Nicotine gum and lozenges release nicotine slowly into the mouth.

Nicotine patches stick to your skin and slowly release nicotine through the skin into your bloodstream.

The nicotine inhaler has a holder that contains nicotine. The inhaler delivers a puff of nicotine vapor into your mouth and throat.

You can buy nicotine gum, patches, and lozenges without a prescription. You do need a prescription to buy nicotine inhalers.

Note: Nonprescription nicotine replacement therapy products cannot be sold legally to people younger than age 18. A doctor may prescribe one of these products if a person younger than 18 is dependent on nicotine.

How It Works

Nicotine replacement therapy (NRT) helps reduce nicotine withdrawal and craving by supplying your body with nicotine. It contains about one-third to one-half the amount of nicotine found in most cigarettes.

People become dependent on the nicotine in cigarettes because it increases the levels of certain chemicals, such as dopamine and norepinephrine, in their brains. When people quit smoking, the levels of those chemicals drop, and their bodies react by having nicotine withdrawal symptoms such as grouchiness and hunger. Nicotine from medicines increases the levels of dopamine and norepinephrine just like nicotine from cigarettes does. Chemical levels in the brain are kept level so withdrawal symptoms are reduced.

When you inhale tobacco smoke, the nicotine in the smoke moves quickly from your lungs into your bloodstream. The nicotine in replacement products takes much longer to get into your system. This is why nicotine replacement medications are much less likely to cause dependence on nicotine than are cigarettes and other tobacco products.

Nicotine replacement therapy is safe when used properly. Nicotine by itself is not nearly as harmful as smoking. Tars, carbon monoxide, and other toxic chemicals in tobacco cause harmful effects, not the nicotine.

What To Think About

Do not continue to smoke while you are using nicotine replacement therapy. You may overdose on nicotine if you smoke regularly and use nicotine replacement products at the same time. An overdose of nicotine can cause headaches, nausea, confusion, and vomiting. If you think you have overdosed, call your doctor right away.

Regardless of the method you use to quit smoking, you may cough more or start coughing for the first week after you quit. This is not a symptom of withdrawal from nicotine—it is the result of your body trying to clear your lungs. This happens whether you use nicotine replacement therapy or not.

With nicotine gum, lozenges, and the inhaler, not taking enough is a common cause of relapse. Avoid drinking beverages, especially acidic beverages (such as coffee, juices, and soda pop) for 15 minutes before and after you use these products. Your body may not absorb the nicotine well because of the acid in these drinks.

Choosing a form of nicotine replacement therapy is usually a matter of personal choice. People who smoke heavily are more successful when they use the strongest forms of the product (gum or lozenge with 4 mg of nicotine or patches with 21 mg or more nicotine in each patch).²

You will begin using a nicotine replacement product on your quit date, not before as with other forms of treatment.

If you find you cannot continue to use one form of nicotine replacement because of its side effects, stop using that form and try a different one. Remember, using nicotine replacement products doubles your chances of quitting smoking.

Long-term use of nicotine gum has not been found to be harmful.

Nicotine replacement therapy will reduce most but not all of the nicotine withdrawal and other symptoms associated with quitting smoking.

By the time you finish nicotine replacement therapy, you will have greatly decreased your dependence on nicotine. You also will have started to get used to not smoking at the usual times. This will take longer for people who have smoked for many years and may mean using nicotine replacement products for several weeks or months. Stopping nicotine replacement therapy too early is a common cause of relapse. When you finally reduce your nicotine intake to zero, you still may have some symptoms of nicotine withdrawal. But these symptoms won’t last. Using nicotine replacement products makes symptoms less severe.

Talk to your doctor before you use two forms of nicotine replacement (such as a nicotine patch and nicotine gum) at the same time.

Using bupropion and nicotine replacement products together may work well for some people who smoke, but it should be tried only under a doctor’s care. Your doctor may recommend bupropion alone instead of using two medicines.

Nicotine nasal spray (Nicotrol) is not widely used.

Nicotine is the primary ingredient in tobacco products.

Nicotine in medical products is used to aid in smoking cessation. Using a controlled amount of nicotine helps reduce nicotine withdrawal symptoms when you quit smoking.

Nicotine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about nicotine?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

You may not be able to use certain forms of this medicine if you have medical conditions that could interfere with use. Ongoing nasal or sinus problems (such as allergies, nasal polyps, or sinusitis) could affect safe use of the nasal spray form of nicotine. Mouth or dental problems may affect safe use of nicotine gum or lozenges. A skin condition may affect safe use of nicotine transdermal patches. Talk with your doctor about the best form of nicotine for you to use.

Do not smoke while you are using nicotine. Stop smoking as soon as your treatment begins. Smoking while using this medication can be dangerous.

What should I discuss with my healthcare provider before using nicotine?

You may not be able to use certain forms of this medicine if you have medical conditions that could interfere with use. Ongoing nasal or sinus problems (such as allergies, nasal polyps, or sinusitis) could affect safe use of the nasal spray form of nicotine. Mouth or dental problems may affect safe use of nicotine gum or lozenges. A skin condition may affect safe use of nicotine transdermal patches. Talk with your doctor about the best form of nicotine for you to use.

Before using this medication, tell your doctor if you have:

• heart disease, an irregular heartbeat, high blood pressure or chest pain;
• a jaw condition called TMJ (temporomandibular joint) disease;
• an overactive thyroid;
• diabetes;
• pheochromocytoma (tumor of the adrenal gland);
• liver or kidney disease;
• a stomach ulcer; or
• asthma or chronic pulmonary disease.

You may not be able to use nicotine, or you may require a dosage adjustment or special monitoring if you have any of the conditions listed above.

Nicotine oral lozenges may contain phenylalanine. Tell your doctor if you have phenylketonuria (PKU).

Nicotine can cause harm to an unborn baby. Do not use nicotine if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Nicotine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take nicotine?

Use nicotine exactly as it was prescribed for you. Do not use the medication in larger amounts or for longer than recommended by your doctor.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

To use the patches:

• Choose a different place on your body to wear the patch each time you put on a new one. Do not use the same skin area twice within 7 days.
• Apply the patch to clean, dry, and hairless skin on the outer part of your upper arm or on your chest. Remove the patch after 24 hours and replace it with a new one.
• If you are using Nicotrol patches, apply a new patch each morning and remove it at bedtime. Do not wear the patch while you are sleeping. If you are using Nicoderm CQ, you may wear the patch for 16 or 24 hours. If you crave cigarettes when you wake up, you may wear the patch for 24 hours. Do not wear the patch at night if you have vivid dreams or trouble sleeping.

To use the chewing gum or oral lozenges:

• Place a piece of gum or a lozenge in your mouth.
• Chew the gum slowly several times and stop chewing when you notice a tingling sensation or a peppery taste in the mouth. “Park” the gum between your cheek and gum and leave it there until the taste or tinging sensation is almost gone. Then slowly chew a few more times until the taste or sensation returns. Park the gum again in a different place in your mouth. Chewing too much or too quickly can cause too much nicotine to be released from the gum and you may have side effects such as nausea, hiccups, or stomach problems. Remove the gum after 30 minutes, or when the taste or tingle no longer return when you chew the gum.
• Allow the lozenge to dissolve slowly without chewing or swallowing. You may notice a warm or tingling sensation in your mouth. Move the lozenge from one side of your mouth to the other while it is dissolving.
• Do not eat or drink for 15 minutes before using the gum or lozenge and while the medicine is in your mouth.

To use the nasal spray:

• Blow nose if it is not clear. Tilt head back slightly. Insert the tip of bottle into your nostril as far as comfortable. Spray once in each nostril. Do not sniff, swallow, or inhale while spraying. If your nose runs, gently sniff to keep the medicine in. Wait 2 or 3 minutes before blowing your nose. Do not use more of the medication than is directed.
• Recap the bottle after each use. If you don’t use the nasal spray for 24 hours, prime the pump by spraying several sprays into a tissue 1, then throw the tissue away.
• Do not get nicotine spray into your eyes or mouth or on your skin. If this does occur, rinse the area with water.

To use the inhaler:

• Inhale deeply or puff in short breaths. As you inhale through the mouthpiece, nicotine turns into a vapor and is absorbed into the mouth and throat. Nicotine in cartridges is used up after about 20 minutes of active puffing.

Keep used and unused nicotine patches or gum out of the reach of children and pets to prevent poisoning. Used bottles of nasal spray should be thrown away with their child-resistant caps in place.

Store nicotine products at room temperature away from moisture, heat, and direct sunlight.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine, or if anyone has accidentally swallowed it.

Symptoms of a nicotine overdose may include nausea; vomiting; diarrhea; stomach pain; cold sweat; headache; dizziness; problems with hearing or vision; confusion; uneven heartbeats; chest pain; seizures; and death.

What should I avoid while taking nicotine?

Do not smoke while you are using nicotine. Stop smoking as soon as your treatment begins. Smoking while using this medication can be dangerous.

What are the possible side effects of nicotine?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using nicotine and call your doctor at once if you have any of these serious side effects:

• seizures; or
• chest pain or uneven heartbeats.

Continue using nicotine and talk with your doctor if you have any of these less serious side effects:

• dizziness;
• belching or hiccups;
• stomach upset or nausea;
• mouth or throat soreness;
• dry or watering mouth;
• watering eyes;
• headache;
• runny or stuffy nose (when using the nasal spray);
• white patches or sores inside your mouth or on your lips (when using the inhaler);
• constipation;
• sneezing and coughing;
• changes in taste; or
• redness, itching, or burning where the patch is worn.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Chemical Name: varenicline

How It Works

Varenicline is a pill you take that acts on sites in the brain affected by nicotine. Like nicotine medicines, varenicline helps with craving and withdrawal symptoms. But it also blocks the effects of nicotine from tobacco. If you start smoking again while taking varenicline, the medicine lowers the sense of satisfaction you get from smoking, improving the chances that you will quit.

Varenicline does not contain nicotine and does not help you quit smoking in the same way that nicotine replacement therapy does.

You start taking varenicline about a week before you quit smoking, and you take it for a total of 12 to 24 weeks.

What To Think About

You start taking varenicline about a week before you plan to stop smoking. You may notice that you do not get the same satisfaction from cigarettes during that week. Try not to increase your smoking to overcome this.

You take varenicline 2 times a day, after meals.

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

When you stop smoking, there may be a change in how these medicines work for you.

Tell your doctor if you:

• Have kidney problems.
• Are pregnant or plan to become pregnant.
• Are breast-feeding.

Some studies show that varenicline helped more people quit smoking than bupropion hydrochloride (Zyban), another medicine that does not contain nicotine and helps people quit smoking. No studies have tested if varenicline works better than nicotine replacement medicines.

Chemical Name: bupropion hydrochloride

How It Works

Bupropion is a pill you take to reduce your craving for tobacco. The way it does this is not entirely known. Bupropion does not contain nicotine and does not help you quit smoking in the same way that nicotine replacement therapy does.

Doctors also prescribe bupropion (under the brand name Wellbutrin) to treat depression. However, bupropion’s ability to help people quit smoking is not related to its antidepressant action. It can help you stop smoking even if you do not have depression.

You begin taking bupropion daily, 1 to 2 weeks before you quit smoking. This builds up the level of medicine in your body. You take bupropion for 7 to 12 weeks after you stop using tobacco. You can take it for as long as 6 months to a year.

What To Think About

You begin using bupropion 1 to 2 weeks before you quit smoking so that you build up the level of medicine in your body. Some people prefer this to other treatments because, it does not contain nicotine and they have something to rely on before their quit date. On the other hand, some people prefer a product they can take as needed for quick relief when craving occurs.

Like other treatments, bupropion works best when it is part of a program that includes setting a quit date; having a plan for dealing with things that make you reach for a cigarette (smoking triggers); and getting support from a doctor, counselor, or support group.

Using bupropion along with nicotine replacement therapy (such as nicotine patches, gum, or inhaler) may work better than either therapy alone. Talk to your doctor before combining bupropion with nicotine replacement therapy.

Bupropion should not be used during pregnancy unless you and your doctor decide the benefits outweigh the risks and you are unable to quit smoking without using medicine. Women should not breast-feed while taking this medicine. Talk with your doctor about whether you can use this medicine during pregnancy.

Clonidine is available by prescription in pill or patch form.

Clonidine has not been approved by the U.S. Food and Drug Administration (FDA) for use in helping people to quit smoking. However, the Tobacco Use and Dependence Clinical Practice Guideline Panel of the U.S. Public Health Service recommends it as a second-choice medication for this use.

The preferred medications to help you quit smoking are bupropion, varenicline, and nicotine replacement therapy.

What To Think About

Side effects can limit clonidine’s usefulness for helping people quit smoking. It often has more side effects than other medicines used to help people quit smoking.

You begin using clonidine 3 to 4 days before your quit date to build up the level of medicine in your body. You use the patch for up to 10 weeks.

You will change the clonidine patch weekly.

Although the U.S. Food and Drug Administration (FDA) has not approved nortriptyline for use in smoking cessation, the Tobacco Use and Dependence Clinical Practice Guideline Panel of the U.S. Public Health Service recommends it as a second-choice medicine for this use.

The preferred medicines to help you quit smoking are bupropion, varenicline, and nicotine replacement therapy.

What To Think About

Start taking nortriptyline 10 to 28 days before your quit date, and continue the medicine for 12 weeks after quitting smoking.