Nicotine Replacement Therapy (NRT)

Provides a "clean" alternative source of nicotine to replace nicotine from cigarettes and reduce intensity and incidence of withdrawal symptoms. 

Nicotine Replacement Therapy is the most commonly used pharmacological treatment for smoking cessation, as it provides a “clean” alternative source of nicotine that the person who smokes would have otherwise received from tobacco.

The aim of NRT is to partially replace nicotine from cigarettes. This may reduce the incidence and intensity of withdrawal symptoms induced by nicotine abstinence during the first few weeks of smoking cessation.

Types of Nicotine Replacement Therapy (NRT) include: Nicotine patch (e.g., Habitrol®, Nicoderm®)

• Can be purchased over the counter (no prescription needed).
• Provides a rate-controlled delivery of nicotine that is absorbed through the skin.
• Treatment generally lasts 8-12 weeks or longer if necessary.
• Has a slow onset and contains lower levels of nicotine than cigarettes and higher levels than gum.

Nicotine gum (e.g., Nicorette®, Nicorette® Plus)

• Can be purchased over the counter (no prescription needed).
• Substitutes a piece of gum for the craving for a cigarette, providing gratification for oral needs and nicotine cravings.
• Is not chewed continuously, rather, chewed 2-3 times, then parked between the cheek and the gum. “Bite, bite and park” between cheek and gums – wait a minute then repeat over 30 mins or less.
• Treatment generally lasts several weeks to several months, or longer if necessary.

Nicotine inhaler (e.g. Nicorette inhaler®)

• Can be purchased over the counter (no prescription needed).
• Is a mouthpiece with a nicotine cartridge insert.
• One puff delivers less nicotine than one puff from a cigarette.
• Addresses both the physical and behavioural dependency of smoking as it mimics the hand to mouth ritual of smoking.
• ‘Puff (into mouth) and hold’. Nicotine is absorbed by blood vessels in the buccal cavity. The number of puffs taken depends on the amount of nicotine required to meet individual’s cravings and dependence.
• 6-12 cartridges a day for 3 months is recommended by manufacturer, many need significantly less.

Nicotine nasal spray, sublingual tablets and lozenges

• Not currently available in Canada.

**There is evidence that combining the nicotine patch with nicotine gum increases long-term abstinence rates over those produced by a single form of NRT.