Jun 1, 2001 Table of Contents

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education Web site.

Information from Your Family Doctor

Using the Nicotine Patch, Nicotine Gum, Nicotine Nasal Spray or Nicotine Inhaler

Am Fam Physician. 2001 Jun 1;63(11):2251-2252.

When you are ready to quit smoking, you may want to use nicotine replacement therapy to help you give up cigarettes. The cost of nicotine replacement therapy is about the same or less than the cost of cigarettes.

The nicotine patch, gum, nasal spray and inhaler are all forms of nicotine replacement therapy. All forms of nicotine replacement can help lessen your urge to smoke. This means you have less craving for nicotine when you stop smoking. You may still feel a craving to smoke, but don't smoke while using the patch, gum, nasal spray or inhaler.

Who should use nicotine replacement therapy?

Almost every smoker can benefit from using nicotine replacement therapy. If you are pregnant or if you have heart or blood vessel problems, your doctor will be careful about giving you the nicotine patch or gum.

How do I know what strength is right for me?

Patch

Most smokers should start using a full-strength patch (15 to 22 mg of nicotine) every day for 4 weeks and then a weaker patch (5 to 14 mg of nicotine) for another 4 weeks.

Gum

Many smokers should start using the 2-mg dose. However, you may want to start with 4-mg gum if you:

  • Smoke more than 20 cigarettes a day.

  • Smoke as soon as you wake up in the morning.

  • Have severe withdrawal symptoms when you don't smoke.

  • Have tried to quit on a lower dose and failed.

If you are a very light smoker (less than 10 to 15 cigarettes a day) or have health problems, your doctor can help you select the right dose.

Should I use the nicotine patch, gum, nasal spray or inhaler?

Any of these treatments can help once you are ready to quit. The choice is up to you. Some people don't like the taste of the gum or don't like chewing in public. They prefer the patch. Other people have been unable to quit on the patch and want to try the gum. Some people prefer to use a nasal spray and some prefer the inhaler. Using the nicotine patch, gum, nasal spray or inhaler almost doubles your chances of quitting. Here is some information to help you decide which one is right for you.

Nicotine Patch

Directions for use

At the start of each day, place a new patch on a part of your body between the neck and the waist. Put the patch on a new spot each day to lessen skin irritation.

Treatment period

The patch is usually used for up to 8 weeks.

Side effects

Some people who use the patch get a rash on their body where the patch is placed. Skin rashes are usually mild and easily treated. Moving the patch to another area of the body helps.

If you have any side effects from the patch, be sure to tell your doctor right away.

How to get the patch

You can buy the patch without a doctor's prescription. To be safe, carefully read and follow the directions inside the package. You can talk to your doctor about how to use it and how long to use it.

Nicotine Gum

Directions for use

The gum must be chewed in a special way to make it work. Chew it slowly until you notice a “peppery” taste. Then stop chewing and move the nicotine gum between your cheek and your gum. Each piece of nicotine gum should be kept in your mouth for about 30 minutes.

Treatment period

A regular schedule (at least one piece of nicotine gum every 1 to 2 hours for 1 to 3 months) may give the best results. Some people don't chew enough pieces of gum a day and or they don't chew the gum for 8 weeks. They might not get the most benefit from nicotine gum.

Side effects

Some people have mild side effects such as hiccups, upset stomach or sore jaws. Most of these side effects go away if the gum is used correctly.

If you have any side effects from the gum, be sure to tell your doctor right away.

How to get nicotine gum

You can buy the gum without a doctor's prescription. To be safe, carefully read and follow the directions inside the package. Also, you can talk to your doctor about how to use it and how long to use it.

Nicotine Nasal (nose) Spray

Directions for use

Apply one spray in each nostril. Use the spray one to two times each hour while you are awake. Use the spray at least 8 times a day. Don't use it more than 40 times a day.

Side Effects

The nasal spray may cause nasal irritation, diarrhea and a fast heart rate. If you have hay fever or sinus infection, ask your doctor about using one of the other forms of nicotine replacement therapy.

If you have any side effects from the nasal spray, be sure to tell your doctor right away.

How to get the nasal spray

You can only get the nasal spray with a doctor's prescription. To be safe, carefully read and follow the directions inside the package.

[corrected] Nicotine Inhaler

Directions for use

Inhale from a cartridge when you have a desire for a cigarette. Use no more than 16 cartridges a day for up to 12 weeks.

Side Effects

You might have irritation of throat and mouth when you first start to use the inhaler. It might make you cough. You should get over this after a while.

If you have any side effects from the inhaler, be sure to tell your doctor right away.

How to get the inhaler

You can only get the nicotine inhaler with a doctor's prescription. To be safe, carefully read and follow directions inside the package.


This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

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