Providing information, advice and support to smokers to access NRT should be guided by your national medicines and health products/devices regulation. Always consult your national regulator. The information given here is for general guidance and should not be treated as specific advice.

Role of nicotine replacement therapy (NRT)

The nicotine in cigarettes leads to physical dependence. WHO international disease classification ICD 10 lists smoking as a nicotine dependency disease (Code F17.2). This can cause unpleasant symptoms when a person tries to quit. Nicotine Replacement Therapy (NRT) gives people nicotine -- in the form of gums, patches, sprays, inhalers or lozenges -- but not the other harmful chemicals in tobacco. It 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 smoker's withdrawal symptoms. NRT should be combined with other smoking cessation methods that help the psychological (emotional and habitual) part of smoking, such as a behavioral changing program. This approach -- pairing NRT with a program that helps to change behavior - can double chances to quit and stay quit.

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

Using NRT

The best time to start NRT is on the Quit Date. The most important thing is to make sure that you are not overdosing on nicotine, which can affect your heart and blood circulation. It is the 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. NRT is licensed for all adult smokers in many countries. However, you must seek physician’s advice when considering pregnant women and people with heart or circulatory diseases. Pregnant smokers should talk with their doctors to get help in choosing the best way for them to quit smoking.

There is limited evidence to support that one type of NRT is far better than another. There is, however, evidence base that suggest that combined therapy (Patch and Nasal Spray, Gum and Nasal Spray) may work better for some smokers. When choosing which type of NRT you will use, think about which method will be the best fit on your lifestyle and pattern of smoking. Whatever type you use, take your NRT at the recommended dose, and for as long as it is 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.

Types of NRT

The US Food and Drug Administration (FDA) has approved 5 types of NRT: Patch, Gum, Nasal spray, Inhalers, Lozenges(1). They can be applied with or without a prescription. Many types and different strengths are available. Dose can be applied depending on smoking amount and physical condition.

• Nicotine patches (transdermal nicotine systems): Patches give a measured dose of nicotine through the skin. You are weaned off nicotine by switching to lower-dose patches over a course of weeks. The FDA recommends using the patch for a total of 3 to 5 months.
• Nicotine gum (nicotine polacrilex): Nicotine gum is a fast-acting form of replacement in which nicotine is taken in through the mucous membrane of the mouth. You can buy it over the counter without a prescription. It comes in 2 mg and 4 mg strengths. Nicotine gum is usually recommended for 1 to 3 months, with the maximum being 6 months. If you have sensitive skin, you may prefer the gum to the patch.
• Nicotine lozenges: Nicotine-containing lozenges as an over-the-counter aid to stop smoking are the newest form of NRT on the market. As with nicotine gum, the lozenge is available in 2 strengths: 2 mg and 4 mg. Smokers choose their dose based on how long after waking up they normally have their first cigarette.
• Nicotine nasal spray and nicotine inhaler: These are available only by prescription.
• Combining the patch and other nicotine replacement products: Using the nicotine patch along with shorter-acting products such as 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 to use one of the shorter-acting products when you have strong cravings. If you are thinking about using more than one NRT product, be sure to talk it over with your doctor first.

Stopping NRT

Most forms of NRT are meant to be used for limited periods of time. Usage should be tapered down to a low dose before NRT is stopped. If you feel that you need NRT for a different length of time than is recommended, it is the best to discuss this with your doctor.