Nicotine Replacement Therapy: What to Know

Medically Reviewed by Brunilda Nazario, MD on September 28, 2023
5 min read

Whether you’re a smoker trying to kick the habit or you know someone who is, you know it’s extremely tough. And that’s all because nicotine – the ingredient in tobacco products like cigarettes – is very addictive.

Nicotine actually changes your brain chemistry to make you crave it more. It also makes you feel unpleasant symptoms of withdrawal when you don’t get the amount your body’s used to.

While withdrawal symptoms usually go away on their own after you quit smoking for a few weeks, some people find that using nicotine replacement therapies can ease the transition and make quitting easier.

Nicotine replacement therapies actually give you small amounts of nicotine through a product like gum or a skin patch. While you’ll continue to get some nicotine in your system, you won’t be exposed to any of the other harmful chemicals that are found in tobacco.

Nicotine replacement won’t help with any emotional connection you may have to smoking. But it can help reduce your cravings and the physical symptoms of withdrawal so you can focus on breaking your mental addiction.

This is the most common type of treatment used to help people quit smoking. Doctors often recommend it, and studies show it’s safe and effective.

There are a variety of nicotine replacement therapies on the market today. You can get some without a prescription, but you’ll have to get your doctor to prescribe others for you.

Nicotine replacement therapy is generally considered safe for most healthy adults, but it’s a good idea to talk to your doctor about the potential risks and benefits for you. Side effects are possible for any treatment option. While some people may have side effects, others may not.

  • Nicotine patch: The over-the-counter patch is placed directly on your skin to release a low, steady amount of nicotine over time. 

    Side effects of a nicotine patch: Irritation or redness on your skin, dizziness, headache, nausea, racing heartbeat, muscle pain or stiffness, or problems sleeping

  • Nicotine gum (nicotine polacrilex): You can buy over-the-counter nicotine replacement gum. It comes in 2-milligram and 4-milligram strengths, and you get the nicotine right away through the mucous membranes in your mouth when you chew it. 

    Side effects of nicotine gum: Irritation to your mouth or throat, bad aftertaste, problems with existing dental work, nausea, jaw pain, racing heartbeat

  • Nicotine lozenges: Like gum, you can get nicotine lozenges over the counter. You suck on them, so you get the nicotine slowly. They’re meant to dissolve like hard candies. 

    Side effects of nicotine lozenges: Coughing, gas, heartburn, trouble sleeping, nausea, hiccups, racing heartbeat

  • Nicotine inhaler: The prescription-only inhaler releases nicotine when you attach the cartridge to a mouthpiece and inhale. They’re the nicotine replacement method that’s most like smoking a cigarette. 

    Side effects of a nicotine inhaler: Coughing, irritation to your mouth or throat, runny nose, nausea. Other side effects include headache, nervousness, and a racing heartbeat. These are related to the nicotine, not the inhaler itself.

  • Nicotine nasal spray: This prescription-only nasal spray lets you squirt a quick burst of nicotine into your bloodstream directly through your nose. 

    Side effects of nicotine nasal spray: Irritation to your nose or throat, coughing, watery eyes, sneezing. These side effects usually get better after 1-2 weeks of treatment. Other side effects include headache, nervousness, and a racing heartbeat. These are related to the nicotine, not the spray itself.

Although it’s rare, nicotine overdose is a possible risk. Follow the instructions on each product carefully. If you have symptoms like a fast heartbeat, nausea and vomiting, dizziness, weakness, or a cold sweat, get medical attention right away.

You can also combine some of these options to quit smoking. Doing so may boost your chances of staying off of cigarettes.

You can use long-acting nicotine patches with shorter-acting options (like nicotine gum or lozenges) to help avoid cravings when you feel them coming on. In the morning, you'll put your nicotine patch on, like normal. Then, throughout the day, you can use the other options if needed.

Your doctor may also have different ideas for how you can combine medications to help you quit smoking.

It’s not necessarily for everyone, but if you’re very dependent on nicotine, it may help. You might want to try it if any of these describe your habit:

  • You smoke more than a pack of cigarettes per day.
  • You wake during the night to smoke.
  • You light up within a few minutes of waking in the morning.
  • You smoke even when you’re sick.

Some people definitely shouldn’t use nicotine replacement. If you’re pregnant or in your teens, it’s not for you. Also, if you're still smoking or are using other forms of tobacco, you shouldn’t use nicotine replacement therapy. It’s only for people who’ve stopped using those tobacco products.

If you smoke fewer than 10 cigarettes a day, researchers don’t know whether nicotine replacement will help you, since it’s designed for people who use tobacco products heavily.

Studies show that all forms of nicotine replacement therapy can help you quit smoking for good, and can more than double your chance of success. How helpful it is depends on how much more support you get for quitting.

Experts suggest you combine nicotine replacement with other smoking cessation methods like counseling, online programs, self-help guides, or other medications prescribed by your doctor.

What is the most effective nicotine replacement therapy?

The different types of NRTs explained above all work equally well to help you quit smoking. People who combine long-term and short-terms NRTs might have a better outcome when it comes to easing withdrawal symptoms and cravings.

How long after quitting smoking are you considered a nonsmoker?

Right after you quit smoking for good, your body starts to benefit. For example, your heart rate and blood pressure begin to recover just 20 minutes after quitting. 

You're considered a nonsmoker whenever you make the decision to quit. It's different for everyone.

Does nicotine gum cause cancer?

NRTs, like nicotine gum, are safe. Using them won't lead to death and disease the way smoking does. The most harmful things in cigarettes include the many toxic chemicals, which aren't in NRTs, not the nicotine.