Nicotine replacement therapy

Also known as NRT

Easy-to-read medicine information about nicotine replacement therapy (NRT) – what it is, how to use it safely and possible side effects.

On this page, you can find the following information:

What is nicotine replacement therapy?

  • Nicotine replacement therapy (NRT) is a medication that provides you with a low level of nicotine, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke.
  • NRT helps you to give up smoking by relieving the urge to smoke (cravings). 
  • When you give up smoking, your body will miss the effects of nicotine and you may have  symptoms such as irritability, frustration or anger, restlessness, sleeplessness, difficulty concentrating, depression, increased hunger or weight gain, and craving for cigarettes.
  • NRT helps you to manage some of the withdrawal effects by providing your body with nicotine. 

What are the benefits of NRT?

  • NRT can be used in place of cigarettes after going ‘cold turkey’ (giving up instantly) or it can be used to help you cut down on the number of cigarettes you are smoking and eventually quit.
  • NRT can double your chances of quitting.
  • NRT reduces the weight gain you may experience after stopping smoking
  • It is the safest option for pregnant women who need an extra aid to help quit smoking. Read more about stopping smoking in pregnancy and the section below is NRT safe to use if I am pregnant or breastfeeding?

Which types is best for me?

NRT comes in different forms. The skin patch releases nicotine slowly over 16 or 24 hours. Other products (chewing gum, lozenges, inhalator and mouth spray) act quickly and are better for helping with cravings.

When deciding which NRT or combinations of NRT to use, there are some things to consider and discuss with your doctor, nurse or pharmacist.

  • Think about the number of cigarettes you smoke a day, whether you smoke within the first hour of waking, and which option you prefer.
  • There's no evidence that any single type of NRT is more effective than another. However, there is good evidence to show that using 2 different NRT products (for example patches and gum) is more effective than using just 1. 
  • Often the best way to use NRT is to combine a patch with a faster acting form (eg, gum or inhalator,)to help cover your cravings.

How long should I take NRT for?

  • NRT is usually used for 8–12 weeks but can be taken for a longer time if needed. During this time, your NRT dose should be reduced with the aim of eventually stopping it. 
  • Some people stop using NRT too soon and can go back to smoking.
  • Make sure you have enough NRT on hand so you can manage your urge to smoke.

Watch this video on how to combine different types of NRT. 

How do I use NRT?

Click on the text below to learn more about how to use the different types of NRT.

What happens if I have a smoke during a quit attempt?

If you have a puff or a cigarette during a quit attempt, it doesn't mean you should stop trying to quit. It might be a sign that you aren’t using enough NRT. For example, you might need to increase how often you are using the faster acting types of NRT. It’s best to speak to your doctor, pharmacist or quit smoke support to help you work out what dose and frequency of NRT you should be using to prevent slip-ups.

Can NRT affect my usual medicines?

No, it is very unlikely that NRT will affect or interact with your usual medicines. Often interactions with medicines are caused by components of tobacco smoke itself, rather than nicotine. If you are  concerned about interactions with your medicines, talk to your pharmacist.

Can I get addicted to NRT?

The amount of nicotine in NRT is less than in a cigarette and it takes longer for the nicotine in NRT to get to the brain. Both of these factors mean it is unlikely you will become addicted to NRT. Some people stay on NRT for a longer period if recommended by their doctor because of their strong dependence on nicotine. But this is still safer than continuing to smoke. 

How much does NRT cost?

In the long run, NRT is cheaper than smoking – and it’s not an ongoing cost. Not all types of NRT are subsidised (low in cost) – the gum, lozenges and some strengths of the patches are subsidised if you get them prescribed for you or through the Quit Card Programme (from Quitline). They can be free from some stop smoking services.

You can call Quitline on 0800 778 778, by texting 4006 or online when you register. Quitline will send you a Quit Card to take to redeem at your local pharmacy. A 4-week supply of one of these products costs around $5 with the option of a free repeat.

The mouth spray and inhalator can be purchased over the counter from supermarkets or pharmacies for the normal retail price.  

Is NRT safe to use if I am pregnant or breastfeeding?

If you are pregnant or breastfeeding, NRT is much safer than smoking. It is best to stick to the fast acting types which include chewing gum, lozenges, inhalator and mouth spray. 

If you are pregnant

  • When using NRT, you and your baby are still exposed to nicotine. However, the nicotine is delivered at lower levels than smoking and without all the other harmful chemicals contained in cigarette smoke.
  • If you have pregnancy-related nausea and vomiting, patches may be a better solution. 
  • The skin patch should be removed before going to bed.

If you are breastfeeding

  • Nicotine does pass into your breastmilk but the amount that gets to the baby is very small and is much less than if you were smoking. 
  • If you do use faster-acting NRT, try to breastfeed your baby first, then use your faster-acting NRT soon after.

What are the possible side effects of NRT?

Like all medicines, NRT can cause side effects, although not everyone gets them and serious side effects are very rare. Side effects may be similar to smoking withdrawal symptoms and should disappear within 4 weeks as your body gets used to the new medicine.

For side effects, see the individual pages chewing gumlozengesskin patchinhalator and mouth spray.

Learn more

Nicotine replacement therapy NZ Formulary Patient Information
Quitline NZ for more information on quitting smoking

References

Nicotine NZ Formulary, 2022
The New Zealand guidelines for helping people to stop smoking update Ministry of Health, NZ, 2021
Getting the most out of nicotine replacement therapy BPAC, NZ, 2009
Facts about nicotine replacement therapy (NRT) Be Smoke Free, Australia  

Additional resources for healthcare professionals

Guide to prescribing nicotine replacement therapy (NRT)Ministry of Health, NZ, 2021
Smoking cessation beyond the ABC: Tailoring strategies to high-risk groups BPAC October 2014
Smoking cessation - helping patients stick with it, until they quit BPAC October 2015
Nicotine replacement therapy (NRT) works SaferRx NZ, 2018
Smokefree pharmacotherapy SaferRx NZ, 2016

Credits: Health Navigator Pharmacists. Reviewed By: Sandra Ponen, BPharm, MPH, Auckland Last reviewed: 25 May 2022