Nicotine replacement therapy (NRT) products are a way of getting nicotine into your bloodstream without you smoking.
They can all be effective, so choose the product that suits you best.
NRT does not 'make' you stop smoking. You still need determination to quit the habit.
About nicotine replacement therapy (NRT) products
|Type of medicine||Nicotine replacement therapy|
|Used for||Stopping smoking|
|Also called||Nicorette®; Nicotinell®; NiQuitin®; NicAssist®, Voke®|
|Available as||Chewing gum, sublingual tablets (placed under the tongue), orodispersible (melt-in-the-mouth) film strips, lozenges, nasal spray, oral spray, inhaler, inhalator and patches|
Nicotine is a drug that is inhaled from the tobacco in cigarettes. It gets into the bloodstream and stimulates the brain. Most regular smokers are addicted to nicotine. Many people who want to stop smoking fail to succeed because nicotine addiction is strong and difficult to break. This is where nicotine replacement therapy (NRT) can help.
NRT is a way of getting nicotine into your bloodstream without you smoking. It acts as a substitute for the nicotine you usually get from cigarettes. It helps to prevent unpleasant cravings and withdrawal symptoms that can occur when you are stopping smoking. You can buy NRT products from pharmacies and other retail outlets, and they are also available on prescription. Getting nicotine from NRT is less harmful than from cigarettes, as the products do not contain the harmful chemicals that cigarettes do. Many different types of product are available - gums, patches, tablets, sprays, inhalators and lozenges. They can all be effective, so choose the one that suits you best.
NRT products stop, or reduce, the symptoms of nicotine withdrawal. This helps you to stop smoking or reduce the number of cigarettes you smoke, without the unpleasant withdrawal symptoms. Nicotine products do not 'make' you stop smoking. You will still need to want to succeed to break the smoking habit.
In the UK, NRT products may be available free of charge for people who get free prescriptions. Ask your pharmacist about free NHS 'Stop smoking' services in your area.
Before using NRT products
- Other medicines. Tell your doctor or healthcare professional if you are taking any other medicines, including those obtained without a prescription. This is because stopping smoking can change the way your body breaks down certain medicines. So, as a result of stopping, the dose of some prescribed medicines may need to be adjusted.
- Pregnancy. During pregnancy it is best to try to stop smoking without using nicotine replacement. However, using NRT is better than smoking and is therefore justified for women who are expecting a baby but finding quitting difficult. To minimise the exposure of the unborn baby to nicotine, products that are taken when required (such as gum, lozenge, spray, inhalator) are preferred to patches, but liquorice-flavoured products should be avoided. Patches can, however, be useful for women who are experiencing pregnancy-related nausea.
- Breastfeeding. Although a small amount of nicotine from NRT does get into breast milk, it causes less of a hazard to a baby than passive smoke does. Nicotine products that are taken when required (such as gum, lozenge, spray, inhalator) are considered preferable to patches for women who are breastfeeding.
- Children. Do not give NRT products to children under 12 years of age. It is best to ask your doctor before giving them to children over 12 years of age, as not all products are licensed for use in this age group.
- Medical conditions. If you have any of the following conditions it is best to discuss these with a doctor before using nicotine replacement products:
- Severe heart problems.
- Stomach ulcers and problems (this only applies to products taken by mouth).
- Uncontrolled thyroid problems.
- Liver or kidney problems.
- Lung or throat problems (this only applies to the inhalator or the nasal spray).
How to use NRT products
Nicotine patches provide a prolonged form of nicotine which helps to reduce craving over the course of a whole day. They are worn for 16 hours or for 24 hours each day. The 16-hour patches are removed at night, which helps to prevent any sleep disturbances. The 24-hour patches are helpful for people who experience strong cravings to smoke first thing in the morning. The patches come in different strengths. The manufacturers normally recommend that you reduce the strength of the patch used, gradually over time, before stopping completely.
A nicotine patch stuck on to your skin releases nicotine into your bloodstream. Remove the plastic backing from the patch before applying. Apply one patch each morning to an area of dry, non-hairy skin on your hip, chest or upper arm. Hold it in place for 10-20 seconds to make sure it sticks well. Remember to remove the previous day's patch before you apply the new patch, and place the new patch on a different area of skin. Do not apply patches to broken or infected skin.
The advantages of patches are that they are discreet and easy to apply. The disadvantage of patches is that a steady amount of nicotine is delivered. This does not mimic the alternate high and low levels of nicotine when you smoke. Products which release nicotine straightaway (such as gums, lozenges, sublingual tablets, inhalators and sprays - see below) are more suitable for this. Some people find that a combination of a patch with a product that releases nicotine straightaway works best for them.
Two different strengths of gum are available. You should use the 4 mg strength if you smoke 20 or more cigarettes a day, and the 2 mg strength if you smoke fewer than this. To release the nicotine, chew the gum slowly until the taste becomes strong, then rest it between your cheek and gums to allow the absorption of nicotine into your bloodstream. Chew the gum again when the taste fades, and rest it again when the taste is strong, and continue like this. One piece of gum lasts for about 30 minutes or so. You can use the gum as often as you need to, up to 15 pieces a day. If you are trying to quit smoking completely, use the gum for three months before you gradually reduce using it. Then, when you feel ready, use the gum less and less. For example, you can reduce the time you chew the gum, cut the gum into smaller pieces, or alternate the nicotine gum with a sugar-free gum. Then stop the gum completely.
The disadvantages of gum are that some people do not like the taste or always having something in their mouth. Gum is not suitable if you wear dentures.
This resembles a cigarette. Nicotine cartridges are inserted into a plastic holder, and inhaled in an action similar to smoking. There are two different strengths of cartridge available to use in the inhalator - 10 mg and 15 mg. You should use the inhalator whenever you feel the urge to smoke, or whenever you would normally expect to have cravings to smoke. It is up to you how many inhalations to take, how often to take them and for how long, but do not use more than 12 cartridges a day of the 10 mg strength or more than 6 cartridges a day of the 15 mg strength. The amount of nicotine you get from one puff of an inhalator is less than with a cigarette, so it is necessary to inhale more often than with a cigarette. When you feel ready (which could be after a number of weeks or months), you can reduce the number of cartridges you use each day. Inhalators are particularly suitable if you miss the hand-to-mouth movements of smoking.
There are several strengths of lozenge available. If you smoke fewer than 20 cigarettes a day, use one of the lower-strength lozenges. If you smoke more than 20 cigarettes a day, use one of the higher-strength lozenges. Place one lozenge in your mouth every 1-2 hours when you feel the urge to smoke, and suck it until the taste becomes strong. Rest the lozenge between your gums and cheek and then suck it again when the taste has faded. Continue like this to allow it to dissolve. Do not chew the lozenge or swallow it whole. It will last for about 10 to 30 minutes depending on the lozenge size. Do not eat or drink while the lozenge is in your mouth and do not use more than 15 each day. If you are trying to quit smoking completely, use the lozenges for 6-12 weeks before you gradually reduce using them.
Nicotine nasal spray
The nicotine in the spray is rapidly absorbed into the bloodstream from your nose. This form of nicotine replacement product closely mimics the rapid increase in nicotine level that you get from smoking cigarettes. This may help to relieve sudden surges of craving. Use one spray in each nostril when the urge to smoke occurs. You can use it up to twice every hour, but do not use more than 64 sprays a day. If you are trying to quit smoking completely, use the spray for eight weeks before reducing the dose. You can gradually reduce the amount you use by using one spray into one nostril only.
Nicotine sublingual tablets
Place the sublingual tablet under your tongue and allow it to dissolve slowly. This allows the nicotine from the tablet to be absorbed into your bloodstream from the lining of your mouth. Do not chew or swallow the tablets. You can use one or two tablets each hour (one if you normally smoke 20 or fewer cigarettes a day, two if you normally smoke more than this amount). Do not use more than 40 tablets each day. If you are trying to quit smoking completely, use the tablets for around three months before you gradually reduce using them.
Nicotine oral spray
Use the spray into your open mouth from as close to your mouth as you can while avoiding your lips. This allows nicotine to pass quickly into your body through the lining of your mouth. Do not breathe in as you spray, and try not to swallow for a few seconds after using it. You can use 1-2 sprays when you feel the urge to smoke or to prevent you craving a cigarette. You can use up to four sprays an hour but do not use more than 64 sprays each day.
Nicotine melt-in-the-mouth film strips
The film strip should be placed on your tongue and then, with your mouth closed, held against the roof of your mouth until it dissolves completely (in about three minutes). Do not chew the film strip or swallow it whole. Do not eat or drink whilst the film is in your mouth. At the start of treatment you should use one film every 1-2 hours and then gradually reduce how often you use them over the course of twelve weeks. Do not use more than 15 film strips per day.
Getting the most from your treatment
- Before you start using nicotine products, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about using the product you have been supplied with.
- Remember that you will need determination and willpower; setting a 'quit date' often helps.
Can NRT products cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the common ones associated with nicotine, although these can often be confused with nicotine withdrawal symptoms. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Common nicotine side-effects||What can I do if I experience this?|
|Feeling sick (nausea), indigestion||Stick to simple foods|
|A feeling that your heart is pounding (palpitations)||This feeling should soon settle. If you are worried or it becomes troublesome, speak with your doctor or smoking advisor|
|The nasal spray can cause nose and throat irritation, coughing, sneezing, nosebleeds, watery eyes, blurred vision||Do not use it whilst driving|
|Throat irritation, increased salivation, dry mouth, changes in bowel habit, bloating, wind (flatulence), swallowing problems, tingling feelings, hot flushes||Some products taken by mouth can cause these. If any become troublesome, speak with your smoking advisor about changing to an alternative product|
|The patches can cause some skin irritation beneath the patch||These effects are usually caused by not changing the site of application each day. Changing the site each day will allow any irritation to disappear|
|Patches can cause abnormal dreaming, aches and pains||Speak with your smoking advisor about changing to an alternative product|
|The 24-hour patch can cause difficulty with sleeping||Talk with your smoking adviser about changing to a 16-hour patch|
How to store nicotine replacement therapy
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
If you buy any medicines, always check with a pharmacist that they are safe to take with your other medicines.
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
If you are having any medical treatment, tell the person carrying out the treatment which medicines you are taking.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about your medicines, ask your pharmacist.
Further reading and references
Manufacturer's PIL, Nicorette 2 mg gum; McNeil Products Ltd, The electronic Medicines Compendium. Dated September 2020.
Manufacturer's PIL, Nicorette Invisi 15 mg Patch; McNeil Products Ltd, The electronic Medicines Compendium. Dated May 2020.
British National Formulary, 80th Edition (Sep 2020); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.