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Nicotine Replacement Therapy (NRT)

It may seem counter-intuitive to put nicotine into your body when you're trying to quit tobacco, but NRT is about twice as effective for quitting smoking than cold turkey, and is now recommended for all smokers trying to quit (when medically appropriate). Studies indicate that NRT can also help smokeless users escape intense withdrawal when quitting, though the FDA hasn't approved NRT for that purpose.

How does NRT work?
NRT gradually decreases the amount of nicotine in your body as your quit progresses. This tapering-off process prevents the onset of full withdrawal--a primary relapse trigger--and allows you to continue living life normally as you quit.

There are five types of NRT. The patch is sold over the counter (OTC), and releases a small, steady dose of nicotine through the skin. The nicotine lozenge and gum, also OTC, are sucked or chewed and deliver limited nicotine through the blood vessels in your cheeks. The nicotine spray and inhaler require prescriptions, and are inhaled through the nose and mouth, respectively. On average, all nicotine replacement products approximately double the likelihood of successfully quitting smoking.

How do I know if I need NRT, or which I should use?
Revisit your quitting history. Do you tend to have severe withdrawal? Have you used NRT before? If so, which product do you feel most confident about? Which best fits your current lifestyle? For example, the patch might be a poor choice if you work a hot, sweaty job which could weaken the adhesive. Are you attached to the oral, hand-to-mouth aspects of smoking? This could make the gum, lozenge or inhaler the right choice. Your review, as well as a medical discussion with your doctor, will help you make a decision.

If you feel that NRT didn't work for you in the past, are you sure you used it properly, at the right dosage, and for the recommended duration? Did you have other support, and were you willing to make quitting a top priority? If you've successfully quit cold turkey in the past, you may consider doing so again, but identify where you stumbled last time and beef up the support and other components of your quit-plan.

Can I use NRT with other NRT or quit-medications?
If you're a heavy smoker, your doctor or quit coach could recommend a combination NRT. For example, you could supplement the patch with an oral NRT for emergency cravings. Since Zyban or Chantix don't necessarily eliminate all withdrawal symptoms, some treatment specialists recommend NRT as a supplement for these medications, too. Talk to your doctor.

Talk To Your Doctor Before Use If You:

  • are under 18 years of age
  • are pregnant or nursing

Content author: Alan S. Peters, CTTS-M
Reviewed by: Ann Wendling, MD, MPH, April 2013

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Nicotine Replacement Therapy
Intro to NRT
Nicotine Patch
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Varenicline (aka Chantix®/Champix®)
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