An Overview of Nicotine Replacement Therapy By Terry Martin | Reviewed by Sanja Jelic, MD Updated October 06, 2016 Print Nicotine replacement therapy (NRT) was the first pharmacological treatment developed for smoking cessation that was approved by the Food and Drug Administration (FDA). Nicotine gum came first in 1984, followed by the nicotine patch in the early 90s. Both became available over the counter (OTC) in 1996. In that same year, the nicotine nasal spray was introduced by prescription, followed by the nicotine inhaler in 1998. Nicotine lozenges were approved for OTC sales directly in 2002.The various forms and strengths of NRTs meet the needs of many ex-smokers, providing a controlled dose of therapeutic nicotine that is reduced over time until the NRT is discontinued. Top 3 Things to Know about Nicotine Replacement Therapy1. Using nicotine replacement therapy is not cheating. New ex-smokers sometimes think that using a quit aid of any kind is "cheating." This holds especially true for NRTs, because they contain nicotine. Article Pros and Cons of Using Nicotine Nasal Spray to Quit Smoking Article Are Nicotine Patches Right For You? While the ultimate goal is to remove all nicotine from your body, it is not necessary to do it quickly. Gradually lowering nicotine in your bloodstream takes the edge off of nicotine withdrawal and makes the task more manageable.There is nothing wrong with using a quit aid to help you stop smoking. In fact, you should look at them as valuable tools at your disposal. 2. You can become dependent on nicotine replacement therapy. Nicotine is addictive whether it's in tobacco products or NRTs, so it's important to use this quit aid only as directed. The course of therapy has been carefully designed to gradually reduce dependence on nicotine over a period of weeks or months. Follow the manufacturer's recommendations, stopping the NRT in the time allotted. If you don't think you're ready to end treatment when the time comes, consult with your doctor.3. NRTs are not magic. For that matter, there isn't a quit aid of any type that will do all of the work for you. Successful recovery from nicotine addiction is a combination of physical and psychological healing, along with plain old practice at living your life one smoke-free day at a time. That said, if you have the determination to do what it takes to stop smoking, quit aids can make the task much easier.Types of Nicotine Replacement TherapyIt is worth noting that all forms of nicotine replacement therapy except the nicotine patch are used multiple times per day. This can be problematic for ex-smokers who might find it difficult to stick to the recommended number of pieces of nicotine gum or nicotine lozenges, for instance. The patch is put on once a day and uses a time-release system to administer the nicotine it contains. Article Is the Nicotine Lozenge an Effective Quit Aid? Article Can You Be Addicted to Nicotine Gum? Nicotine Patch The nicotine patch looks like a small, square tan or clear bandage. It has an adhesive backing and is put on the upper arm or leg, or anywhere that is hairless. It comes in three strengths and users "step down" on dosage as recommended, usually stopping the patch altogether between six and 20 weeks. The patch is available OTC.Nicotine GumNicotine gum comes in a variety of flavors and two strengths. Each piece is chewed until ex-smokers feel a tingling sensation, and then the gum is "parked" between the cheek and gum until the tingling stops. The process is then repeated until the gum is used up, usually about 30 minutes. Nicotine gum is a commonly misused form of NRT, so be aware and follow instructions exactly, weaning off in the time recommended. Nicotine gum can be purchased OTC.Nicotine LozengesNicotine lozenges come in a pill or candy-like tablet and are used multiple times per day to reduce cravings to smoke. Like nicotine gum, the lozenge comes in two strengths and is put between the cheek and gum where it slowly dissolves over the course of a half hour or so. The nicotine lozenge is sugar-free and comes in several flavors. Nicotine lozenges are available OTC.Nicotine InhalerThe nicotine inhaler is a cylindrical tube that houses a cartridge of liquid nicotine. Users draw on the mouthpiece to receive "puffs" of vapor that enter the lungs and send nicotine into the bloodstream. Each cartridge lasts about 20 minutes, administering roughly the same amount of nicotine as would be contained in one cigarette. The nicotine inhaler requires a prescription.Nicotine Nasal SprayNicotine nasal spray comes in a pump-style bottle with a nicotine solution that is sprayed into the nostrils. The amount of nicotine used (number of pump sprays) is up to your doctor, who will decide on dosage and provide the prescription for this medicine for you.What's the Difference Between the Nicotine Inhaler and Electronic Cigarettes?This is a good question, and it's important to know why these two similar products are not interchangeable. As mentioned above, all NRTs, including the nicotine inhaler, are developed to gradually wean users off of nicotine. Article Will Nicotine Gum Help Me Quit Smoking? Article Nicotine Inhaler Pros and Cons They are all also federally regulated, and this means that the nicotine in NRT products is manufactured using standards that guarantee consistency. The ingredients used are known and monitored, including the exact amount of nicotine. Consumers can trust that they are receiving what the package says is in the product. This is not the case with electronic cigarettes, which have been historically manufactured and imported from other countries with no regulatory structure in place. The amount of nicotine in the e-juice solution can and does vary from what the packaging reports.The FDA is beginning to impose regulations on manufacturers of what are known as ENDS (electronic nicotine delivery systems), of which e-cigarettes are a part. So, eventually consumers will benefit from the new standards imposed. Even so, electronic cigarettes have not been medically approved as a quit aid, which means there isn't a course of therapy for smoking cessation associated with e-cigarettes. That may come in the future, but for now, smokers are on their own when using e-cigarettes to stop smoking. Electronic cigarettes are considered to be a smoking alternative rather than a quit aid.Why Use Nicotine to Stop Using Nicotine?It might seem wrong to employ the substance you're addicted to for recovery, but it offers the advantage of reducing nicotine cravings in a gradual way, allowing your body to get used to less and less until the nicotine is stopped completely. At the same time, ex-smokers can turn more of their attention toward the habitual side of smoking, which is where the majority of the work of smoking cessation lies. And, while they do contain nicotine, NRTs do not contain the many thousands of other toxic chemicals that are in cigarettes.Using NRTs in Combination With Prescription Quit AidsIf you find that NRTs are not doing enough to help you with smoking cessation, talk to your doctor about combining the NRT you're using with other NRTs or prescription quit aids like Chantix or Zyban. This could improve your chances for success, but it should be done with a doctor's supervision.Don't Smoke When Using NRTs The nicotine in cigarettes could put you at risk of a nicotine overdose if you smoke while using NRTs. A nicotine overdose may cause you to feel dizzy, nauseous, confused, or weak. You might vomit, experience a cold sweat, or have blurred vision, a bad headache, or even hearing problems. If anything like this happens to you while using NRTs, discontinue the NRT and seek medical help immediately. Add Some Counseling and Support to Your Quit ProgramMost doctors today will recommend adding some type of support or counseling to round out your quit program. Your chance of success goes up if you have the help of others who have knowledge of what you're going through. Talk to your doctor about support groups in your area, and add some online support as well for round-the-clock help.Are NRTs a Smart Quit Aid Choice?Yes, just use care so that the NRT you're using to stop smoking doesn't become habit-forming. Follow the manufacturer's directions carefully, tapering down and stopping use entirely in the time recommended.Nicotine replacement therapy has helped many thousands of people stop smoking successfully. But the fact is, whatever you use as a quit aid will work if you put your back into it. NRTs won't become a problem of their own as long as you use them according to manufacturer's directions. Ex-smoker Michelle used the nicotine patch as a quit aid. Read her perspective, especially if you're on the fence about NRTs. How the Nicotine Patch Help Me Quit Smoking A Word From Verywell:Remember, quit aids are just that—aids. Use them with that in mind and be patient with yourself. You didn't form your habit overnight, and it will take some time to heal and find a new and healthier way of living life that doesn't involve smoking (or cravings to smoke). It is normal to feel fear when you think about quitting, but that is only because you are addicted to nicotine. Forge ahead. Your Quit Smoking ToolboxFostering the Mindset for SuccessChoose your quit aid, pick your date, start reading about what you can expect from smoking cessation, and then follow through when your quit day arrives.Sources:National Cancer Institute. Smokefree.gov. Explore Quit Methods.National Institute on Drug Abuse. Are There Effective Treatments for Tobacco Addiction? Updated July 2012.U.S. Food and Drug Administration. Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS). Updated August 30, 2016.