. In most cases, healthcare providers recommend using NRT for eight to 12 weeks. If NRT hasn’t significantly helped your craving and withdrawal symptoms by this point, talk to your provider about the next steps to take.

What if NRT doesn’t work for me?

There are many options for permanently quitting smoking. It’s important to remember that it often takes many tries. If NRT doesn’t work for you, you’re not alone. Talk to your healthcare provider. They may recommend a different approach to NRT, like different products or doses.

The FDA approves two other prescription medications (pills) for quitting smoking: varenicline and bupropion. They don’t contain nicotine. Your provider may recommend taking one of these medications with an NRT product to quit smoking.

Addressing the psychological, emotional and social elements of smoking is also crucial to permanently quitting. Ask your provider about smoking cessation programs you can join that address these challenges. The best thing you can do is keep trying.

When should I see my healthcare provider about NRT?

It’s important to talk to a healthcare provider about NRT and which strategy is best before you start the therapy. If you’re having bothersome or worrisome side effects or any other issues related to quitting smoking, see your provider. They can offer guidance and other options.

Quitting smoking may make you feel depressed or anxious, whether you use NRT to quit or not. Be sure to talk to your provider or see a mental health specialist (like a psychologist) if these mood changes are persistent or are causing you distress.