A Guide to Nicotine Replacement Therapy (NRT)

Learn about patches, gums, lozenges, nasal sprays and inhalers that may help smokers wean themselves off nicotine.

Medically reviewed in September 2021

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Nearly 70 percent of smokers say they want to quit, according to the Centers for Disease Control and Prevention (CDC), and quitting smoking can help to lower the risk of numerous serious health conditions, including, heart disease, many types of cancer and chronic obstructive pulmonary disease (COPD).

While quitting smoking is not easy, smokers have many tools at their disposal to help them kick the habit, including medications, counseling services and self-help materials. And many have found success through nicotine replacement therapy (NRT), the use of nicotine delivery methods to help ease withdrawal symptoms and cravings caused by the loss of nicotine from cigarettes.

Wondering if NRT could help you or someone you love quit smoking? Continue reading for the lowdown on the five forms of NRT approved by the U.S. Food and Drug Administration (FDA).


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Nicotine Patch

Usually worn on the arm, a nicotine patch releases nicotine into the body through the skin. The patch is available in several doses, or "steps," so that smokers can gradually wean themselves off nicotine completely. Someone who used to smoke a pack a day (20 cigarettes) would start with a full-strength patch (21 milligrams of nicotine per day). Someone who smoked less may begin at a lower dose.

  • The Pros: The different levels of nicotine patches available allow smokers to choose the appropriate one for their smoking habits. By gradually working down the levels, they're able to cut down on the amount of nicotine until the addiction dissipates completely.
  • The Cons: A patch may not be suitable for people with sensitive skin. Because the nicotine patch slowly releases nicotine into the bloodstream, the level of nicotine can't be adjusted if the person happens to have a strong nicotine craving—a piece of nicotine gun or lozenge may help at the time of craving or before an anticipated craving. Unlike a gum or lozenges, a patch also does not address certain aspects of the psychological addiction, including the need to do something with your hands or mouth.
  • Side Effects: Possible side effects include skin irritation at the site of the patch, sleep problems and headaches. Side effects vary, depending on the dose of nicotine, the person's level of skin sensitivity, how long the patch is used and how it's applied.

People who are exposed to excessive amounts of nicotine may develop other symptoms, including dizziness, nausea, vomiting and racing heartbeat.

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Nicotine Gum

This special chewing gum delivers nicotine to the bloodstream through absorption by the tissues of the mouth. The gum is chewed until it's soft and gives off a tingly sensation and/or peppery taste. Then it should be pressed between the cheek and gums, known as "parking." When the tingling sensation stops, the gum is chewed again and then parked in a different place in the mouth. This process should be continued until the gum is depleted of nicotine (about 30 minutes). Nicotine gum is available over-the-counter, in both 2 mg and 4 mg strengths. A person who smokes a pack or more per day or smokes within 30 minutes of waking up may need to start with the higher 4 mg dose. Nicotine gum is usually recommended for one to three months, but some people may benefit from using it longer. Those using nicotine gum for a prolonged period of time should discuss it with their healthcare provider.

  • The Pros: Nicotine gum allows people to control the nicotine doses their bodies receive. The nicotine is also absorbed through the lining of the mouth, so it gets into the blood more quickly than patches. The gum can initially be chewed as needed or on a fixed schedule, or every one to two hours during the day. Over time, it may be used less frequently.  No more than 24 pieces of gum are recommended per day. It's also a good choice for people who have sensitive skin and don't want to use a nicotine patch.
  • The Cons: Long-term dependence is one possible disadvantage of nicotine gum, though it is not common. The gum can damage dentures and dental prostheses. You cannot eat or drink 15 minutes before using the gum or while using it.
  • Side Effects: Potential side effects of nicotine gum include a bad taste in the mouth, throat irritation, mouth sores, hiccups, nausea and jaw discomfort. Symptoms related to the stomach and jaw are usually caused by improper use of the gum, such as swallowing nicotine or chewing too fast.
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Nicotine Lozenges and Tablets

These smoking-cessation lozenges and mini-lozenges release nicotine as they slowly dissolve in the mouth. Initially, it is recommended to use no more than 20 lozenges per day, or one lozenge every one to two hours. Eventually, the quitter will use fewer and fewer lozenges during the 12-week program until he or she is completely nicotine-free. Smokers can choose their dose based on how long after waking up they normally have their first cigarette. People that smoke within 30 minutes of waking up usually use the 4 mg dose.

  • The Pros: Because the nicotine is absorbed through the lining of the mouth (like the gum), it gets into the blood more quickly than patches, and it reaches the brain much faster, sending the message that the body has enough nicotine.
  • The Cons: Biting or chewing the lozenge or tablet can cause too much nicotine to be swallowed quickly, resulting in indigestion or heartburn. You cannot eat or drink 15 minutes before using the lozenge or while using it.
  • Side Effects: Possible side effects include nausea, hiccups, coughing, heartburn, headache, gas and trouble sleeping.
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Nicotine Nasal Spray

The nasal spray delivers nicotine to the bloodstream as it's quickly absorbed through the nose. It is available only by prescription.

  • The Pros: It relieves withdrawal symptoms very quickly and lets the user control their nicotine cravings.
  • The Cons: Because the person controls how much of the spray he or she uses, there's the potential danger of using too much. In addition, those with asthma, allergies, nasal polyps or sinus problems are usually discouraged from using this product.
  • Side Effects: The most common side effects can include nasal irritation, a runny nose, watery eyes, coughing, sneezing and throat irritation.
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Nicotine Inhalers

Not to be confused with electronic cigarettes (which are not approved by the FDA for smoking cessation), inhalers are composed of a thin plastic tube with a nicotine cartridge inside, and are available by prescription only. When the person puffs on the inhaler, the cartridge emits a nicotine vapor. Unlike other inhalers, which deliver the majority of the medicine to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth.

  • The Pros: Nicotine inhalers are the closest thing to smoking a cigarette, which some smokers find helpful.
  • The Cons: Also because nicotine inhalers are the closest thing to smoking a cigarette, using one is reinforcing behavior a quitter is trying to break.
  • Side Effects: The most common side effects, especially when first using the inhaler, include coughing, throat irritation and upset stomach.


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The Benefits of Quitting

Making the decision to stop smoking is one of the best things you can do for your health. According to reports from the U.S. Surgeon General, two weeks to three months after quitting, your circulation improves and your lung function increases. One year after quitting, your risk of coronary heart disease is half that of a smoker's. Five to fifteen years after quitting, your stroke risk is reduced to that of a nonsmoker. Ten years after quitting, your risk of cancer of the mouth, throat, esophagus, lungs, bladder, cervix and pancreas decrease. And after 15 years of quitting, your risk of coronary heart disease is equal to that of a non-smoker.

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