Nicotine replacement therapy (NRT) can help gradually reduce a person’s dependence on nicotine and prevent cigarette cravings.

There are several types of NRT:

  • patches
  • gum
  • lozenges
  • nasal spray
  • inhalers

Some types of NRT are available over the counter (OTC), while others may require a prescription. A 2018 study found that all forms of NRT increase the rate of quitting smoking by 50–60%.

This article reviews each type of NRT and how to choose the right one on an individual basis.

there is a black and white image of a man's torso with a white nicotine patchShare on Pinterest
Ralf-Finn Hestoft/Getty Images

Nicotine patches are a topical NRT. A person applies the patch to their skin per the instructions on the package.

How they work

Patches are available in both OTC and prescription forms.

They are available in three strengths: 7, 14, and 21 milligrams (mg) of nicotine.

Typically, if a person smokes more than 10 cigarettes per day, it is recommended they start with the 21-mg option. If they smoke fewer than 10 cigarettes each day, it is recommended they start with the 14-mg option. A person then slowly lowers their dose after about 8–12 weeks.

The Food and Drug Administration (FDA) has approved using nicotine patches for up to 5 months, but some people may find using them longer is necessary.

A person applies the patch once per day, often on the upper chest, upper arm, shoulder, back, or inner arm.

Learn about whether nicotine patches expire here.

Possible side effects

Nicotine patches may cause side effects in some people, such as:

A person may try switching brands, reducing their dose, or trying a different form of NRT if they experience any side effects.

Nicotine gum (nicotine polacrilex) provides a buccal dose of nicotine. This means a person absorbs the nicotine into the bloodstream through their gums and cheek. People can buy it without a prescription.

How it works

Nicotine gum is available in strengths of 2 and 4 mg. People who smoke within half an hour of waking, have trouble not smoking in restricted areas, or smoke more than 25 cigarettes per day may want to start with the higher dose.

A person chews the gum for a few seconds until a peppery or tingly taste starts, and then they tuck it into their cheek. The mucous membrane of the person’s gums then absorbs the nicotine from the gum.

When the flavor fades, the person chews the gum again and then holds it in their cheek. They repeat this process for about 20–30 minutes.

One of the main advantages of nicotine gum is that a person can choose how much nicotine they get. They can use a set schedule or chew it as needed throughout the day.

A person should follow all instructions on the packaging and avoid chewing more than 24 pieces of nicotine gum per day.

Experts recommend using the gum for about 6–12 weeks. A person should also consider reducing their use after 3 months to help reduce their nicotine intake.

Possible side effects

Nicotine gum may cause side effects in some people, including:

Some people may find the gum sticks to and damages dentures and dental work.

Lozenges are a form of oral NRT. They are available without a prescription.

How they work

Nicotine lozenges are available in doses of 2 and 4 mg.

To use, a person places the lozenge in their mouth and allows it to dissolve. The recommended doses are as follows:

  • 1 lozenge every 1–2 hours for 6 weeks
  • 1 lozenge every 2–4 hours for weeks 7–9
  • 1 lozenge every 4–8 hours for weeks 10–12

A person should not take more than 1 lozenge at a time. They should avoid drinking or eating 15 minutes before and while using the lozenges. A person should also allow the lozenge to dissolve completely without swallowing it.

If a person still feels the need to use lozenges after 12 weeks, they should talk with a doctor.

Possible side effects

Lozenges may cause some side effects, including:

Nicotine nasal sprays are only available with a prescription, so a person needs to talk with a doctor if they are interested in using a spray to help them quit smoking.

How they work

Nasal sprays create a mist that a person releases in their nostril and breathes in through their mouth. Absorption of the spray in the nose delivers the nicotine directly to the bloodstream quickly. It may help with cravings and reduce symptoms of nicotine withdrawal if they occur.

Typically, a person uses 1–2 sprays per hour. One spray in each nostril is equivalent to 1 dose.

At first, a person may start with up to 8 doses per day, but they may gradually reduce the number of doses to taper off nicotine slowly.

Possible side effects

Nasal sprays may cause some side effects. They often clear within 1–2 weeks. Side effects may include:

A person may also experience the following nicotine-related side effects:

  • headache
  • nervousness
  • racing heart

Nicotine inhalers are a form of NRT only available with a prescription.

How they work

Inhalers provide nicotine directly to the mouth and throat, which allows for quick absorption into the bloodstream.

The dose comes in a cartridge that a person can take all at once over about 20 minutes, or more slowly by puffing on it for a few minutes. The recommended dose is between 4 and 20 cartridges per day with a gradual tapering off over 6 months.

Possible side effects

Some people may experience side effects from using nicotine inhalers, such as:

  • upset stomach
  • coughing
  • mouth irritation
  • throat irritation
  • runny nose

Side effects are most common when first starting the treatment.

A person may also experience the following nicotine-related side effects:

  • headache
  • racing heart
  • nervousness

A person having trouble deciding which type of NRT may work best for them or who has tried to quit smoking before may find talking with a doctor helpful. A healthcare professional can provide recommendations and prescribe some types of NRT.

People already using NRT should consider speaking with a doctor if their cravings are not going away. A doctor can help them adjust their dose.

NRT may cause side effects, such as a racing heart, nervousness, or a headache. A person should let their doctor know if their NRT is causing these symptoms, or if other symptoms do not go away within a few days.

People may find that NRT helps them quit smoking by reducing cravings for cigarettes. However, a person may also benefit from using other strategies to help them stop smoking. recommends people aiming to quit smoking create a personal quit plan. The website provides a free tool a person can use to help develop a plan.

A person answers a few questions about when they want to stop, how much they spend on cigarettes, and their reasons for quitting. They can access the tool here.

NRT may help reduce cravings for cigarettes and help a person quit smoking. There are several forms of NRT to choose from.

Each type of NRT works differently and may cause different side effects. People should aim to taper off NRT slowly and consider using additional strategies to quit smoking.

A healthcare professional can help advise which type of NRT may work best for each person and monitor any side effects a person may experience.