Easy-to-read medicine information about nicotine replacement therapy (NRT) – what it is, how to use NRT safely and possible side effects.
What is nicotine replacement therapy?
Nicotine replacement therapy helps you to give up smoking by relieving the desire to smoke.
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.
Nicotine replacement therapy helps you to manage some of the withdrawal effects by providing your body with nicotine. It is usually used for 8-12 weeks but can be taken for a longer time if needed.
You can start nicotine replacement therapy while you are smoking, to help you cut down on the number of cigarettes you are smoking and eventually quit.
How do I choose the formulation that is suitable for me?
Nicotine replacement therapy comes in different forms – chewing gum, lozenges, skin patch, inhalator and mouth spray. Discuss with your doctor, nurse or pharmacist which formulation is suitable for you.
This decision will depend on many factors such as the number of cigarettes you smoke a day, whether you smoke within the first hour of waking, and personal preference.
Not all nicotine formulations are subsidised – the gum, lozenges and some strengths of the patches are subsidised if supplied on prescription or via the Quit Card Programme. The mouth spray and inhalator can be purchased over the counter from supermarkets or pharmacies for the normal retail price.
Some people find using two different formulations (the patch plus lozenges, gum or inhaler) helpful to reduce the cravings.
Smoking can change how some medicines work. Talk to your doctor if you are taking regular medicines, the dose may need to change when you stop smoking.
If you have diabetes, your blood glucose may need to be checked more often when you start using nicotine replacement therapy.
Like all medicines, nicotine replacement therapy can cause side effects, although not everyone gets them. These may be similar to smoking withdrawal symptoms. Often side effects improve as your body gets used to the new medicine.
Side effects
What should I do?
Tiredness
Headache
Dizziness
These are quite common when you first start taking nicotine and usually go away with time.
The gum is available in two strengths — 2 mg and 4 mg.
How to use nicotine chewing gum?
Chew 1 piece of gum when the urge to smoke occurs.
The dose is usually 8-12 pieces of the 2 mg strength or 4-6 pieces of the 4 mg strength per day.1
The maximum daily dose is 20 pieces of 2 mg strength gum or 10 pieces of the 4 mg strength gum.1
Chew the gum until the taste becomes strong, then rest it between the cheek and gum.
When the taste starts to fade, repeat this process. 1 piece of gum lasts for approximately 30 minutes.
To better manage nicotine cravings, some people are advised to use nicotine gum together with the patches. The strength of the patch and the gum will depend on the number of cigarettes you smoke a day, and whether you smoke within the first hour of waking. Your health care provider will advise you on the best dose for you.2
Avoid acidic drinks such as coffee or fruit juice for 15 minutes before chewing the gum.
Possible side effects
Like all medicines, nicotine replacement therapy can cause side effects, although not everyone gets them. These may be similar to smoking withdrawal symptoms. Often unwanted side effects improve as your body gets used to the new medicine.
Side effects
What should I do?
Tiredness
Headache
Dizziness
These are quite common when you first start taking nicotine and usually go away with time.
Restlessness
Anxiety
Difficulty in sleeping
Depression
Irritability
Tell your doctor if troublesome
Increased appetite
Weight gain
Tell your doctor if this is a concern
Scratchy throat
Increased salivation
Fast heart beats
This is quite common when using the chewing gum
Discuss with your doctor if troublesome - you may need to use a different formulation
Lozenges are available in two strengths — 2 mg and 1 mg.
How to use nicotine lozenge?
Suck 1 lozenge when the urge to smoke occurs.
The maximum daily dose is 25 of the 1 mg strength lozenges, or 15 of the 2 mg strength lozenges.1
Slowly suck the lozenge until the taste becomes strong, then rest it between the cheek and gum; when the taste starts to fade, repeat over 30 minutes.
To better manage nicotine cravings, some people are advised to use nicotine lozenges together with the patches. The strength of the patch and the lozenge will depend on the number of cigarettes you smoke a day, and whether you smoke within the first hour of waking. Your health care provider will advise you on the best dose for you.2
Avoid acidic drinks such as coffee or fruit juice for 15 minutes before sucking a lozenge.
Possible side effects
Like all medicines, nicotine replacement therapy can cause side effects, although not everyone gets them. These may be similar to smoking withdrawal symptoms. Often side effects improve as your body gets used to the new medicine.
Side effects
What should I do?
Tiredness
Headache
Dizziness
These are quite common when you first start taking nicotine and usually go away with time.
Restlessness
Anxiety
Difficulty in sleeping
Depression
Irritability
Tell your doctor if troublesome
Increased appetite
Weight gain
Tell your doctor if this is a concern
Scratchy throat
Dry mouth
Increased salivation
Difficulty in swallowing, mouth ulcers
This is quite common when using the lozenges
Discuss with your doctor if troublesome - you may need to use a different formulation
To better manage nicotine cravings, some people are advised to use nicotine gum or lozenges together with the patches. The strength of the patch, gum or lozenges will depend on the number of cigarettes you smoke a day, and how soon after waking in the morning you smoke. Your health care provider will advise you on the best dose for you.2
How to use nicotine patch?
Apply the patch once a day. Some patches stay on for 16 hours, some stay on for 24 hours.
You may switch to a lower strength over 3 to 4 weeks.
Put the patch on in the morning to dry, non-hairy skin on the hip, trunk, or upper arm.
Hold the patch on for 10–20 seconds to ensure it sticks.
Remove the old patch at bedtime if it is the 16 hour patch, or in the morning if it is the 24 hour patch. Put the new patch on a different area in the morning. Avoid using the same site for several days.
Dispose of used patches safely — fold the patch in half with the sticky sides together. Make sure to dispose of it out of the reach of children.
The patch can be used together with the gum or lozenges if you have breakthrough cravings for cigarettes.
Do not tear or cut nicotine patches.
Some procedures such as MRI scan may overheat the patch and burn the skin. Talk to your health care provider before your procedure.
Possible side effects
Like all medicines, nicotine replacement therapy can cause side effects, although not everyone gets them. These may be similar to smoking withdrawal symptoms. Often side effects improve as your body gets used to the new medicine.
Side effects
What should I do?
Tiredness
Headache
Dizziness
These are quite common when you first start taking nicotine and usually go away with time.
Restlessness
Anxiety
Difficulty in sleeping
Depression
Irritability
Tell your doctor if troublesome
Remove the patch before bedtime
Increased appetite
Weight gain
Tell your doctor if this is a concern
Skin irritation
Redness
Itching
This is quite common when using the patch
Discuss with your doctor if troublesome - you may need to use a different formulation
Use the inhaler when you get the urge to smoke or cravings for a cigarette.
Insert the cartridge into the device and draw in air through the mouthpiece.
The amount of nicotine from 1 puff of the cartridge is less than that from a cigarette; inhale more often than when smoking a cigarette (8–10 times as many puffs as when smoking a cigarette).1
Initially, use 1 cartridge when you have an urge to smoke or every 2-4 hours. For best results use 3-6 cartridges per day. Gradually reduce to 1-2 cartridges a day and then stop use.2
A single 15 mg cartridge lasts for approximately 40 minutes of continuous use.
Avoid acidic drinks such as coffee or fruit juice for 15 minutes before inhaling a puff from the cartridge..
Possible side effects
Like all medicines, nicotine replacement therapy can cause side effects, although not everyone gets them. These may be similar to smoking withdrawal symptoms. Often side effects improve as your body gets used to the new medicine.
Side effects
What should I do?
Tiredness
Headache
Dizziness
These are quite common when you first start taking nicotine and usually go away with time.
Restlessness
Anxiety
Difficulty in sleeping
Depression
Irritability
Tell your doctor if troublesome
Increased appetite
Weight gain
Tell your doctor if this is a concern
Scratchy throat
Nasal congestion
This is quite common when using the inhalator
Discuss with your doctor if troublesome - you may need to use a different formulation
Release the oral spray into the mouth. Hold the spray as close to the mouth as possible and avoid the lips.
Do not inhale while spraying and avoid swallowing for a few seconds after use.
Use 1–2 sprays in the mouth when the urge to smoke occurs or to prevent cravings.1
Do not have more than 2 sprays per episode (up to 4 sprays every hour), and a maximum of 64 sprays daily.1
If using in combination with nicotine patches, 1–2 sprays can be used at a time (up to 2 sprays every hour), up to a maximum of 32 sprays per day
Possible side effects
Like all medicines, nicotine replacement therapy can cause side effects, although not everyone gets them. These may be similar to smoking withdrawal symptoms. Often side effects improve as your body gets used to the new medicine.
Side effects
What should I do?
Tiredness
Headache
Dizziness
These are quite common when you first start taking nicotine and usually go away with time.
Restlessness
Anxiety
Difficulty in sleeping
Depression
Irritability
Tell your doctor if troublesome
Increased appetite
Weight gain
Tell your doctor if this is a concern
Scratchy throat
Nasal congestion
Irritation in the nostrils
This is quite common when using the oral spray
Discuss with your doctor if troublesome - you may need to use a different formulation
