Nicotine Replacement Therapy (NRT)

What Is Nicotine Replacement Therapy?

Nicotine Replacement Therapy (NRT) is a popular tool to help people quit smoking or using other tobacco products. The available forms of NRT have been approved by the U.S. Food and Drug Administration (FDA) for smoking cessation.

Nicotine replacement products (i.e., nicotine patches, gum, etc.) help people trying to quit a nicotine addiction by allowing them to gradually decrease their daily dose of nicotine while avoiding the harmful chemicals found in cigarettes, vapes (e-cigarettes), and smoke-free tobacco products (e.g., dip, snuff).

By tapering the amount of nicotine their body gets each day, people can slowly (but safely) decrease their dependency on nicotine while avoiding more intense nicotine withdrawal symptoms.

FDA-approved types of NRT products include:

• Nicotine Patch: Skin patches you can stick on a part of your body to provide a steady dose of nicotine, helping to reduce withdrawal symptoms and cravings.
• Nicotine Inhaler: Allows users to inhale a vaporized form of nicotine, mimicking the hand-to-mouth action of cigarette smoking.
• Nicotine Lozenge: Dissolves in the mouth, releasing nicotine to help manage cravings and withdrawal symptoms.
• Nicotine Gum: Chewing gum that releases nicotine, helping to curb cravings and manage withdrawal symptoms.
• Nicotine Nasal Spray: Delivers nicotine through the nasal membranes for quick relief from cravings.

Notably, nicotine gum, lozenges, and patches are available over the counter; nasal sprays and inhalers require a prescription from your doctor or primary healthcare provider.

How Does Nicotine Replacement Therapy Work?

Nicotine Replacement Therapy (NRT) works by giving your brain a controlled level of nicotine, which then helps reduce any symptoms of withdrawal you’d experience after quitting smoking or using other products containing nicotine.

NRT products provide nicotine at a lower and more consistent level compared to tobacco smoke, vapor, or smoke-free products. Additionally, some NRT products also appeal to the part of our brain that has formed physical habits around using nicotine.

For example, chewing pieces of gum can maintain a steady level of nicotine in the bloodstream while also keeping the mind busy with repetitive chewing.

Effectiveness of Nicotine Replacement Therapy

According to the CDC, NRT can nearly double your chances of quitting smoking or using other tobacco products compared to those who do not use it.

Of course, the success rates for NRT will vary based on the individual, but research shows that between 50-70% of people who use NRT are more likely to quit smoking successfully than those who do not use any pharmacotherapy at all.

Several factors can influence the effectiveness of NRT, including:

• The level of nicotine dependency
• Using the NRD products correctly/as directed
• Combining NRT product use with behavioral support (i.e., therapy, counseling, support groups)

For instance, someone with a high dependency on nicotine might need higher doses of NRT or a combination of NRT products, and it may take them longer to wean off nicotine entirely.

Nicotine Replacement VS. Smoking Cessation Pills

Nicotine replacement therapy is not the same thing as taking stop-smoking pills, but the two can often be used together (or one instead of the other). Again, the best method for you will vary from person to person.

Smoking cessation pills, like varenicline (Chantix) and bupropion (Zyban), also provide similar benefits that you’d get from NRT.

With NRT, the body receives a steady dose of nicotine to help decrease cravings and withdrawal symptoms. While stop-smoking pills don’t contain nicotine, they also help decrease cravings and withdrawal symptoms—they just do it by targeting different brain chemicals.

Varenicline, for example, works by partially stimulating nicotine receptors in the brain, reducing both cravings and the pleasurable effects of smoking. Clinical trials also show that varenicline is sometimes even more effective than NRT.

On the other hand, Bupropion (an antidepressant) also helps reduce cravings and withdrawal symptoms by helping your brain regulate dopamine.

Benefits of Nicotine Replacement Therapy

There are many benefits of nicotine replacement therapy, which is likely why its success rates are so high for people who use it.

Key benefits of nicotine replacement therapy include:  

• Reducing symptoms of withdrawal (i.e., anxiety, irritability, depression, insomnia, etc.)
• Lower health risks compared to tobacco use
• Minimizes relapse by gradually tapering nicotine dosage
• Several types of NRT to choose from
• Readily available (both prescription and over-the-counter options)
• Relatively affordable; often covered by insurance

Potential Side Effects of Nicotine Replacement Therapy

While Nicotine Replacement Therapy (NRT) is generally considered safe for most people, it can have some negative side effects.  Potential NRT side effects vary depending on the form of NRT used and how nicotine affects the individual.

Common side effects can include:

• Skin irritation, including rash or itching (nicotine patches)
• Sore throat (nicotine gum, lozenges, or inhalers)
• Nausea
• Headaches
• Dizziness (more common early on)
• Insomnia, particularly if patches are worn overnight
• Hiccups (gum, lozenges)
• Coughing (inhalers, nasal sprays)

Additionally, these rare but serious side effects might occur with NRT:

• Rapid or irregular heartbeat
• Allergic reactions (including swelling of face or tongue, difficulty breathing, etc.)
• High blood pressure
• Intense or constant stomach pain

NOTE: If you experience any of the above serious side effects, seek immediate medical intervention.

Additional Precautions

NRT can be a really effective tool for quitting tobacco use for many people, but it’s not the right solution for everyone. Your doctor or healthcare provider can offer advice and input about whether NRT is a safe option for you.

Some individuals who might need to take extra precautions or avoid NRT can include:

• Pregnant or breastfeeding women
• Adolescents and young people under the age of 18
• People with heart conditions or recently had a heart attack
• Individuals with diabetes

Nicotine can also interact with certain medications, so checking with your doctor or pharmacist before you start using an NRT can ensure you avoid any problematic combinations.

Additional Support During Nicotine Replacement Therapy

NRT alone can offer a great deal of support when quitting nicotine use, but used alongside additional services —like therapy or support groups—can increase your potential for success in living a healthy, nicotine-free life.

Some additional types of support you might consider alongside NRT include:

• Individual therapy can help you discover your triggers for wanting to use nicotine, as well as establish healthier coping mechanisms and ways for handling cravings.
• Specialized helplines, such as the CDC’s quitline at 1-800-QUIT-NOW, provide coaching, support, and additional information for quitting cigarettes and other forms of tobacco.
• Support groups (in-person or online), like Nicotine Anonymous, offer accountability as well as support from people who can understand both your struggles and your triumphs on this nicotine-free journey.
• Online forums can also provide a safe environment for peers to provide encouragement and strength, especially on more difficult days.
• Smartphone apps (e.g., Quit Tracker, EasyQuit) offer a wide range of additional assistance, from encouraging quotes to tracking how many days you’ve been nicotine-free.

Get Started on Nicotine Replacement Therapy

Research shows that nicotine replacement therapy is not only safe for most people, it doubles your chances of quitting tobacco products for good.

To get started, talk with your doctor or healthcare provider about NRT options that would work best for you and your situation.

You can also call the CDC’s Quitline (1-800-QUIT-NOW) for individualized coaching and details about quitting nicotine use.