7 Symptoms of Nicotine Withdrawal

Knowing the signs can help you prepare

Person in an office looking stressed with hand on forehead

PeopleImages / Getty Images

Nicotine withdrawal is the one thing that many smokers fear when embarking on a smoking cessation plan. It can be a distressing experience for some, triggering a host of physical and psychological symptoms.

This doesn't mean that everyone will experience nicotine withdrawal in the same way. People who quit "cold turkey" usually have worse symptoms than those who take a cohesive approach with counseling, support systems, and quit smoking aids including nicotine replacement therapy (NRT).

While nicotine withdrawal can be challenging, it's important to remember that it's only temporary. With a little preparation and persistence, you will get through it.

What Is Nicotine Withdrawal?

Nicotine withdrawal refers to what happens in the body when someone who has been using nicotine regularly stops or cuts down their intake. The symptoms, which can begin within two to three hours after the last use and are strongest a few days later, can be physical and psychological. Nicotine withdrawal is one of the main reasons why quitting smoking or other forms of tobacco is so difficult.

The Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines criteria for tobacco withdrawal. This condition was changed from "nicotine withdrawal" in the DSM-IV. The symptoms discussed here are not all the same as the criteria listed in the DSM-5.

By understanding some of the signs and symptoms of nicotine withdrawal, you can better prepare for them and know how to act if and when they occur.

1

Nicotine Cravings

Smoking urges, commonly known as nicotine cravings, are one of the most challenging and persistent symptoms of nicotine withdrawal. The cravings you feel are caused by nicotinic receptors in the brain. When suddenly deprived of nicotine, the brain will no longer release the "feel-good" hormone dopamine which the body has grown accustomed to.

A craving is a physiological response in which the body yearns for something to which it has adapted and become tolerant.

Nicotine cravings typically last for five to 10 minutes. They may be extremely uncomfortable, but try to wait them out and remind yourself that the feeling will pass. Chewing nicotine gum or taking a long, brisk walk usually helps.

2

Weight Gain

The urge to snack is about more than just replacing cigarettes with food. Nicotine causes changes to cells that make so they don't respond as well to insulin, which can increase your body's blood sugar levels.

As a result, when you stop smoking, you can experience a drop in blood sugar and feel the need to consume carbs, sweets, and other foods to satiate this sudden and often unexplained hunger. Thankfully, this effect will stabilize as your body adjusts to being nicotine-free.

Research shows that people who quit cigarettes will gain an average of 10 pounds after one year with most of the gain occurring during the first three months.

3

Sleep Disturbances

Sleep problems are common side effects of nicotine withdrawal and can run the gamut from insomnia to needing extra sleep during the day. The symptoms are also closely linked to the dysregulation of dopamine, which is also involved in sleep regulation. 

While sleep disturbances and insomnia are symptoms of nicotine withdrawal, research has indicated that smokers experience worse sleep than non-smokers.

4

Persistent Cough

Some people develop a persistent cough after they quit smoking. As odd as this may seem, coughing at this stage is a sign that your lungs are getting better, not worse.

When you smoke, the tiny finger-like projections in the lining of your airways, called cilia, will become immobilized and eventually flatten out. After you quit, the cilia will return to their normal shape and function, pushing toxic deposits out of the lungs to be coughed up.

You can help relieve this symptom by staying well-hydrated, humidifying the air, and using honey or an over-the-counter cough drop to ease any throat irritation.

5

Flu-Like Symptoms

While in the process of quitting, you may experience something popularly referred to as the "quitter's flu." The condition, characterized by a mild fever, malaise, sinusitis, coughing, and body aches, is simply your body's response to an unfamiliar state.

The sudden cessation of smoking can trigger an immune response in much the same way as it would respond to a bacteria or virus it considers abnormal.

In most cases, a quitter's flu will last for only a couple of days. Nicotine replacement therapy, along with over-the-counter pain relievers, may help ease the symptoms. 

6

Mood Changes

Stress and irritation are common symptoms of early nicotine withdrawal, triggered by the profound dysregulation of the endocrine (hormonal) and central nervous systems.

This stress can not only cause extreme changes in mood, including sudden and irrational outbursts, but it can also trigger short-term physiological changes, including increased blood pressure and heart rate. Memory problems, difficulty concentrating, and dizziness are also common.

The psychological symptoms can further deepen if you are sleep-deprived, leading to bouts of anxiety or depression that may require medical treatment. 

7

Constipation

In addition to the lungs and brain, the digestive tract can be affected when you suddenly stop smoking. Stopping the use of nicotine alters the motility and contraction of the intestines, dramatically slowing the speed by which food is digested. Older research from 2003 revealed that as many as one in six people who quit cigarettes will experience bouts of constipation, generally lasting for one to two weeks.

This symptom may be further exacerbated by the "munchies" some people experience while quitting, increasing both the volume of food you eat and intake of foods more likely to cause constipation (such as white bread, chocolate, potato chips, and ice cream). 

Drinking plenty of water and increasing your intake of dietary fiber can usually help normalize bowel movements.

Causes and Treatment for Nicotine Withdrawal

Nicotine withdrawal occurs because the body has become dependent on it. Specifically, nicotine stimulates the release of dopamine in your brain, so when you stop using nicotine, there is less released, and this can result in withdrawal symptoms. Nicotine affects other neurotransmitters as well.

Behavioral factors are also thought to influence these withdrawal symptoms; for example, just seeing someone smoking or smelling a cigarette can increase cravings. There are a few treatments to help with nicotine withdrawal, including:

  • Nicotine replacement therapies (NRTs): Examples of NRTs include nicotine gum, patches, lozenges, which are available over the counter. Nicotine nasal sprays and inhalers are available with a prescription.
  • Prescription medications: The antidepressant Zyban (bupropion) (also sold under the brand name Wellbutrin) and the smoking cessation aid Chantix (varenicline) can help with symptoms.

Speak to a healthcare provider about what treatment might be best for you. In addition to medications and NRTs, you can seek psychological support from a support group, quit-tobacco program, or mental health professional.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. 

For more mental health resources, see our National Helpline Database.

A Word From Verywell

Nicotine withdrawal can be intense and uncomfortable. But this phase of smoking cessation won't last forever and, if prepared, you can learn to manage and cope with the symptoms as they come.

Try not to get ahead of yourself and worry about never smoking again. Just focus on today, and do whatever you can to remain smoke-free.

In the end, the benefits of quitting far outweigh any short-term discomfort you may experience through withdrawal. If you take it one step at a time, you'll get there.

18 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Nicotine withdrawal.

  2. MedlinePlus. Nicotine and tobacco.

  3. Centers for Disease Control and Prevention. Why quitting smoking is so hard.

  4. American Psychological Association. Nicotine withdrawal.

  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

  6. Jackson KJ, Muldoon PP, De biasi M, Damaj MI. New mechanisms and perspectives in nicotine withdrawal. Neuropharmacology. 2015;96(Pt B):223-34. doi:10.1016/j.neuropharm.2014.11.009

  7. Centers for Disease Control and Prevention. Smoking and diabetes.

  8. Aubin HJ, Farley A, Lycett D, Lahmek P, Aveyard P. Weight gain in smokers after quitting cigarettes: Meta-analysis. BMJ. 2012;345:e4439. doi:10.1136/bmj.e4439

  9. Liao Y, Xie L, Chen X, et al. Sleep quality in cigarette smokers and nonsmokers: Findings from the general population in central China. BMC Public Health. 2019;19(1):808. doi:10.1186/s12889-019-6929-4

  10. Davenport PW, Vovk A, Duke RK, Bolser DC, Robertson E. The urge-to-cough and cough motor response modulation by the central effects of nicotine. Pulm Pharmacol Ther. 2009;22(2):82-9. doi:10.1016/j.pupt.2008.11.013

  11. Beard E, Shahab L, Curry SJ, West R. Association between smoking cessation and short-term health-care use: Results from an international prospective cohort study (Attempt). Addiction. 2013;108(11):1979-1988. doi:10.1111/add.12281

  12. Nakajima M, Al'absi M. Nicotine withdrawal and stress-induced changes in pain sensitivity: A cross-sectional investigation between abstinent smokers and nonsmokers. Psychophysiology. 2014;51(10):1015-22. doi:10.1111/psyp.12241

  13. Hajek P, Gillison F, McRobbie H. Stopping smoking can cause constipation. Addiction. 2003;98(11):1563-7. doi:10.1046/j.1360-0443.2003.00497.x

  14. National Institute on Drug Abuse. Tobacco, nicotine, and e-cigarettes report: Is nicotine addictive?.

  15. National Institute on Drug Abuse. Tobacco, nicotine, and e-cigarettes research report: Is nicotine addictive?

  16. Food and Drug Administration. Want to quit smoking? FDA-approved products can help.

  17. Centers for Disease Control and Prevention. How quit smoking medicines work.

  18. American Cancer Society. Dealing with the mental part of tobacco addiction.

Additional Reading
  • McLaughlin, I.; Dani, J.; and De Biasi, M. Nicotine withdrawal. Curr Top Behav Neurosci. 2015;24:99-123. doi:10.1007/978-3-319-13482-6_4

By Terry Martin
Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction.