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Which type of nicotine replacement may be right for you?

There’s no evidence that any one type of nicotine replacement therapy (NRT) is any better than another. When choosing the type of NRT you will use, think about which method will best fit your lifestyle and pattern of smoking. For example, do you want/need something in your mouth or something to keep your hands busy? Are you looking for once-a-day convenience?

Here are some important points to think about as you decide:

  • Nicotine gums, lozenges, and inhalers are substitutes you can put into your mouth that let you control your dosage to help keep cravings under better control.
  • Nicotine gums and lozenges are generally sugar-free, but if you are diabetic and have any doubts, check with the manufacturer.
  • Nicotine nasal spray works very quickly when you need it.
  • Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler. It also works very quickly.
  • Nicotine patches are convenient and only have to be put on once a day.
  • Both inhalers and nasal sprays require a doctor’s prescription.
  • Some people may not be able to use patches, inhalers, or nasal sprays because of allergies or other conditions.
  • Nicotine gum may stick to dentures or dental work making it hard to chew before “parking.”

Whatever type you use, take your NRT at the recommended dose, and use it only for as long as it’s recommended. If you use a different dose or stop taking it too soon, it can’t be expected to work like it should. If you are a very heavy smoker or a very light smoker, you may want to talk with your doctor about whether your NRT dose should be changed to better suit your needs.

Combining the patch and other nicotine replacement products: Using the nicotine patch along with shorter-acting products, like the gum, lozenge, nasal spray, or inhaler, is another method of NRT. The idea is to get a steady dose of nicotine with the patch and then use one of the shorter-acting products when you have strong cravings.

The few studies that have been done on combination NRT used this way have found that it may work better than a single product and it’s relatively safe. Still, more research is needed to prove this and find safe and effective doses. And the combined use of NRT products has not yet been approved by the FDA. If you’re thinking about using more than one NRT product, be sure to talk it over with your doctor first.

High-dose nicotine replacement therapy for heavy smokers: Another NRT option is to give smokers a higher dose based on the amount of nicotine that they have been getting from cigarettes. Sometimes this method requires larger than usual doses of NRT. High-dose NRT with patches has been studied with patients getting from 35 mg to 63 mg of nicotine per day. The research suggests that patients’ withdrawal symptoms go away with these higher doses and their cravings improve without harmful effects on the heart and circulation. Patients were carefully watched in these studies to make sure they were OK and were not becoming ill or having any problems. But not much is known about this option and research results using high-dose patches are mixed. High-dose NRT should be considered only with a doctor’s guidance and supervision. It may worsen things if you already have heart disease or other health problems.

When may I begin using nicotine replacement therapy?

You can start using NRT as soon as you throw away your last cigarette. You don’t need to wait a certain length of time to put on the patch or start using the gum, lozenge, nasal spray, or inhaler. You should double-check this information with the instructions on your chosen method of nicotine replacement, but in general there is no need to wait to start using NRT.

Can people start nicotine replacement therapy while still smoking?

Many smokers ask if it’s OK to start NRT while they’re still smoking. At this time the companies that make NRT products say that they should not be used if you’re still smoking, and the FDA has not approved them to be used in this way in the United States. But some research has been done with smokers using NRT while still smoking, with the intent to cut down on cigarettes and, over time, stop completely.

In 2009, researchers looked at several studies in which active smokers were given NRT over the long term. Overall, those who got NRT were more likely to quit smoking than those who got placebo (fake NRT), but all the studies included a lot of support and supervision from the doctor and health team. Side effects were minor in these studies. The most important thing is being sure that you are not overdosing on nicotine, which can affect your heart and blood circulation. It’s safest to be under a doctor’s care if you wish to try smoking and using NRT while you are tapering down your cigarette use.

Stopping nicotine replacement therapy

As mentioned before, most forms of NRT are meant to be used for limited periods of time. Use should be tapered down to a low dose before NRT is stopped. Studies to date have not shown that extending NRT use longer than the recommended time greatly impacts quit success.

Research is still being done to refine the use of NRT. For example, even though the patch is usually used for 3 to 5 months, some studies have suggested that using it for 8 weeks or less works just as well. But other researchers have noted that the risk of relapse goes up when nicotine replacement is stopped, even after it’s been used for 5 months. These differences have not been fully explained. More studies are needed to learn which smokers are likely to be successful using shorter or longer NRT than usual. If you feel that you need NRT for a different length of time than is recommended, it’s best to discuss this with your doctor.

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