Nicotine Replacement Therapy (NRT)

Symptoms of nicotine withdrawal can include physical symptoms (e.g., headache, sleep problems, tiredness, difficulty concentrating, dizziness) and emotional symptoms (e.g., irritability, moodiness, depression, anger, frustration, restlessness). These symptoms can last for a few days or several weeks or more.

Although smoking results in an addiction to nicotine, it is also a habit, or familiar routine. Nicotine replacement therapy (NRT) helps people who are trying to quit adjust to giving up this familiar routine while reducing the discomforts of nicotine withdrawal. In general, NRT is most effective when used as a part of a complete tobacco cessation program—one that includes information, support, and counseling.

Nicotine replacement therapy works by delivering a dose of nicotine through a gum, skin patch, lozenge, nasal spray, or inhaler. Nicotine gum, lozenge, and skin patch are available over the counter, allowing those who are not enrolled in formal cessation programs to use them on their own. Nasal spray and inhalers require a prescription.

NRT products vary in several ways, including the method and speed of nicotine delivery, side effects, difficulty discontinuing use of the product, and cost per day. For example, the nicotine patch is worn all day and gradually delivers a constant level of nicotine and nasal spray delivers a quick dose that is similar to the delivery of a cigarette.

Also, most NRT products are available in different nicotine doses—depending in part on how many cigarettes per day were smoked before trying to quit. In later stages of therapy, the dosage is lowered and eventually stopped.

The length of time that NRT products are used also varies, usually between 8 and 12 weeks without skipping doses. In some cases, a low dose NRT product is recommended for a longer period of time. Although it's preferred to stop using nicotine altogether, using an NRT product is generally considered less harmful than smoking or using other tobacco products.

Side effects also vary from one nicotine replacement product to another. Patients should be sure to consult a health care provider to help choose the best product, and should be sure to follow recommendations and instructions. A combination of NRT products (e.g., one for a regular dose and another to suppress urges as they arise) may be used.

Women who are pregnant and people with certain medical conditions like heart disease experience greater risks when using NRT products and should be monitored closely by a health care provider.

In April 2013, after reviewing almost 30 years of scientific research, the U.S. Food and Drug Administration (FDA) decided that some of the warnings on over-the-counter NRT products are unnecessary. By changing or removing some of the warnings, the goal is to allow more people to use these products to stop smoking.

Changes recommended by the FDA include the following:

  • Remove warnings not to use the product if you continue to smoke, use another tobacco product, or use another NRT product. Research shows that this poses no significant safety concerns. According to the FDA, if you smoke while using an OTC nicotine replacement product, you should continue using the product and keep trying to quit.
  • Change the wording from "stop smoking completely when you begin using this product" to "begin using this product on your quit day."
  • Remove the instruction to "stop using this product at the end of [specified number] weeks." Instead, the label should instruct people to talk to their health care provider if they feel they need to use the product for a longer period of time in order to avoid smoking. According to the FDA, it's safe to use NRT for longer than indicated in most cases (if necessary).

While using over-the-counter products to quit smoking, it's important to read labels thoroughly, follow directions carefully, talk to your health care provider if you have concerns, and report any side effects.

Publication Review By: Karen Larson, M.D., Stanley J. Swierzewski, III, M.D.

Published: 14 Jul 2006

Last Modified: 01 Oct 2015