What are nicotine replacement therapies?

Donna Hill Howes, RN
Family Practitioner

Nicotine replacement therapy (NRT) reduces nicotine withdrawal symptoms and helps fight the craving to smoke. NRT gives you some nicotine while you're quitting, without the other harmful chemicals in tobacco. This satisfies your craving for nicotine and allows you to gradually get used to not having it at all.

The nicotine inhaler and nasal spray (Nicotrol) require a prescription. Nicotine gum, lozenges, and skin patches (for example, Commit, Habitrol, NicoDerm, Nicorette, and Thrive) are available without a prescription.

The nicotine patch is applied to the skin and gives a steady, small dose of nicotine. Nicotine gum is chewed, then placed between the cheek and gums to slowly release the nicotine. Lozenges dissolve slowly in the mouth. The inhaler uses a cartridge and mouthpiece to deliver nicotine to the lungs. The nasal spray is inhaled from a pump bottle. 

This answer was adapted from Sharecare's award-winning AskMD app. Start a consultation now to find out what's causing your symptoms, learn how to manage a condition, or find a doctor. 

Nicotine is the addictive thing in tobacco products, but not the harmful stuff.   Nicotine Replacement Therapies or “NRTs” are exactly what they sound like. They are tobacco cessation helpers that contain nicotine, the addicting part of tobacco (not the cancer causing part). The NRT’s on the market that do not require a prescription include Nicotine gum (nicotine absorbed through skin inside mouth), Nicotine patch (not for people with eczema, psoriasis or atopic dermatitis, nicotine is absorbed through skin), and Nicotine lozenge (like dissolving hard candies that are very effective at handling short but intense cravings). The NRT’s that do require a prescription include Nicotine inhaler (not for asthmatics, involves a puff of nicotine-laced vapor that you hold in your mouth and then blow out), and Nicotine spray (works well for very heavy smokers, but it may be addicting).

Hold on a hot second, why would you want to put nicotine in your body if you’re trying to quit? The NRT philosophy is based on the fact that weaning off of nicotine is more than twice as effective as going cold turkey.1 Why? It helps you manage those strong initial cravings and withdrawal symptoms. NRTs also come in different quantities of nicotine. The patch for example comes in doses of 21, 14, and 7 milligrams. This way you can gradually lower you body’s nicotine levels with time without your body declaring war on you because you suddenly took away something that it demands.

Remember, tobacco addiction is both mental and physical. For most people, the best way to quit will be some combination of medicine, a method to change personal habits, and emotional support.

As mentioned earlier, the nicotine in cigarettes leads to actual physical dependence. This can cause unpleasant symptoms when a person tries to quit. Nicotine replacement therapy (NRT) gives you nicotine—in the form of gums, patches, sprays, inhalers, or lozenges—but not the other harmful chemicals in tobacco. It can help relieve some of the withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting.

Intermountain Registered Dietitians
Nutrition & Dietetics Specialist

Nicotine replacement therapy (NRT) helps ease nicotine withdrawal by giving your body a steady supply of nicotine in gradually decreasing doses. It comes in the form of nicotine chewing gum, skin patches, inhalers, nose sprays, and lozenges. Some types of NRT are available over the counter, while others require a prescription.

Dr. Kelly Traver

Nicotine replacement therapies are designed to prevent and treat withdrawal symptoms experienced by people when they stop smoking. These withdrawal symptoms are what 70-90 percent of smokers say is the sole reason they don't quit. There are many different forms of nicotine replacement, which are listed below.

Nicotine gum - Nicotine gum comes in 2- and 4-milligram doses and can be obtained without prescription. The 4-milligram dose is appropriate for heavier smokers, those who smoke more than one pack a day. Do not eat or drink anything within 15 minutes of chewing, otherwise, it will diminish the nicotine absorption.

  • Advantages: Acts fast, avoids the skin irritation that can occur with patches, and provides more flexibility to match replacement therapy with cravings.
  • Disadvantages: Sore throat, mouth sores, jaw discomfort, damage to dentures or dental prostheses, racing heartbeat, headache, nausea, and insomnia

Nicotine patch - A nicotine patch provides a steady, continuous level of nicotine throughout the day. Nicotine is absorbed through the skin.

  • Advantages: Slow absorption helps to reduce nicotine side effects, and steady levels help prevent sudden nicotine withdrawal that can lead to intense cravings.
  • Disadvantages: Insomnia, especially with the 24-hour patch, skin irritation, headache, and nausea

Nicotine inhaler - Nicotine inhalers are available only by prescription. Nicotine is delivered through a plastic tube shaped like a cigarette, which has a nicotine cartridge in it.

  • Advantages: Because this form of therapy is so similar to smoking, some smokers find this the most comforting form of replacement when they are experiencing withdrawal symptoms.
  • Disadvantages: This is the most expensive form of nicotine replacement. Side effects include headache, nausea, and insomnia.

Nicotine nasal spray - Nicotine nasal sprays are available only by prescription. They are very effective and offer immediate relief from withdrawal symptoms.

  • Advantages: Quick, potent, and easy to use
  • Disadvantages: Nasal irritation, runny nose, watery eyes, and sore throat. People with a history of allergies or asthma or nasal polyps should use a different nicotine replacement therapy. Side effects include headache, nausea, and insomnia.

Nicotine replacement therapies come as patches and inhalers. They supply your brain with some nicotine, so stopping smoking doesn't cause severe withdrawal symptoms.

Take the RealAge Test!

Continue Learning about Smoking Treatment

New Info About Risks of Smoking Anything
New Info About Risks of Smoking Anything
We weren’t blowin’ smoke when we warned (over and over) about the health risks of smoking—anything! We know you want to kick the habit: Over 80 percen...
Read More
What should I expect when I quit smoking?
Honor Society of Nursing (STTI)Honor Society of Nursing (STTI)
You should expect to have withdrawal symptoms such as headaches, irritability, lighheadedness, restl...
More Answers
What can cause weight gain after quitting smoking?
Dr. Mehmet Oz, MDDr. Mehmet Oz, MD
There are a few reasons why people gain weight when they stop smoking. One relates to the effect...
More Answers
The Best Time to Quit Smoking
The Best Time to Quit Smoking

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.