Products to Help you Quit: Nicotine Replacement Therapy

As you’ve probably figured out, there are a lot of stop smoking aids on the market that are supposed to help you quit smoking.  Some of the most common ones are what are called “Nicotine Replacement Therapy” products – like the patch, nicotine gum and lozenges, and nicotine sprays and inhalers. (The abbreviation “NRT” refers to this entire class of Nicotine Replacement Therapy products.) 

NRT products all work in about the same way and have similar success rates, so first I’ll talk about them all together here.  At the bottom of this page I give you my recommendations, and  at the tabs above you’ll also find more specific information about nicotine patches, nicotine gum and lozenges, and nicotine inhalers and sprays, if you’re interested in those specific stop smoking aids.

Stop Smoking Aids: How do they work? 

How do nicotine patches, nicotine gum, and other nicotine replacement products help you quit smoking?

The idea behind NRT is that quitting smoking will be easier if you don’t have to deal with nicotine withdrawal symptoms while you quit.  So NRT products work by replacing the nicotine you would have gotten from cigarettes after you quit smoking.  Since your body is still getting nicotine, you don’t suffer from nicotine withdrawal while you are using the NRT product.  For some people, this makes quitting smoking easier.

Of course, eventually you need to wean yourself off of the nicotine from the NRT product, too, or you have just replaced one type of addiction with another one…  Fortunately, most of these stop smoking aids come with instructions for tapering off the product after you’ve quit smoking.  Tapering helps to minimize nicotine withdrawal symptoms you might experience when you get off the NRT product. 

Here’s an important fact about NRT products:  According to the FDA, smoking while on NRT can be dangerous, so you really do have to quit before you start to use one of these.

Success Rates: Do NRT products really work?

Is there any evidence that nicotine patches, nicotine gum, and other NRT stop smoking aids actually help people quit successfully?

The answer to this is yes, there is research that shows that NRT stop smoking aids do help people quit, but the effect is relatively modest.  Meta-analytic research shows that NRT products increase your chances of quitting successfully by a factor of about 1.75.  In other words, people using some form of NRT were almost twice as likely to quit successfully as people who were not using NRT.  There was no difference in the success rates for different NRT products.

To keep this in perspective, though, the success rate for people quitting cold turkey is about 5%, so a product that doubles success rates would give you about a 10% chance of quitting successfully, on average, if used by itself.  (Keep in mind that most stop smoking aids can and should be used with a behavioral plan for quitting to improve your chances of success.)

Since all forms of NRT work basically the same way – that is, they all deliver replacement nicotine – it makes sense that the success rates are about the same.  So if you decide to try NRT, since there is no overall difference in success rates you can simply choose the one that fits your preferences.  Be sure to read the pros and cons below, and the pages about each type of NRT to find out about differences in levels of addictiveness and side effects you can expect, if you decide NRT is something you want to try. 

I also make some specific recommendations at the end of this page about nicotine replacement products generally, and about quitting smoking.

Pros and Cons

What are the pros and cons of NRT products overall?

Pros:

• The main ‘pro’ about NRT stop smoking aids is that they do help you deal with the physical addiction to nicotine when you quit smoking.  They do this by replacing the nicotine from cigarettes with the nicotine from the product, so that you don’t suffer from nicotine withdrawal while you are quitting.  (You may suffer some physical withdrawal later, when you have to wean yourself from the product, but it should be fairly minimal because of the tapering process.)

Cons:

• The primary downside is that NRTs by themselves do not help you deal with the psychological dependence, but if you choose to use them, they can – and should – be combined with a program or plan to help deal with psychological issues related to quitting smoking. 

• NRTs are physically addictive – just like cigarettes – because they contain nicotine, and will require you to ‘quit’ them, as well.  (See the pages on the different types of products to read more about which ones are most addictive and difficult to quit.)

• NRTs may have side effects, such as skin irritations, sleep disturbances, sore throat, etc., depending on which one you choose.  (You can read more about the specific side effects on the pages for each product type.)

• NRTs can be relatively expensive, ranging from about $250 for a full course of treatment with patches or gum to nearly $2,000 for a course of inhaler treatment.

• Some NRT products require a prescription from your doctor, making them less convenient.

How to Choose

How do you decide if an NRT approach is right for you, and if so, which stop smoking product should you choose? 

Since NRT helps only with the physical addiction, if you choose this option, it will be really important to combine it with a behavioral program to help you deal with the psychological aspects of smoking. 

The table below compares each of the NRT products to help you decide whether an NRT product may be the best quit smoking aid for you.  For comparison, I’ve include a simple alternative that works on the same principle as NRTs – the gradual reduction of nicotine.  This technique is called nicotine fading, which is sometimes used in structured programs for quitting.

Compare Stop Smoking Aids

	Prescription Needed?	Treatment Length	Addictive?	Side Effects?	Estimated Cost
Patch	No	8-10 weeks	Yes	Yes	~$225+
Gum	No	12 weeks	Yes	Yes	~$300
Lozenges	No	12 weeks	Yes	Yes	~$300
Nasal Spray	Yes	12-14 weeks	Highly	Yes	~$350+
Inhaler	Yes	3-6 months	Highly	Yes	~$1800+
Alternative technique:
Nicotine Fading	No	2 – 4 weeks	No	No	None

 

My Recommendations

The most important thing I can say about NRT stop smoking aids is that they are not a ‘magic pill’ that will make quitting effortless.  They are one way to help avoid the physical withdrawal from nicotine while you quit, but for most people, the psychological dependence is at least as important as the physical addiction, when it comes to trying to quit.  So my advice is to come up with a plan for dealing with the psychological aspects of your dependence, and then see if NRT works well within that plan. 

All of the FDA-approved NRT products pretty much do what they are designed to do, which is replace nicotine after you quit so you can temporarily avoid withdrawal symptoms.  However, they differ in areas such as cost, ease of use, and their level of addictiveness. 

If you think NRT may be right for you, use the links on this page to find out more about the different types of NRT stop smoking aids, including common side effects, contraindications for use and the potential for ongoing addiction. 

Can a Nicotine Patch Help You Quit?

Nicotine patches, along with nicotine gums & lozenges, and nicotine sprays & inhalers are all types of nicotine replacement products which work basically the same way – by replacing the nicotine from cigarettes with a dose of nicotine from the product.  (If you haven’t read about nicotine replacement  stop smoking aids overall, you may want to read that first.)   

Nicotine Patches use what is called a “transdermal” delivery system – in other words, through your skin - to provide a steady level of nicotine for the entire time you’re wearing it.  With these, it can take up to three hours to ‘deliver the hit,’ so you can’t regulate your nicotine intake in the moment the way you can with other NRT methods like gum or sprays.  On the other hand, you don’t get the up-and-down effect of a normal nicotine addiction, either, which is good.  Nicotine patches are easier to quit than other nicotine replacement methods, so that another bonus. 

The patches themselves look like large round or rectangular band-aids, and are applied to your skin in a similar way.

16-hour-a-day vs. 24-hour-a-day patches

Different brands of nicotine patches come in different formulations with regard to how long you are supposed to wear them: 24-hour-a-day patches and16-hour patches. 

The 16-hour patches are designed to be taken off before you go to bed at night.  When you wake up in the morning, you put on a new one.  The downside to this kind of patch is that you may experience some withdrawal symptoms or cravings in the morning, since it takes a while to get the nicotine flowing into your system via the patch.

24-hour patches are designed to be worn around the clock – you take off the old one and apply a new one immediately, once a day.  These can help avoid the morning cravings, but can result in sleep disturbances because of the extra nicotine that you get from wearing it while you’re trying to sleep.

A possible solution to this dilemma is to take the patch off at night (whether you use a 16 hour patch or a 24 hour patch), but supplement your nicotine intake in the morning with nicotine gum or lozenges, which can deliver the nicotine faster than the patch.

“Step-down” patches

Some brands offer patches in different nicotine amounts.  The idea is to start with a dose that meets your initial nicotine intake needs, and after a few weeks, switch to a lower dose, until you eventually quit using the patch altogether.  The three usual dosages are 21, 14, and 7 mg of nicotine per day. 

A gradual reduction in nicotine intake should result in less withdrawal, but you may still experience some minor symptoms when you quit the patch altogether.  If you decide to use the patch to help you quit, I do recommend going down to the 7 mg/day level.  Once you quit that, even if you experience some withdrawal symptoms, don’t go back to it.  On average your body can ‘flush out’ all of the nicotine you take in when you are at about 5 mg/ day, so as long as you don’t reintroduce more nicotine, any withdrawal you experience should be relatively minor and short-lived. 

Side Effects

Common side effects with the nicotine patch include skin irritation and sleep disturbances, especially if you use the kind that you wear through the night.  You could also experience dizziness, headaches, racing heart, nausea or vomiting, and muscle aches and stiffness.

Nicotine patches are available without a prescription, but if you develop any concerning side effects or if you have any serious medical conditions to begin with you will certainly want to check in with your doctor. 

Also, you should NOT smoke while using the patch, as you could get an overdose of nicotine.  Symptoms of nicotine overdose include vision problems, heart palpitations, low blood pressure, cold sweat, confusion, etc. 

Pros and Cons

What are the pros and cons of using a Nicotine Patch to help quit smoking?   

Pros:

• You can put it on and forget about it.  Of the all the nicotine replacement stop smoking aids, patches require the least maintenance, and so are behaviorally the most similar to not smoking at all.  This is good because you should be using the time you are on the patch to ‘get used to’ not smoking. 

• Patches give you a steady dose of nicotine – there are then no ‘ups and downs.’  Although you’re still on nicotine, you’ve at least gotten off the nicotine ‘rollercoaster.’

• The patch is the least addictive of the nicotine replacement products.  Because of its slow-and-steady delivery, it is not as addictive as the other forms of NRT, so it is easier to get off of when the time comes.

 Cons:

• There are side effects – not severe for most people, but they can be annoying.  You may want to consider whether the potential side effects are better or worse than symptoms from nicotine withdrawal.

• Cost – about the same as many other treatments, but still not cheap. 

• Slow nicotine delivery means that heavy smokers/morning smokers may have to choose between sleep disturbances (if you wear the patch all night) or morning cravings (if you take the patch off before bed).

Compare Nicotine Patches

	16 or 24 hours	Gradual reduction of nicotine?	Mg nicotine per day
Nicoderm CQ	24	Yes	7, 14, 24
Habitrol	24	Yes	7, 14, 21
Nicotrol	16	No	15
Alternative:
Nicotine Fading	NA	Yes	Infinitely variable

 

My Recommendations

If you want to use some form of NRT stop smoking aid, patches are my favorite choice, primarily because of the 'pros' listed above.

But my caveat concerning NRT aids generally also applies to nicotine patches: they are NOT a ‘magic pill’ that will make quitting effortless – you must still have a plan for eliminating the psychological dependence on cigarettes if you want to be successful.  However, that said, patches can help, for all of the reasons detailed above. 

If you decide to use the patch to help you quit, I do recommend using the ‘step’ method to gradually reduce your intake to the lowest level (7 mg/day).  This should help minimize withdrawal symptoms.   

Whether you should wear the patch for 16 hours a day or 24 depends on you: if you are a very heavy smoker who smokes first thing in the morning, you may want to wear the patch all night.  If you experience sleep disturbances, consider taking it off before going to bed, but using gum or lozenges to supplement your nicotine intake in the morning, before the patch has had a chance to kick in.

Stop Smoking Gum and Lozenges

Nicotine stop smoking gum and lozenges, along with nicotine patches, and nicotine sprays & inhalers, are all types of nicotine replacement products which work basically the same way – by replacing the nicotine from cigarettes with a dose of nicotine from the product.  (If you haven’t read about nicotine replacement stop smoking aids overall, you may want to read that first.) 

Stop smoking gum and lozenges deliver nicotine to your body through the lining of your mouth, NOT through your stomach/digestive system.  This method of delivery is still slower than cigarettes, but it is faster than the patch.  Sprays and inhalers are faster than gum and lozenges.  The only brand of stop smoking gum is Nicorette, and the nicotine lozenges are called "Commit."

The speed of nicotine delivery does two things: One the one hand, faster delivery means you can regulate your nicotine intake ‘in the moment.’  However, it also makes the product more addictive.  So gum and lozenges may be more difficult to quit than the patch (even with equivalent nicotine content), but less difficult than sprays and inhalers. 

How to Use Gum and Lozenges

Nicorette gum is used by chewing a piece when you have an urge for a cigarette.  The idea, however, is to make sure that the ‘juice’ from the gum is absorbed by the lining in your mouth, not swallowed and processed by your digestive system. 

The instructions for using nicotine gum instruct you to chew for a little while until you feel a tingle, which indicates that nicotine has been released.  Then you ‘park’ the gum between your gum and cheek to allow the nicotine to be absorbed through the lining of your mouth. 

If you decide to use stop smoking gum, be careful to follow these instructions.  If you just chew continually, instead of ‘parking’ the gum as directed, the nicotine goes through your digestive system instead of the lining in your mouth.  The end result is you’ll get an upset stomach, plus the nicotine won’t get into your system in sufficient concentration to alleviate withdrawal/craving, because of the length of time it takes to process through your digestive system.

Besides Nicorette gum, there is now also a lozenge to deliver replacement nicotine to your body, called the Commit lozenge.  The lozenge is used in basically the same way as stop smoking gum – you put a piece in your mouth when you need a dose of nicotine.  Of course, with the lozenges, it is important not to chew.  They take about half an hour to dissolve. 

Because you can choose the nicotine content of the gum/lozenges, and also ‘chew and park’ at your own intervals for the gum, these products allow you to control your nicotine dosage. 

Dosage

Both the gum and the lozenges come in two dosages: 2 mg and 4 mg.  Each piece of gum or lozenge contains the specified amount of nicotine.  The idea is that heavy smokers should start out with the larger dosage, and lighter smokers with the lower dosage.

A heavy smoker is alternately defined as someone who smokes more than 24 cigarettes a day, or someone who smokes their first cigarette within 30 minutes of waking up.  You could also calculate the amount of nicotine in the cigarettes you smoke by multiplying the nicotine content per cigarette – usually listed on the side of the pack – by your usual number of cigarettes per day. 

Maximum recommended number per day for lozenges is 20; for gum the maximum recommended number per day is 24. 

For both the gum and the lozenge, the idea ultimately is to use them for a couple of months and then gradually wean yourself off of them by reducing your intake. 

Side Effects

Side effects of both the stop smoking gum and lozenges include sore mouth, indigestion, and irritated throat.  Some people may also experience strange dreams or other sleep disturbances, jaw soreness, headaches and nausea. 

Many people don’t care much for the flavor, either, but manufacturers have been working to improve that, and there are now some different flavor choices available.

Gum or Lozenge?

Both the gum and the lozenge allow you to control your nicotine dose ‘in the moment,’ although it actually takes a few minutes to feel the effect.  So which should you choose? 

If you are a ‘chewer,’ stop smoking gum may be a natural choice for you.  (Certainly, if you’re one of those people – like me – who could never get to the center of a tootsie pop without biting, you’ll want to avoid the lozenges – chewing them is a bad idea.)  You may also want to consider using the nicotine patch, and just using regular (non-nicotine) chewing gum to freshen your breath and occupy your mouth.

Nicotine gum is a bit sticky and more difficult to chew than regular gum, so if you have problems with gum sticking to dental work, or if you just don’t want to be chewing all the time, consider trying the lozenges.  You might also consider using a patch instead of an oral nicotine product, and sucking on mints or cinnamon toothpicks to occupy your mouth. 

Pros and Cons

What are the pros and cons of using nicotine gum or lozenges to help quit smoking? 

 Pros

• Nicotine gum and lozenges are less addictive than sprays and inhalers, but more difficult to quit than the patch, when the time comes.

• They are easy to use, and allow you to control your nicotine dosage, including gradually weaning yourself off of them after a couple of months.

Cons

• Nicotine gum and lozenges require more attention than the patch – you have to consciously remember to put one in your mouth before you start craving nicotine, or you may begin to experience withdrawal symptoms.

• They are more difficult to quit than the patch.  It is not uncommon for quitters to report using nicotine gum for several months, or even a year or more.

• Cost – gums and lozenges may cost you a bit more than therapy with the patch, depending on your usage.  Still, it is within the range of most quit smoking aids.  

Compare Stop Smoking Aids

	Prescription Needed?	Treatment Length	Addictive?	Side Effects?	Estimated Cost
Patch	No	8-10 weeks	Yes	Yes	~$225+
Gum	No	12 weeks	Yes	Yes	~$300
Lozenges	No	12 weeks	Yes	Yes	~$300
Nasal Spray	Yes	12-14 weeks	Highly	Yes	~$350+
Inhaler	Yes	3-6 months	Highly	Yes	~$1800+
Alternative technique:
Nicotine Fading	No	2 – 4 weeks	No	No	None

 

My Recommendations

Like other NRTs, nicotine stop smoking gum and lozenges have been shown to be moderately effective at helping people quit smoking, so I wouldn’t discourage you from using them if they seem right to you, but see the two notes below.

1. Do remember that NRT products, including nicotine gum and lozenges, are NOT a ‘magic pill’ that will make quitting effortless – you must still have a plan for eliminating the psychological dependence on cigarettes if you want to be successful. 

2. While the research shows no overall difference in effectiveness, I think that the patch has some advantages over stop smoking gum and lozenges for dealing with the psychology of quitting.  Because of its slow and steady delivery of nicotine, you don’t have to respond to constant ‘ups and downs’ of nicotine levels in your body, as you do with other NRTs.  The patch will help keep withdrawal symptoms at bay while allowing you to learn new ways to respond to events.  The patch is also the least psychologically addictive of the NRTs, so it should be easier to quit when the time comes.

Sprays and Inhalers

Nicotine quit smoking aids such as sprays and inhalers, along with nicotine patches, and nicotine gum & lozenges, all work basically the same way – by replacing the nicotine from cigarettes with a dose of nicotine from the product.  (If you haven’t read the overview about nicotine replacement stop smoking aids, you may want to read that first - there you will find success rates and comparisons of different nicotine quit smoking aids.) 

Nasal sprays deliver the nicotine through your nasal passages, and nicotine inhalers through the tissues in your mouth in a matter of seconds.  They are by far the quickest delivery systems, and allow you to regulate your nicotine intake as you feel necessary.  The downside to this very rapid delivery of nicotine is that nicotine sprays and inhalers are also the most addictive of the nicotine quit smoking aids, and therefore the most difficult to wean yourself from, too. 

Both sprays and inhalers require a doctor’s prescription. 

Nicotine Spray

Nicotine spray (the brand name is Nicotrol) comes in a small bottle with a metered spray pump designed to dispense a measured dose into each nostril.  You use it by putting your thumb on the bottom of the bottle and a finger on either side of the top to pump one spray into each nostril for a ‘dose.’  The nicotine in the fluid is absorbed through your nasal passages.  (You don’t inhale or ‘sniff’ the fluid.)

Nicotine Inhaler

The nicotine inhaler consists of a mouthpiece and cartridges that you put into your mouth a ‘puff’ on for 20-30 minutes.  Using the nicotine inhaler to quit smoking is both expensive and somewhat labor intensive.  You must puff on it 3-4 times to get the equivalent nicotine as a puff from a cigarette.    Each cartridge is good for about 20 minutes of active puffing, and the recommendation is to use at least six, but no more than 16 cartridges per day. 

Side Effects

All nicotine quit smoking aids are addictive, but a sprays and inhalers are the most addictive of them all.  A secondary addiction to nicotine spray or the nicotine inhaler is very likely.  In other words, because of the delivery method of these nicotine replacement therapy products, you will likely become addicted to them instead of cigarettes as you use them to quit, so you will have to wean yourself from the product itself as the final step in your quitting process. 

Besides the secondary addiction, side effects for these nicotine quit smoking aids can include irritation of the nose/throat/mouth, and sometimes upset stomach. 

Pros and Cons

What are the pros and cons of using a Nicotine Inhalers or Nicotine Sprays to help quit smoking? 

Pros

• Nicotine sprays and inhalers, like other NRT products, can help you quit.  They allow you to regulate your nicotine dosage.  However, it is this very feature that makes them so addictive.

 Cons

• The inhaler in particular can be very expensive, running upwards of $1800 for a full course (6 months) of treatment

• Both the spray and the inhaler require a doctor’s prescription

• Sprays and inhalers are the most addictive of all of the NRT stop smoking aids, which means they are also the most difficult to quit, with no measurable increase in overall effectiveness.   

Compare Quit Smoking Aids

As you can see in the table below, the spray and the inhaler require a prescription from your doctor, generally require a somewhat longer treatment period, are both more highly addictive and more expensive than other NRT options. 

	Prescription Needed?	Treatment Length	Addictive?	Side Effects?	Estimated Cost
Patch	No	8-10 weeks	Yes	Yes	~$200+
Gum	No	12 weeks	Yes	Yes	~$300
Lozenges	No	12 weeks	Yes	Yes	~$300
Nasal Spray	Yes	12-14 weeks	Highly	Yes	~$350+
Inhaler	Yes	3-6 months	Highly	Yes	~$1800+
Alternative technique:
Nicotine Fading	No	2 – 4 weeks	No	No	None

 

My Recommendations

As I mentioned on previous pages, Nicotine Replacement Therapy in general has been shown to have a moderate effect at helping people quit smoking, but these products are not by a long stretch the ‘magic pill’ that will make quitting effortless. 

Sprays and inhalers require a doctor’s prescription for a very good reason – they are quite addictive!  I would consider this a therapy of last resort.  If you feel you’ve tried everything else, including a good behavioral program to help you overcome the psychological dependence on smoking, then perhaps this is worth trying – but BE SURE you’ve done your homework around the psychology of your nicotine addiction, because otherwise you’ll probably just trade your smoking addiction for a nicotine spray or inhaler addiction.