Cochrane for Clinicians

Putting Evidence into Practice

Nicotine Replacement Therapy for Smoking Cessation


Am Fam Physician. 2020 Jul 1;102(1):17-18.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does combining long-acting and short-acting nicotine replacement therapy (NRT) help patients quit smoking? Is any single form of NRT more effective than another?

Evidence-Based Answer

Patients using a combination of nicotine patch and fast-acting NRT are more likely to quit smoking than those on any single therapy alone (number needed to treat [NNT] = 29; 95% CI, 20 to 47). Rates of smoking cessation are not significantly different when directly comparing nicotine patches with fast-acting forms (e.g., lozenges, gum, inhalers, sprays), although dropout rates are higher with fast-acting forms. Rates of smoking cessation do not significantly differ among the various fast-acting forms.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

In 2017, roughly 47.4 million U.S. adults (19.3%) used tobacco products; cigarettes were the most commonly used product.2 Tobacco use is a leading cause of preventable illness and death worldwide, accounting for more than 7 million deaths annually.1 Although two-thirds of smokers are interested in quitting, less than one-third use evidence-based cessation aids, and less than 10% successfully quit annually.3 The authors of this review sought to determine the effectiveness and safety of different formulations, doses, durations, and schedules of NRT.

This review included 63 randomized controlled trials, involving 41,509 participants, that compared various forms of NRT with a primary outcome of smoking cessation at six months (with or without additional 12-month follow-up) and a secondary outcome of cardiac adverse effects.1 Participants were 45 years of age on average and smoked at least one pack per day.

High-quality evidence gathered from 14 randomized controlled trials with 11,356 participants suggested that a combination of nicotine patches and fast-acting NRT (e.g., lozenges, gum, inhaler, oral spray) yielded better smoking cessation rates than either single therapy alone

Author disclosure: No relevant financial affiliations.


show all references

1. Lindson N, Chepkin SC, Ye W, et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019;(4):CD013308....

2. Babb S, Malarcher A, Schauer G, et al. Quitting smoking among adults—United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017;65(55):1457–1464.

3. Wang TW, Asman K, Gentzke AS, et al. Tobacco product use among adults — United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(44):1225–1232.

4. U.S. Preventive Services Task Force. Final recommendation statement: tobacco smoking cessation in adults, including pregnant women: behavioral and pharmacotherapy interventions. September 15, 2015. Accessed December 15, 2019.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



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