An Overview of Nicotine Replacement Therapy

Nicotine Patch

Nicotine replacement therapy (NRT) was the first pharmacological treatment developed for smoking cessation that was approved by the Food and Drug Administration (FDA). Nicotine gum came first in 1984, followed by the nicotine patch in the early 90s. Both became available over the counter (OTC) in 1996. In that same year, the nicotine nasal spray was introduced by prescription, followed by the nicotine inhaler in 1998. Nicotine lozenges were approved for OTC sales directly in 2002.

The various forms and strengths of NRTs meet the needs of many ex-smokers, providing a controlled dose of therapeutic nicotine that is reduced over time until the NRT is discontinued. 

Top 3 Things About Nicotine Replacement Therapy

1. Using Nicotine Replacement Therapy Is Not Cheating

New ex-smokers sometimes think that using a quit aid of any kind is "cheating." This holds especially true for NRTs because they contain nicotine. While the ultimate goal is to remove all nicotine from your body, it is not necessary to do it quickly. Gradually lowering nicotine in your bloodstream takes the edge off of nicotine withdrawal and makes the task more manageable.

There is nothing wrong with using a quit aid to help you stop smoking. In fact, you should look at them as valuable tools at your disposal.

2. You Can Become Dependent on Nicotine Replacement Therapy

Nicotine is addictive whether it's in tobacco products or NRTs, so it's important to use this quit aid only as directed. The course of therapy has been carefully designed to gradually reduce dependence on nicotine over a period of weeks or months. Follow the manufacturer's recommendations, stopping the NRT in the time allotted. If you don't think you're ready to end treatment when the time comes, consult with your doctor.

3. NRTs Are Not Magic

For that matter, there isn't a quit aid of any type that will do all of the work for you. Successful recovery from nicotine addiction is a combination of physical and psychological healing, along with plain old practice at living your life one smoke-free day at a time. That said if you have the determination to do what it takes to stop smoking, quit aids can make the task much easier.

Types of Nicotine Replacement Therapy

It is worth noting that all forms of nicotine replacement therapy except the nicotine patch are used multiple times per day. This can be problematic for ex-smokers who might find it difficult to stick to the recommended number of pieces of nicotine gum or nicotine lozenges, for instance. The patch is put on once a day and uses a time-release system to administer the nicotine it contains. 

Nicotine Patch 

The nicotine patch looks like a small, square tan or clear bandage. It has an adhesive backing and is put on the upper arm or leg, or anywhere that is hairless. It comes in three strengths and users "step down" on dosage as recommended, usually stopping the patch altogether between six and 20 weeks. The patch is available OTC.

Nicotine Gum

Nicotine gum comes in a variety of flavors and two strengths. Each piece is chewed until ex-smokers feel a tingling sensation, and then the gum is "parked" between the cheek and gum until the tingling stops. The process is then repeated until the gum is used up, usually about 30 minutes. Nicotine gum is a commonly misused form of NRT, so be aware and follow instructions exactly, weaning off in the time recommended. Nicotine gum can be purchased OTC.

Nicotine Lozenges

Nicotine lozenges come in a pill or candy-like tablet and are used multiple times per day to reduce cravings to smoke. Like nicotine gum, the lozenge comes in two strengths and is put between the cheek and gum where it slowly dissolves over the course of a half-hour or so. The nicotine lozenge is sugar-free and comes in several flavors. Nicotine lozenges are available OTC.

Nicotine Inhaler

The nicotine inhaler is a cylindrical tube that houses a cartridge of liquid nicotine. Users draw on the mouthpiece to receive "puffs" of vapor that enter the lungs and send nicotine into the bloodstream. Each cartridge lasts about 20 minutes, administering roughly the same amount of nicotine as would be contained in one cigarette. The nicotine inhaler requires a prescription.

Nicotine Nasal Spray

Nicotine nasal spray comes in a pump-style bottle with a nicotine solution that is sprayed into the nostrils. The amount of nicotine used (number of pump sprays) is up to your doctor, who will decide on dosage and provide the prescription for this medicine for you.

What's the Difference Between the Nicotine Inhaler and Electronic Cigarettes?

This is a good question, and it's important to know why these two similar products are not interchangeable. 

As mentioned above, all NRTs, including the nicotine inhaler, are developed to gradually wean users off of nicotine. They are all also federally regulated, and this means that the nicotine in NRT products is manufactured using standards that guarantee consistency. The ingredients used are known and monitored, including the exact amount of nicotine. Consumers can trust that they are receiving what the package says is in the product. 

This is not the case with electronic cigarettes, which have been historically manufactured and imported from other countries with no regulatory structure in place. The amount of nicotine in the e-juice solution can and does vary from what the packaging reports.

The FDA is beginning to impose regulations on manufacturers of what are known as ENDS (electronic nicotine delivery systems), of which e-cigarettes are a part. So, eventually, consumers will benefit from the new standards imposed. 

Even so, electronic cigarettes have not been medically approved as a quit aid, which means there isn't a course of therapy for smoking cessation associated with e-cigarettes. That may come in the future, but for now, smokers are on their own when using e-cigarettes to stop smoking. 

Electronic cigarettes are considered to be a smoking alternative rather than a quit aid.

Recent illnesses have been associated with the use of e-cigarettes (vaping). The Centers for Disease Control and Prevention (CDC) recommends that people refrain from all vaping products.

The Centers for Disease Control and Prevention (CDC) has identified a new lung disease linked to vaping, which they call e-cigarette or vaping product use-associated lung injury (EVALI). Common symptoms of the condition include chest pain, cough, and shortness of breath resulting in numerous hospitalizations and deaths.

As of the end of January 2020, FDA regulations require that all e-cigarette companies cease the manufacture and sale of flavored vaping products (except for menthol and tobacco).

Why Use Nicotine to Stop Using Nicotine?

It might seem wrong to employ the substance you're addicted to for recovery, but it offers the advantage of reducing nicotine cravings in a gradual way, allowing your body to get used to less and less until the nicotine is stopped completely. At the same time, ex-smokers can turn more of their attention toward the habitual side of smoking, which is where the majority of the work of smoking cessation lies. And, while they do contain nicotine, NRTs do not contain the many thousands of other toxic chemicals that are in cigarettes.

Using NRTs in Combination With Prescription Quit Aids

If you find that NRTs are not doing enough to help you with smoking cessation, talk to your doctor about combining the NRT you're using with other NRTs or prescription quit aids like Chantix or Zyban. This could improve your chances of success, but it should be done with a doctor's supervision.

Don't Smoke When Using NRTs 

The nicotine in cigarettes could put you at risk of a nicotine overdose if you smoke while using NRTs. A nicotine overdose may cause you to feel dizzy, nauseous, confused, or weak. You might vomit, experience a cold sweat, or have blurred vision, a bad headache, or even hearing problems. If anything like this happens to you while using NRTs, discontinue the NRT and seek medical help immediately. 

Add Some Counseling and Support to Your Quit Program

Most doctors today will recommend adding some type of support or counseling to round out your quit program. Your chance of success goes up if you have the help of others who have knowledge of what you're going through. Talk to your doctor about support groups in your area, and add some online support as well for round-the-clock help.

Are NRTs a Smart Quit Aid Choice?

Yes, just use care so that the NRT you're using to stop smoking doesn't become habit-forming. Follow the manufacturer's directions carefully, tapering down and stopping use entirely in the time recommended.

Nicotine replacement therapy has helped many thousands of people stop smoking successfully. But the fact is, whatever you use as a quit aid will work if you put your back into it. NRTs won't become a problem of their own as long as you use them according to the manufacturer's directions. 

A Word From Verywell

Remember, quit aids are just that—aids. Use them with that in mind and be patient with yourself. You didn't form your habit overnight, and it will take some time to heal and find a new and healthier way of living life that doesn't involve smoking (or cravings to smoke). 

It is normal to feel fear when you think about quitting, but that is only because you are addicted to nicotine. Forge ahead.  

Choose your quit aid, pick your date, start reading about what you can expect from smoking cessation, and then follow through when your quit day arrives.

2 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. CDC. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products.

  2. Kalininskiy A, Bach CT, Nacca NE, Ginsberg G, Marraffa J, Navarette KA, McGraw MD, Croft DP. E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. Lancet Respir Med. 2019;7(12):1017-1026. doi:10.1016/S2213-2600(19)30415-1

Additional Reading

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