Nicotine Replacement Therapy: What to Know

Medically Reviewed by Carol DerSarkissian, MD on November 27, 2022

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. Some are available without a prescription, but some you’ll have to get your doctor to prescribe 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 experience 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. Possible side effects: 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 mg and 4 mg strengths and you get the nicotine immediately through the mucous membranes in your mouth when you chew it. Possible side effects: Irritation to your mouth or throat, bad aftertaste, problems with existing dental work, nausea, jaw pain, racing heartbeat.
  • Nicotine lozenges: Like gum, nicotine lozenges are available over the counter. You suck on them so you get the nicotine slowly. They’re meant to dissolve like hard candies. Possible side effects: 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. Possible side effects: Coughing, irritation to your mouth or throat, runny nose, nausea. Other side effects that can occur 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. Possible side effects: 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 that can occur 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 immediately.

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 less 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 additional support you get around 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.

Show Sources


NIH: “Is Nicotine Addictive?”

American Cancer Society: “Nicotine Replacement Therapy to Quit Smoking.” “Nicotine Replacement Therapy to Quit Smoking,” “Busting NRT Myths.”

Cochrane Database of Systematic Reviews: “Nicotine replacement therapy for smoking cessation.”  

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