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As mentioned earlier, the nicotine in cigarettes leads to actual physical dependence. This can cause unpleasant withdrawal symptoms when a person tries to quit. Nicotine replacement therapy (NRT) gives you nicotine – in the form of gums, patches, sprays, inhalers, or lozenges – but not the other harmful chemicals in tobacco. NRT can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting. Many studies have shown using NRT can nearly double the chances of quitting with success.

How does nicotine replacement therapy work?

Nicotine replacement therapy (NRT) can help with the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. Using NRT reduces those symptoms.

Many smokers can quit smoking without using NRT, but most of those who attempt quitting do not succeed on the first try. In fact, smokers usually need many tries – sometimes as many as 10 or more – before they’re able to quit for good. Most quitters go back to smoking within the first 3 months of quitting.

Lack of success is often related to the onset of withdrawal symptoms. So don’t be discouraged if you start smoking again. Just make a plan to stop again, and make your attempt more successful by adding another method or technique to help you quit. You can reduce withdrawal symptoms with NRT and reduce the way they affect you by getting support. This gives you a better chance of quitting and staying quit.

Getting the most from nicotine replacement therapy

Nicotine replacement therapy (NRT) only deals with the physical dependence. It’s not meant to be the only thing you use to help you quit smoking. You’ll need other methods that help with the psychological (emotional and mental) part of smoking, such as a stop smoking program. Use these support systems during treatment with NRT and for at least a few months after you quit. Studies have shown that this approach – pairing NRT with a program that helps to change behavior – can improve your chances of quitting and staying quit compared to approaches that use only one method.

The best time to start NRT is when you first quit. Often smokers first try to quit on their own then decide to try NRT a day or more into quitting. This does not give you the greatest chance of success, but don’t let this discourage you. There are many options for quitting smoking and staying quit. Just remember that it often takes many tries.

Are there smokers who should not use NRT?

The US Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guideline on Smoking Cessation in 2000 stated that NRT was safe for all adult smokers except pregnant women and people with heart or circulatory diseases. But the 2008 Clinical Practice Guidelines for treating tobacco dependence says that NRT (in this case, the nicotine patch) can be used safely under a doctor’s careful monitoring, even in people who have heart or blood vessel disease. Studies have found the benefits of quitting smoking outweigh the risks of NRT in people with cardiovascular (heart and blood vessel) disease. When looking at NRT use, the benefits of quitting smoking must outweigh the potential health risks of NRT for each person.

As of 2014 there’s still not enough good evidence one way or the other to be absolutely sure that NRT is safe for pregnant women. A 2012 analysis of 6 studies done on NRT in 1,745 pregnant women showed no significant differences in ill effects (such as miscarriage, premature birth, low birth-weight and newborn admission to an intensive care unit) between the NRT groups and the groups that didn’t get NRT. And smoking during pregnancy can cause these problems and many others, so many doctors think NRT is less harmful than smoking during pregnancy.

Also, while NRT exposes the fetus to nicotine, smoking exposes the fetus to nicotine and a number of other chemicals, too. Nicotine may have unknown effects as the child grows up, and this has not been carefully studied over the long term. With all of this in mind, it’s best to quit smoking before getting pregnant. If it’s too late for that, quitting in early pregnancy can still greatly reduce many risks to the baby. Smokers who find themselves pregnant should talk with their doctors right away to get help in choosing the best way for them to quit smoking.

Note that NRT has not yet been proven to help people who smoke fewer than 10 cigarettes a day. You might want to talk with your doctor about a lower dose of NRT if you smoke less than that but feel you need nicotine replacement.

Can you get too much nicotine from NRT?

Nicotine overdose is rare, but possible. NRT products are labeled to match the amount of nicotine you get from NRT to the amount you got when you smoked. If used this way, you should get a nicotine dose fairly close to what you’ve been getting from cigarettes. You don’t want to get more than that, because higher doses of nicotine can cause harm. Even just a bit too much can cause some of the milder symptoms listed below. To avoid this, follow dosing instructions carefully. Also, don’t use heat (like a heating pad or heat lamp) on the skin near your nicotine patch – you could absorb more nicotine due to the increased blood supply.

Nicotine absorbs through the skin and mucous membranes, so you must store and dispose of your NRT safely. Nicotine overdose can cause death. Because of their smaller size, overdose is more of a problem in children and pets. Keep NRT and used gum, patches, empty cartridges, bottles, etc., safely away from children and pets. Never drop them on the street or in open trash cans where kids and animals can reach them.

It’s very rare for an adult who is following the instructions to get a serious overdose. But especially with liquid forms (such as sprays and inhalers) that absorb quickly through the skin and mucous membranes, overdose could happen. All forms of nicotine can cause harm if too much is taken in.

Here are some symptoms of too much nicotine:

  • Headache
  • Nausea and vomiting
  • Belly pain
  • Diarrhea
  • Agitation, restlessness
  • Fast or irregular heartbeat
  • Cold sweat
  • Pale skin and mouth
  • Weakness
  • Tremors (shaking)
  • Confusion
  • Disturbed vision and hearing
  • Weakness
  • High blood pressure, which then drops
  • Dizziness or faintness due to low blood pressure
  • Seizures
  • Fast breathing in early poisoning, breathing may stop later

Call Poison Control and get emergency help if you suspect an overdose. If you are taking NRT as prescribed and are still having mild symptoms such as headache, vomiting, diarrhea, or sweating, lower your dose and talk to your doctor.

How do I know if I’m a light, average, or heavy smoker?

Most NRT products are recommended on the basis of how much you smoke. But there’s no formal category in any textbook or group that defines a light, average, or heavy smoker.

In general, a light smoker is someone who smokes fewer than 10 cigarettes per day. Someone who smokes a pack a day or more is thought of as a heavy smoker. An average smoker falls in between.

Sometimes a doctor will use the term pack year to describe how long and how much a person has smoked. A pack year is defined as the number of packs of cigarettes a person has smoked every day multiplied by the number of years he or she has smoked. Since 1 pack is 20 cigarettes, a person who has smoked 20 cigarettes a day for 1 year is considered to have smoked 1 pack year. Someone who has smoked 30 cigarettes a day (1½ packs) for 4 years is described as having smoked 6 pack years (1½ x 4), and so on. This is another way to figure out how high your risk of smoking-related disease might be.

Last Medical Review: 02/06/2014
Last Revised: 02/06/2014