In June 2012, a new study supported by the National Institutes of Health (NIH) confirmed earlier study results indicating that genetic factors play an important role in determining if medications are likely to help a person who is trying to quit smoking. More research is needed, but these findings may lead to improved treatment programs geared to helping each individual smoker quit successfully.

Nicotine Replacement Therapy (NRT)

This treatment reduces dependency on nicotine by delivering it through less harmful methods, that is, through the skin in the transdermal method (nicotine patch) or through the oral or nasal tissues (nicotine gum, inhalers, and nasal sprays).

Nicotine patches (Nicoderm CQ®, Nicotrol®, and generic) are available over-the-counter. All patches are applied and worn in the same manner. At the start of each day of the treatment period, the smoker places a new patch on relatively hairless skin somewhere between the neck and waist.

Nicoderm CQ® is usually worn for 6 weeks for 16 or 24 hours a day at a dosage of 21 mg, then for 2 weeks at a dosage of 14 mg, then for 2 additional weeks at a dosage of 7 mg. Nicotrol® is worn for 6 weeks for 16 hours a day at a dosage of 15 mg.

People who have serious arrhythmia, serious or worsening angina pectoris, those with high blood pressure, depression, or asthma, or those who have recently suffered a heart attack should consult their health care provider before using a patch.

The most common side effect is a local skin reaction, experienced by 50% of patch users. This reaction is usually mild and easily treated by hydrocortisone or triamcinolone cream, or by rotating patch sites. Another common side effect is insomnia. In that case, the 24-hour patch may be removed before bedtime, or a change may be made to the 16-hour patch.

Nicotine gum (Nicorette® or Nicorrett Mint®) is available over-the-counter. The gum is chewed until a "peppermint" taste emerges and then held between the cheek and gums to allow the nicotine to be absorbed. It is alternately chewed and held between the cheek and gums for about 30 minutes until the taste dissipates.

Nicotine gum is available in 2 mg and 4 mg per piece doses. The 2 mg per piece gum is recommended for those who smoke less than 25 cigarettes per day and the 4 mg per piece gum is recommended for those who smoke more than 25 cigarettes per day. The gum is usually used for up to 12 weeks with no more than 24 pieces per day.

Nicotine gum therapy often fails if people chew too few pieces per day or do not continue chewing for a sufficient number of weeks. The U.S. Public Health Service recommends a fixed schedule of a minimum of one piece every 1–2 hours for at least 1–3 months.

Common side effects include soreness of the mouth, hiccups, indigestion, and jaw ache. Modifying the chewing technique can usually alleviate these effects.

Nicotine nasal spray (Nicotrol NS®) is available by prescription only. It is administered in one 0.5 mg dose to each nostril. Initially, the spray is administered in 1–2 doses per hour, and then increased as needed to relieve symptoms. A minimum of 8 doses per day and a maximum of 40 doses per day is recommended. Treatment usually lasts 3–6 months.

Ninety-four percent of people using nicotine nasal spray experience moderate to severe nasal irritation in the first 2 days of use. Eighty-one percent experience nasal irritation after 3 weeks, although the effect is much less severe.

Some users develop a dependency to nicotine nasal spray. About 15–20% of users reported using the spray for 3–6 months longer than recommended, and at a higher dose than recommended. Nicotine nasal sprays cannot be used in combination with other NRT (such as a patch).

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

Published: 15 Jul 2006

Last Modified: 08 Aug 2013