Quitting Tobacco: Nicotine Replacement Therapy (NRT)

Author: Christina Bach, LCSW, MBE, OSW-C
Content Contributor: Carolyn Vachani, MSN, RN, AOCN and Anil Vachani, MD
Last Reviewed: December 19, 2022

Nicotine is an addictive ingredient found in tobacco products. Nicotine binds to receptors in your brain and increases the release of dopamine. Dopamine is a neurotransmitter that helps you feel pleasure. Not having nicotine can also change your mood. Some people who quit smoking become depressed. This may be because the levels of dopamine in their brain is affected by the lack of nicotine.

Nicotine remains in your body for a short period of time. Not having nicotine can cause cravings for it. This can make it hard to quit tobacco use. There are a few things that can help you quit tobacco use. These are:

This article will focus on nicotine replacement therapy (NRT). Taking NRTs can help you quit tobacco. They are safe and effective for most people. Talk with your healthcare provider about your plan for quitting or about any past experiences trying to quit. Together you can make a plan based on what did or did not work before.

Nicotine Replacement Therapies (NRT)

Nicotine replacement therapy (NRT) replaces some of the nicotine found in tobacco use. As a result, withdrawal symptoms and cravings can be reduced. Talk with your provider about what kind of NRT may be best for you, how to use it, and possible side effects. NRT is available in different ways:

  • Nicotine Patch.
    • Available over the counter without a prescription.
    • Long-acting form of NRT that gives a continuous level of nicotine over 24 hours.
    • Can be used with short-acting NRT to manage cravings.
    • Comes in multiple doses. You will start at a higher amount and slowly lessen your dose as your body craves nicotine less.
    • Side effects include skin redness, burning, and itching (changing the location of your patch daily can help), headache, blurred vision, or changes in your sleep patterns.
  • Nicotine Gum.
    • Available over the counter without a prescription.
    • Short-acting form of NRT.
    • Can be used with long-acting NRT to help manage cravings.
    • Shouldn’t be chewed like gum, but instead placed between the teeth and gums until it is absorbed.
    • Side effects include jaw pain, mouth sores, upset stomach, and hiccups.
  • Nicotine Lozenge.
    • Available over the counter without a prescription.
    • Short-acting form of NRT.
    • Can be used if you can’t manage the gum.
    • Side effects include jaw pain, mouth sores, upset stomach, hiccups, and mouth/throat irritation.
  • Nicotine Nasal Spray
    • Needs a prescription.
    • Sends higher doses of nicotine to the brain faster.
    • Side effects include runny nose, throat irritation, and cough.
  • Nicotine Inhaler
    • Needs a prescription.
    • Looks and feels like a cigarette; can mimic the “feel” of smoking.
    • Don’t eat or drink for 15 mins after using the inhaler or while you are using it.
    • Can be used alone or with other forms of NRT.
    • Side effects include mouth/throat irritation and cough.

NRTs are not right for everyone. If you have a history of heart attack, chest pain, or abnormal heart rhythms, talk with your provider before starting any kind of NRT.

It is important to use NRT with other strategies to help you quit tobacco, including quit programs, calling a quit line, or attending a quit tobacco group/therapy. You can learn more about these programs here.

Want to quit tobacco? See our article Smoking Cessation. Where do I Start? for tips to help you quit.


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