Version October 2024
| Drug | How sold in United States | Dosing | Administration* | Common adverse effects | Advantages | Disadvantages and precautions | Other notes |
| Nicotine patch | Rx or OTC | 21 mg for >10 cigarettes/day 14 mg for ≤10 cigarettes/day | Apply 1 new patch daily May start patch before quit date Rotate application site Tapering dose is not required | Skin irritation, insomnia, vivid dreams | Provides steady nicotine level Easiest nicotine product to use | User cannot alter nicotine level if cravings occur | If removed before bedtime, takes 30 minutes to 3 hours after reapplication to reach effective levels |
| Nicotine gum | Rx or OTC | 2 mg if first cigarette ≥30 minutes after waking 4 mg if first cigarette <30 minutes after waking | 1 piece every hour as needed Maximum: ≤24 pieces/day No food or drink for 30 minutes before and during use | Mouth irritation, jaw soreness, hiccups, heartburn, nausea¶ | User controls nicotine dose Oral substitute for cigarettes | Can damage dental work Difficult for denture wearers to use | Proper chewing technique required ("chew and park")Δ |
| Nicotine lozenge | Rx or OTC | 2 mg if first cigarette ≥30 minutes after waking 4 mg if first cigarette <30 minutes after waking | 1 piece every 1 to 2 hours as needed Maximum: 20 lozenges/day No food or drink for 30 minutes before and during use | Mouth irritation, hiccups, heartburn, nausea | User controls nicotine dose Oral substitute for cigarettes Can be used by smokers with poor dentition or dentures | ||
| Nicotine inhaler◊ | Rx only | 10 mg per cartridge (1 cartridge = 80 puffs) | Inhale as needed (eg, every 1 to 2 hours) Maximum: 16 cartridges/day | Mouth and throat irritation, cough | User controls nicotine dose Oral substitute for cigarettes | Use caution in reactive airway disease | Frequent puffing required to obtain adequate nicotine delivery |
| Nicotine nasal spray | Rx only | 0.5 mg per spray (10 mg/mL) (1 bottle = 200 sprays) | Apply 1 spray to each nostril every 1 to 2 hours as needed Maximum: 10 sprays/hour, 80 sprays/day | Nasal discomfort, throat irritation, rhinitis, sneezing, coughing | User controls nicotine dose Most rapid delivery of nicotine among NRT products | Local irritation to nasal mucosa is difficult for many to tolerate | Do not sniff, swallow, or inhale while spraying Wait 2 to 3 minutes before blowing nose |
| Varenicline | Rx only | 0.5 mg pill to start, then titrate up to 1 mg pill | 0.5 mg/day for 3 days, then 0.5 mg twice a day for 4 days, then 1 mg twice a day Start 1 to 4 weeks before quit date Abrupt quitting smoking is preferred; gradual smoking reduction is an alternative: reduce smoking by 50% by week 4, another 50% by week 8, quit by week 12 | Nausea, insomnia, vivid dreams, headache | Dual action: relieves nicotine withdrawal and blocks reward from smoking Oral agent (pill) Option for flexible quit date | Reduce dose in moderate to severe kidney function impairment | Prior FDA concerns of psychiatric side effects have been refuted |
| Bupropion sustained release | Rx only | 150 mg pill | 150 mg/day for 3 days, then 150 mg twice a day Start 1 to 2 weeks before quit date | Insomnia, agitation, dry mouth, headache | Blunts postcessation weight gain while being used Oral agent (pill) | Contraindicated in patients with seizure disorder or seizure predisposition, including anorexia nervosa or bulimia Monitor for suicidality§ | A lower dose of 150 mg/day is an option for patients who do not tolerate the full dose |
FDA: US Food and Drug Administration; NRT: nicotine replacement therapy; OTC: over-the-counter (nonprescription) sale; Rx: prescription product.
* All pharmacologic agents are generally used for 3 months. They may be extended for an additional 12 weeks (or even up to 1 year) if the patient has quit smoking but still feels at risk for relapse. NRT may be continued indefinitely.
¶ Gastrointestinal side effects usually due to overly vigorous chewing.
Δ Chew and park technique: User should chew gum slowly until a distinct taste indicates that nicotine is being released then place the gum between the cheek and gum until the taste disappears to allow the nicotine to be absorbed through the oral mucosa and not swallowed. Repeat the sequence for 30 minutes, then discard the gum.
◊ The availability of the nicotine inhaler is uncertain because the product's sole manufacturer discontinued sale of the nicotine inhaler in fall 2023.
§ Monitor for new or increased suicidal thoughts or behaviors, especially during first 1 to 2 months of treatment.Do you want to add Medilib to your home screen?
