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Considering Nicotine Replacement Therapy

May 11 2021
6 min read
Closeup of doctor writing notes on clipboard as patient sits in the background.

You’re determined to quit smoking.

And while that commitment will be crucial to your success, it may not be enough to change your habit and secure lasting changes. For many, it takes a few tries—even as many as 11, according to one study—to put down that pack for good. And there’s a reason for that. You not only have emotional and behavioral attachments to smoking, but you’ve developed a physical dependency on nicotine, an extremely powerful substance.

This is what can make quitting ‘cold turkey’ so tough. Though it works for some, it often comes with withdrawal symptoms such as irritability, headaches, increased appetite and depression that can make lighting up all too tempting. Many find themselves disheartened by the struggle between what the heart and mind want (to quit) and what the body is saying it still needs (another cigarette). In these cases, nicotine replacement therapy (NRT) may help. Instead of abruptly removing something your body has come to depend on, these options allow you to slowly reduce the amount of nicotine in your system while you work on changing your feelings and behaviors toward smoking. This may help lessen cravings and discomfort as your body adjusts to your new lifestyle.

NRT products contain smaller quantities of nicotine than cigarettes, but none of their harmful tar, chemicals and additives. While it may seem counterintuitive to continue using the very substance you’re trying to quit, the tapering doses NRT options provide are far safer than puffing away. And some studies have shown that NRT may double your chances of quitting permanently, compared to going it alone.

Nicotine Replacement Therapy Options

If you think you may benefit from nicotine replacement therapy, speak with your doctor about the five forms on the market to determine if one may be appropriate for you. (NRT may not be advised for those with some heart conditions or who are pregnant.) Nicotine replacement options won’t do all of the work for you; seeking support from others and establishing an environment that’s conducive to your success are also key. But one of these may provide you that extra help you seek to quit for good.

Nicotine Gum: If you need something to take the physical place of a cigarette in your mouth, this over-the-counter option may be helpful. Pop at least one piece of gum every one to two hours, but no more than 24 pieces in a day. Start by slowly chewing the gum until you taste a peppery flavor, and then allow it to sit on the side of your mouth for about 25 to 30 minutes. During the recommended period of use (which is usually six to 12 weeks, but can be as long as six months) gradually use less and less gum before stopping entirely. You shouldn’t experience any side effects; however, hiccups, upset stomach or sore jaw are a possibility if you chew multiple pieces in quick succession. Sticking to it is important: Chewing too few pieces of gum or not continuing for the recommended treatment time may lead to ineffectiveness.

Nicotine Lozenges: These hard candies deliver nicotine to your system as they slowly dissolve in your mouth. Like gum, they are available without a prescription and provide an oral fix that may be soothing if you miss having a cigarette in your mouth. Suck on at least nine lozenges (but no more than 20) per day for six weeks. During the next, final six weeks, cut down on the number of lozenges used as your body becomes more accustomed to being nicotine-free (follow your doctor’s instructions). Taking lozenges one right after the other may cause hiccups, upset stomach or heartburn.

Nicotine Skin Patches: This over-the-counter option works best when used for eight weeks. During this time, affix the small, bandage-like patch on a different area of your skin (above the waist, but below your neck) each day so that you can receive a steady dose of nicotine over 24 hours. Over the course of your treatment, you’ll use patches with lower and lower levels of nicotine. Which strength patch you start with (there are several) depends on how much you smoke. But if you light up fewer than five times a day, even the weakest patch may be too potent for your needs. Those with sensitive skin or a dermatological disorder, such as psoriasis or eczema, should be aware that patches may cause irritation.

Nicotine Inhalers: This prescription-only device, which is different from an e-cigarette, consists of a plastic holder containing a nicotine cartridge; many like that it gives them something not only to put in their mouth, but hold. ‘Puff’ on the inhaler like you would a cigarette to receive about 4 mg of nicotine over 80 inhalations; you’ll go through anywhere from six to 16 cartridges per day, depending on your smoking history. The recommended dosage decreases during your last three months of treatment, which is not to exceed six months. Side effects can be similar to smoking cigarettes, including throat and mouth irritation, coughing and stuffy nose.

Nicotine Nasal Spray: You can use this spray for quick relief from cravings. It requires a prescription and is best if you’re experiencing severe withdrawal symptoms, or battling a pack-a-day or more habit. The initial dosage is one to two sprays in each nostril every hour, but may be increased as needed; aim for a minimum of eight doses, but no more than 40, each day. Nicotine nasal sprays are typically used for three to six months. You may experience nasal irritation, stuffy nose or even changes in sense of taste and smell with use.