- Nicotine Replacement Therapy for Quitting Tobacco
- How does nicotine replacement therapy work?
- Getting the most from nicotine replacement therapy
- Who should not use NRT?
- Can you get too much nicotine from NRT?
- How do I know if I’m a light, average, or heavy smoker?
- How do I know what NRT dose to use based on my smokeless tobacco use?
- Types of nicotine replacement therapy
- Nicotine patches (transdermal nicotine systems)
- Nicotine gum (nicotine polacrilex)
- Nicotine nasal spray
- Nicotine inhalers
- Nicotine lozenges
- Choosing and using the right nicotine replacement therapy for you
- Combining the patch and other nicotine replacement products
- High-dose nicotine replacement therapy for heavy smokers
- Stopping nicotine replacement therapy
- Long-term nicotine replacement therapy dependence
- The Different Options
- A complete guide to nicotine gum
- What You Need to Know About Nicotine Gum
- FDA Approves Perrigo’s Coated Nicotine Gum
- Gum facts
- Use the gum correctly, don’t waste your money
- What if I forget and just chew this like regular gum?
- Look at the costs
- How long should nicotine gum be used?
- Tips for quitting
- Combine gum with patches?
- Remember the choice is up to you
- Nicotine Gum
- Topic Overview
- Nicotine patches, gum and lozenges
Nicotine Replacement Therapy for Quitting Tobacco
The nicotine in tobacco leads to actual physical dependence. This can cause unpleasant withdrawal symptoms when a person tries to quit. Nicotine replacement therapy (NRT) gives you nicotine – in the form of gum, patches, sprays, inhalers, or lozenges – but not the other harmful chemicals in tobacco. NRT can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting. Many studies have shown using NRT can nearly double the chances of quitting smoking. It hasn’t been studied as much for quitting smokeless tobacco, but the NRT lozenges may help.
Smokers who are significantly dependent on nicotine should consider nicotine replacement or drug therapy to help them quit. Signs of severe dependence are:
- Smoking more than 1 pack a day
- Smoking within 5 minutes of waking up
- Smoking even while sick
- Waking up at night to smoke
- Smoking to ease symptoms of withdrawal
The more of these that apply, the more serious the dependence.
How does nicotine replacement therapy work?
Nicotine replacement therapy (NRT) can help with the difficult withdrawal symptoms and cravings that most people say is their only reason for not giving up tobacco. Using NRT reduces those symptoms.
Many people can quit tobacco without using NRT, but most of those who attempt quitting do not succeed on the first try. In fact, smokers usually need many tries – sometimes as many as 10 or more – before they’re able to quit for good. Most people who try to quit on their own go back to smoking within the first month of quitting – often because of the withdrawal symptoms.
Together with counseling or other support, NRT has been shown to help increase the number of smokeless tobacco users who quit, too.
You can start using nicotine replacement therapy (NRT) as soon as you throw away your tobacco. You don’t need to wait a certain length of time to put on the patch or start using the gum, lozenge, nasal spray, or inhaler. Double-check this information with the instructions on your chosen method of nicotine replacement, but in general there’s no need to wait to start using NRT.
Getting the most from nicotine replacement therapy
Nicotine replacement therapy (NRT) only deals with the physical dependence. It’s not meant to be the only thing you use to help you quit smoking. You’ll need other methods that help with the psychological (emotional and mental) part of tobacco, such as a quit program. Use these support systems during treatment with NRT and for at least a few months after you quit. Studies have shown that this approach – pairing NRT with a program that helps to change behavior – can improve your chances of quitting and staying quit compared to approaches that use only one method.
The best time to start NRT is when you first quit. Often people first try to quit tobacco on their own then decide to try NRT a day or more into quitting. This does not give you the greatest chance of success, but don’t let this discourage you. There are many options for quitting and staying quit. Just remember that it often takes many tries.
The Food and Drug Administration (FDA) has approved the NRT products discussed here as effective aids for helping people quit smoking. None of these products has been FDA-approved specifically to help people quit smokeless tobacco. Still, studies are being done, and some have shown the lozenge form may help.
Who should not use NRT?
The US Agency for Healthcare Research and Quality states that nicotine replacement therapy (NRT) is safe for all adult who want to quit smoking except pregnant women and teens. Still, it’s best to discuss NRT use with your health care provider before starting it. You may have medical problems that should be considered. When looking at NRT use, the benefits of quitting tobacco must outweigh the potential health risks of NRT for each person.
People who are still smoking or using any other form of tobacco should not use NRT. The companies that make NRT products warn that you should not use them if you’re still using tobacco, and the FDA has not approved them to be used in this way. Get the advice of a health care provider if you want to use NRT and smoke or chew.
NRT has not yet been proven to help people who smoke fewer than 10 cigarettes a day. You might want to talk with your health care provider about a lower dose of NRT if you smoke less than that but feel you need nicotine replacement.
Can you get too much nicotine from NRT?
Nicotine overdose is rare, but possible. Nicotine replacement therapy (NRT) products are labeled to match the amount of nicotine you get from NRT to the amount you got from tobacco. If used this way, you should get a nicotine dose fairly close to what you’ve been getting. You don’t want to get more than that, because higher doses of nicotine can cause harm. To avoid this, follow dosing instructions carefully. Also, don’t use heat (like a heating pad or heat lamp) on the skin near your nicotine patch – you could absorb more nicotine due to the increased blood supply.
Nicotine absorbs through the skin and mucous membranes, so you must store and dispose of your NRT safely. Nicotine overdose can cause death. Overdose is more of a problem in children and pets because of their smaller size. Keep NRT and used gum, patches, empty cartridges, bottles, etc., safely away from children and pets. Never drop them on the street or in open trash cans where kids and animals can reach them.
Symptoms of nicotine overdose
Here are some symptoms of too much nicotine:
- Nausea and vomiting
- Belly pain
- Agitation, restlessness
- Fast or irregular heartbeat
- Cold sweat
- Pale skin and mouth
- Tremors (shaking)
- Disturbed vision and hearing
- High blood pressure, which then drops
- Dizziness or faintness due to low blood pressure
- Fast breathing in early poisoning, breathing may stop later
Call Poison Control and get emergency help if you suspect an overdose. If you’re taking NRT as prescribed and are still having mild symptoms such as headache, vomiting, diarrhea, or sweating, lower your dose and talk to your health care provider.
How do I know if I’m a light, average, or heavy smoker?
Most nicotine replacement therapy (NRT) products are recommended on the basis of how much you smoke. But there’s no formal category in any textbook or group that defines a light, average, or heavy smoker.
These are general guidelines:
- Light smoker: Smokes fewer than 10 cigarettes per day
- Heavy smoker: Smokes a pack a day or more
- An average smoker falls in between.
How do I know what NRT dose to use based on my smokeless tobacco use?
For smokeless tobacco users, certain types of NRT may help more than others. If you look at the way the tobacco is used, nicotine gum and lozenges are most like using smokeless tobacco. They also let you control your dose to help keep nicotine cravings down.
NRT products are supposed to roughly match the amount of nicotine you typically took in through tobacco. It can be more of a challenge to get the dose right for smokeless tobacco users, since NRT products are labeled for smokers.
To avoid withdrawal symptoms, you want to aim for a nicotine dose fairly close to what you got from snuff or tobacco use.
These are general guidelines
- A heavy user is a person who uses more than 3 cans of snuff or 3 pouches of tobacco a week, and would typically use the higher doses of NRT (the dose for heavy smokers).
- Those who use 2 to 3 cans or pouches per week would usually try the moderate doses.
- Those who use less than 2 would start with the lowest doses of NRT.
If you’ve decided to try NRT, discuss your dose with a health care provider before you quit tobacco.
Types of nicotine replacement therapy
The US Food and Drug Administration (FDA) has approved 5 forms of nicotine replacement therapy (NRT):
- Nasal spray
The most important thing to do with any form of NRT is read and follow the package instructions very carefully.
Nicotine patches (transdermal nicotine systems)
Patches can be bought with or without a prescription.
Patches give a measured dose of nicotine through the skin. You’re weaned off nicotine by switching to lower-dose patches over a course of weeks. Many different types and strengths are available. Package instructions tell you how to use them, and list special considerations and possible side effects.
The 16-hour patch works well if you are a light-to-average smoker. It’s less likely to cause side effects. But it doesn’t deliver nicotine during the night, so it may not be right if you have early morning withdrawal symptoms.
The 24-hour patch provides a steady dose of nicotine, avoiding highs and lows. It helps with early morning withdrawal. But there may be more side effects.
How to use nicotine patches: Depending on body size and smoking habits, most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5-14 mg of nicotine) for another 4 weeks. The patch is changed every day. It should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist – for instance, on the upper arm or chest. The FDA has approved using the patch for a total of 3 to 5 months.
Possible side effects of the nicotine patch include:
- Skin irritation (redness and itching)
- Racing heartbeat
- Sleep problems or unusual dreams
- Muscle aches and stiffness
No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because the dose of nicotine is too high for you. Stop using the patch and talk to your health care provider if this happens. You can also have nicotine withdrawal symptoms during this time if your NRT dose is too low.
What to do about side effects
- Try a different brand of patch if your skin becomes irritated.
- Reduce the amount of nicotine by using a lower-dose patch.
- Sleep problems may go away in 3 or 4 days. If not, and you’re using a 24-hour patch, try switching to a 16-hour patch.
- Stop using the patch and try a different form of NRT.
Nicotine gum (nicotine polacrilex)
Nicotine gum can be bought without a prescription.
Nicotine gum is a fast-acting form of replacement. Nicotine is taken in through the mucous membrane of the mouth. You can buy it over the counter (without a prescription). It comes in 2 mg and 4 mg strengths.
How to use nicotine gum
For best results, follow the instructions in the package. Chew the gum slowly until you get a peppery taste or tingle. Then tuck it inside your cheek until the taste fades. Chew it to get the peppery taste back, and hold it again. Do this off and on for 20 to 30 minutes. Food and drink can affect how well the nicotine is absorbed, so don’t eat or drink for at least 15 minutes before and during gum use.
In choosing your dose, think about whether you
- Smoke 25 or more cigarettes per day
- Smoke within 30 minutes of waking up
- Have trouble not smoking in restricted areas
If any of these describe you, you may need to start with the higher 4mg gum dose.
Chew no more than 24 pieces of gum in one day. Nicotine gum is usually recommended for 6 to 12 weeks, with the maximum being 6 months. Tapering down the amount of gum you use as you approach 3 months may help you stop using it.
Another advantage of nicotine gum is that it allows you to control the nicotine doses. The gum can be used as needed or on a fixed schedule during the day. The most recent research has shown that scheduled dosing works better. A schedule of 1 to 2 pieces per hour is common. On the other hand, with an as-needed schedule, you can use it when you need it most – when you have cravings.
Possible side effects of nicotine gum include:
- Bad taste
- Throat irritation
- Mouth sores
- Jaw discomfort
- Racing heartbeat
The gum can also stick to and damage dentures and dental work.
Stomach and jaw discomfort are usually caused by improper use of the gum, such as swallowing the nicotine or chewing too fast. No one has all of the side effects, and some people have none. If your heart is racing or beating irregularly, stop using the gum and talk to your health care provider. You can also have nicotine withdrawal symptoms during this time if your NRT dose is too low.
Nicotine nasal spray
Nicotine nasal spray is only available by prescription.
The nasal spray delivers nicotine to the bloodstream quickly because it’s absorbed through the nose. It relieves withdrawal symptoms very quickly and lets you control your nicotine cravings. Smokers usually like the nasal spray because it’s easy to use when you need it.
How to use nicotine nasal spray
Most people are told to use 1 to 2 doses per hour. (1 dose = 2 sprays, 1 in each nostril.) At least 8 doses (16 sprays) each day may be needed when you first start, but use as directed by your health care provider. You should not use more than 40 doses (80 sprays) per day. Instructions can vary. Talk to your provider about the plan that’s best for you.
The FDA recommends that the spray be prescribed for 3-month periods and that it not be used for longer than 6 months.
Possible side effects of nicotine spray:
The most common side effects of the spray get better in about 1 to 2 weeks and can include:
- Nasal irritation
- Runny nose
- Watery eyes
- Throat irritation
Other side effects are related to nicotine:
- Racing heart
No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because you’ve gotten too much nicotine. Stop using the spray to see if the feelings get better and talk to your health care provider if this happens. You may need to use it less often. You can also have nicotine withdrawal symptoms during this time if your NRT dose is too low.
If you have asthma, allergies, nasal polyps, or sinus problems, your provider may suggest another form of NRT.
Special note: This form of NRT poses a more serious risk to small children and pets because the empty bottles of nasal spray contain enough nicotine to harm them. Do not get the liquid on your skin. If there’s any skin contact, rinse thoroughly with plain water right away. If a bottle breaks or liquid leaks out, put on plastic or rubber gloves to clean it up. Call Poison Control and get emergency help if there’s any question of overdose.
Inhalers are available only by prescription.
The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. Unlike other inhalers, which deliver most of the medicine to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth where it’s absorbed into the bloodstream. Nicotine inhalers are the FDA-approved nicotine replacement method that’s most like smoking a cigarette, which some smokers find helpful.
At this time, inhalers are the most expensive form of NRT available. They are not the same as electronic cigarettes, which are not approved by the FDA to help people quit smoking.
How to use the nicotine oral inhaler
You puff on the inhaler and the cartridge sends a pure nicotine vapor into your mouth. You may use up the cartridge all at once over about 20 minutes, or puff on it only a few minutes at a time. The recommended dose is between 4 and 20 cartridges a day, slowly tapering off over 6 months.
Possible side effects of the nicotine inhaler:
The most common side effects, especially when first using the inhaler, include:
- Mouth and/or throat irritation
- Runny nose
- Upset stomach
Other side effects are related to nicotine:
- Racing heart
No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because you’ve gotten too much nicotine. Stop using the inhaler to see if the feelings get better and talk to your health care provider if this happens. You may need to use it less often. You can also have nicotine withdrawal symptoms during this time if your NRT dose is too low.
Special note: This form of NRT poses an extra risk to small children and pets because the used cartridges still have enough nicotine in them to cause harm if it gets on skin or mucous membranes (for instance, if licked or touched to the eyes, mouth, or other mucous membrane). Be sure to store and dispose of the cartridges away from children and pets. Call Poison Control and get emergency help if there’s any question of overdose.
Nicotine lozenges can be bought without a prescription.
The lozenge is available in 2 strengths: 2 mg and 4 mg. Smokers choose their dose based on how long after waking up they normally have their first cigarette. If you smoke your first cigarette within 30 minutes of waking up, use 4 mg nicotine lozenges. If you smoke your first cigarette more than 30 minutes after waking up, use 2 mg-nicotine lozenges.
How to use nicotine lozenges
The recommended dose is 1 lozenge every 1 to 2 hours for 6 weeks, then 1 lozenge every 2 to 4 hours for weeks 7 to 9, and finally, 1 lozenge every 4 to 8 hours for weeks 10 to 12. The lozenge makers also recommend:
- Do not eat or drink for at least 15 minutes before using a lozenge or while using a lozenge. (Some drinks can reduce how well the lozenge works.)
- Do not use more than 1 lozenge at a time and do not use one right after another.
- Suck on the lozenge until it is fully dissolved, about 20 to 30 minutes. Move it from side to side in your mouth. Do not bite or chew it like a hard candy, and don’t swallow it. The nicotine absorbs through the mucous membranes of the mouth.
- Do not use more than 5 lozenges in 6 hours, or more than 20 lozenges per day.
- Stop using the lozenge after 12 weeks. If you still feel you need to use the lozenge, talk to your doctor.
Possible side effects of the nicotine lozenge include:
- Sore throat
- Trouble sleeping
- Racing heart
Choosing and using the right nicotine replacement therapy for you
No one type of nicotine replacement therapy (NRT) is any better than another. When choosing the type of NRT you will use, think about which method will best fit your lifestyle and pattern of smoking or using smokeless tobacco. For example, do you want/need something in your mouth or something to keep your hands busy? Are you looking for once-a-day convenience?
Here are some important points to think about as you decide:
- Nicotine gums, lozenges, and inhalers are substitutes you can put into your mouth that let you control your dosage to help keep cravings under better control.
- Nicotine gums and lozenges are generally sugar-free, but if you are diabetic and have any doubts, check with the manufacturer.
- Nicotine nasal spray works very quickly when you need it.
- Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler. It also works very quickly.
- Nicotine patches are convenient and only have to be put on once a day.
- Both inhalers and nasal sprays require a doctor’s prescription.
- Some people may not be able to use patches, inhalers, or nasal sprays because of allergies or other conditions.
- Nicotine gum may stick to dentures or dental work making it hard to chew before “parking.”
Whatever type you use, take your NRT at the recommended dose, and use it only for as long as it’s recommended.
If you use a different dose or stop taking it too soon, it can’t be expected to work like it should. If you are a very heavy smoker or a very light smoker, or a smokeless tobacco user, you may want to talk with your health care provider about how to get the NRT dose that best fits your needs.
Combining the patch and other nicotine replacement products
Using the nicotine patch along with shorter-acting products, like the gum, lozenge, nasal spray, or inhaler, is another method of NRT. The idea is to get a steady dose of nicotine with the patch and then use one of the shorter-acting products when you have strong cravings. If you’re thinking about using more than one NRT product, be sure to talk to your health care provider first.
High-dose nicotine replacement therapy for heavy smokers
Another NRT option is to give smokers a higher dose based on the amount of nicotine that they’ve been getting from cigarettes. Sometimes this method requires larger than usual doses of NRT. At this time, not much is known about this option. High-dose NRT should be considered only with a health care provider’s guidance and close supervision. It may worsen things if you already have heart disease or other health problems.
Stopping nicotine replacement therapy
Nicotine replacement therapy (NRT) is meant to be used for a limited period of time. Use should be tapered down before NRT is stopped. Studies to date have not shown that extending NRT use longer than the recommended time greatly impacts quit success.
Research is still being done to refine the use of NRT. If you feel that you need NRT for a different length of time than is recommended, it’s best to discuss this with your health care provider.
Long-term nicotine replacement therapy dependence
Nicotine replacement therapy (NRT) has the potential for long-term dependence. Nicotine is addictive, and people can transfer their dependence from tobacco to the NRT.
Use NRT only as long as you need it, as prescribed by your health care provider. Talk to your provider if you’re having trouble stopping NRT.
The Different Options
There are a variety of nicotine replacement therapies on the market today. Some are available without a prescription, but some you’ll have to get your doctor to prescribe for you.
Nicotine replacement therapy is generally considered safe for most healthy adults, but it’s a good idea to talk to your doctor about the potential risks and benefits for you. Side effects are possible for any treatment option. While some people may experience side effects, others may not.
- Nicotine patch: The over-the-counter patch is placed directly on your skin to release a low, steady amount of nicotine over time. Possible side effects: Irritation or redness on your skin, dizziness, headache, nausea, racing heartbeat, muscle pain or stiffness, or problems sleeping.
- Nicotine gum (nicotine polacrilex): You can buy over-the-counter nicotine replacement gum. It comes in 2 mg and 4 mg strengths and you get the nicotine immediately through the mucous membranes in your mouth when you chew it. Possible side effects: Irritation to your mouth or throat, bad aftertaste, problems with existing dental work, nausea, jaw pain, racing heartbeat.
- Nicotine lozenges: Like gum, nicotine lozenges are available over the counter. You suck on them so you get the nicotine slowly. They’re meant to dissolve like hard candies. Possible side effects: Coughing, gas, heartburn, trouble sleeping, nausea, hiccups, racing heartbeat.
- Nicotine inhaler: The prescription-only inhaler releases nicotine when you attach the cartridge to a mouthpiece and inhale. They’re the nicotine replacement method that’s most like smoking a cigarette. Possible side effects:Coughing, irritation to your mouth or throat, runny nose, nausea. Other side effects that can occur include headache, nervousness, and a racing heartbeat. These are related to the nicotine, not the inhaler itself.
- Nicotine nasal spray: This prescription-only nasal spray lets you squirt a quick burst of nicotine into your bloodstream directly through your nose. Possible side effects: Irritation to your nose or throat, coughing, watery eyes, sneezing. These side effects usually get better after 1-2 weeks of treatment. Other side effects that can occur include headache, nervousness, and a racing heartbeat. These are related to the nicotine, not the spray itself.
Although it’s rare, nicotine overdose is a possible risk. Follow the instructions on each product carefully. If you have symptoms like a fast heartbeat, nausea and vomiting, dizziness, weakness, or a cold sweat, get medical attention immediately.
A complete guide to nicotine gum
Chewing gum is a surprisingly ancient human behaviour, dating back at least 6,000 years. The ancient greeks even chewed gum with antiseptic properties to freshen their breath!
In the 1980s, researchers came up with the clever idea that gum containing nicotine could help people quit smoking.
Nicotine gum is a type of nicotine replacement therapy (NRT) — a group of products designed to provide you with a small amount of nicotine, without the tar and other harmful chemicals found in cigarettes.
It’s a medically-proven way to help you quit smoking, by dealing with the physical side to your nicotine addiction. So, by continuing to receive low levels of nicotine after stopping smoking, cravings and withdrawal symptoms are significantly reduced, and people often find that this makes the quitting process a lot less challenging.
As a result, NRT is one of the most popular ways to quit , and nicotine gums are both commonly used and widely available as quit smoking aids.
What is nicotine gum?
Nicotine gum is an over-the-counter, medicated chewing gum that delivers a dose of nicotine orally. It’s intended to replace the nicotine that people would otherwise get from smoking cigarettes or other tobacco products.
While it contains the chemical responsible for the addictiveness of cigarettes, nicotine gum doesn’t include any of the other nasty substances. It’s also sugar-free.
It’s a scientifically tested product, and research shows that it can be very effective as a quit smoking aid. However, it’s important to note that the reasons for taking up smoking and maintaining the habit are complex, and the addiction to nicotine is only one part of the problem.
Experts therefore advise that nicotine gum should be used in conjunction with therapies that target the psychological factors associated with smoking, whether that’s through visiting a therapist, or using an evidence-based virtual therapy like the Quit Genius app.
Nicotine gum should be used in conjunction with therapies that target the psychological factors associated with smoking.
Who should use it?
If you have a nicotine addiction and are trying to either quit smoking or cut down on the amount of cigarettes you smoke, nicotine gum could help you on your way.
While all nicotine replacement therapy products (gums, patches, lozenges etc.) are equally as effective as each other, you may wish to go with a gum if your cravings are sudden, and you require immediate relief from your symptoms.
The act of chewing gum itself can also be a distraction from smoking, as it can satisfy the oral fixation that often results when you give up cigarettes.
Before starting nicotine gum therapy, you should visit your doctor or speak to your pharmacist to ensure that it’s suitable for you, and that you don’t have any health conditions which could be compromised by using these products. You’ll also need to inform your doctor or pharmacist of any medications you take, including non-prescription products like vitamin supplements.
It’s especially important that pregnant women or those who are breastfeeding seek medical advice before using nicotine gum, in order to check whether using this medication will have any adverse effects on your baby. This also applies to women who become pregnant during nicotine gum therapy.
Nicotine gums are available in two strengths. The specific nicotine dose that you require depends on the number of cigarettes you’re used to smoking.
The Quit Genius app contains a helpful quiz to decide what type and dose of gum would be most helpful to you. In general however, if you smoke less than 25 cigarettes per day, opt for the gums containing 2mg of nicotine and see how you get on. If you’re a heavy smoker, you may be better off starting with the 4mg gum.
You should wait at least 15 minutes after eating or drinking before using nicotine gum. Like regular gum, this product should be chewed, although there is a bit of a technique required to ensure a steady and complete release of nicotine.
How to use nicotine gum
Repeat this cycle until chewing no longer produces the tingling sensation, meaning that all the nicotine has been released. This can take up to around 30 minutes.
Take care not to swallow the gum and do not chew more than one piece at a time.
You can chew up to one piece of gum per hour, with a view to reduce the frequency of use as your smoking cessation program progresses. Do not use more than 24 pieces in a day.
If you miss a dose, do not use 2 pieces to make up for it. Either use a piece of gum as soon as you realise, or simply wait until the next dose is due.
How long do I use it for?
Start using nicotine gum on your quit day, at the time when you’d usually smoke your first cigarette.
Nicotine gum is a quit smoking aid, but it is not a long-term solution. Its purpose is to help you fight your addiction by making the process smoother and easier to sustain. While using these products, you’re still delivering a supply of nicotine into your bloodstream, so if you continue to use them indefinitely, you won’t be able to break the physical addiction to nicotine.
Instead, you’ll need to gradually wean yourself off nicotine gum, as both your body and your mind begin to adapt to being smoke-free.
When you start out using nicotine gum, you should keep track of the dates, and work by the following schedule:
- During weeks 1-6: chew 1 piece of gum every 1-2 hours
- During weeks 7-9: chew one piece of gum every 2-4 hours
- During weeks 10-12: chew one piece of gum every 4 to 8 hours
Nicotine gum is a quit smoking aid, but it is not a long-term solution.
Nicotine gum is not designed for prolonged use and therefore shouldn’t be used for more than 12 weeks. If you feel that you are still struggling with nicotine withdrawal symptoms after the 12 week mark, seek help from a medical professional rather than continuing usage.
Although a far safer option than cigarettes, it’s important to remember that nicotine is addictive, and so it is possible to become heavily reliant on nicotine gum if you do not take care to prevent this from happening.
Tips to promote successful weaning (in addition to following the aforementioned schedule):
- If you started out on 4mg nicotine gum, aim to reduce this to 2mg as you proceed through therapy.
- Gradually reduce the amount of time that you spend chewing the gum (remember the more you chew, the more nicotine is released).
- Consider replacing nicotine gum with regular chewing gum every now and then. Increase this over time.
As with most medications, some people may notice side effects when using nicotine gum.
Some side effects may include:
- Mouth ulcers
- Aching of the jaw muscles
These symptoms are usually mild. However, if they are affecting your ability to sustain nicotine gum treatment, visit your doctor for further advice.
If you notice any of the following symptoms, discontinue use immediately and seek medical help:
- Irregular heartbeat or increased heart rate
- Trouble breathing
It’s very important to stick to the usage guidelines when taking these products, as if you take more than the recommended dose, you could be at risk of nicotine overdose. If you feel that you may have overdosed, seek medical help immediately. Symptoms include:
- Blurred vision
- Cold sweats
- Severe headache
- Difficulty hearing
Ensure all nicotine gum is stored out of reach of children. Because these products appear similar to regular chewing gum, it can be easy for children to make the mistake of consuming them. If children do use nicotine gum, they are at risk of nicotine poisoning, so it’s vital to prevent this from occurring. If it does, seek medical help immediately.
Where to buy
Nicotine gum is an over-the-counter product, meaning you don’t need a prescription from your doctor in order to purchase it.
It’s available from pharmacies including high-street chains such as Walgreens and CVS in the US, and Boots and Lloyd’s Pharmacy in the UK, as well as all major supermarkets.
Take home message
Nicotine gum is a scientifically proven quit smoking aid. As a medicated product, it works to replace the nicotine that people would otherwise get from cigarettes, reducing withdrawal symptoms and therefore decreasing the risk of relapse.
Although a very effective treatment, it only addresses the physical aspects of a smoking habit, and should therefore be used in combination with therapies that focus on the psychological factors contributing to your smoking habit.
Nicotine gum is not a permanent solution and should not be abused. It should be used in accordance with recommended guidelines, with the aim of gradually reducing usage over time, until the therapy period has ended and the product is no longer required.
What You Need to Know About Nicotine Gum
Seventy-four percent of Americans who smoke say they would like to give it up, and 67 percent of smokers believe they are addicted to cigarettes, according to a Gallup poll. Although quitting can be a challenge, there are a number of methods that have been proven to help, including medication and counseling.
Many people who want to stop smoking turn to nicotine gum, which research shows can be helpful for smokers who are trying to quit but are struggling with nicotine withdrawal. It was the first nicotine replacement therapy to be approved for over-the-counter sale by the U.S. Food and Drug Administration, which gave it the nod back in February 1996, months before nicotine patches were approved for non-prescription use.
A Look at Nicotine Gum Choices
Nicotine gum is available under the brand names Nicorette and Nicorette DS. Generic forms of nicotine polacrilex gum are available, under names such as Habitrol, Nicotrol, and Prostep.
The gum comes in dosages of 2 and 4 milligrams (mg). You can purchase nicotine gum at most drug stores, grocery stores, and department stores. On average you’ll spend $4.50 for 10 pieces of gum, the amount most people need to chew daily to control nicotine withdrawal.
How You Use Nicotine Gum
You don’t chew nicotine gum the way you chew normal gum. If you did, all the nicotine would be released directly into your saliva. If you swallowed the nicotine-soaked saliva, it would provoke a terrible stomachache and a nasty and overwhelming craving for a cigarette.
Instead, you use a method called “chew-and-park”:
- Chew the gum slowly a few times to break it down, until you sense a peppery taste or note a tingling in your mouth.
- Then park it between your cheek and gum, as you would chewing tobacco. The nicotine will pass through the lining of your mouth into your bloodstream, providing you with a hit of nicotine that reaches your brain in a matter of minutes.
- When the tingling or peppery taste subsides, in about one minute, repeat the chewing and parking process.
- Continue to chew and park the gum for about 20 to 30 minutes; at that point you will have absorbed all the nicotine.
How Much Nicotine Gum to Chew
People who smoke 24 or fewer cigarettes per day should use the 2 mg dosage. Smokers of 25 or more cigarettes daily should use the 4 mg dosage. You might also want to consider the higher dose if you crave a cigarette within a half-hour of waking up or find it hard not to smoke in restricted areas. Each piece of gum is one dose, and you should not chew more than 24 pieces a day. After two or three months, you should begin tapering off the amount of gum you chew each day.
An important point to remember: What you eat and drink will affect how you absorb the nicotine from gum. Avoid acidic substances like coffee, soft drinks, and juices for at least 15 minutes prior to and during gum use.
The Pros and Cons of Nicotine Gum
Nicotine gum has several advantages over the nicotine patch:
- The smoker controls the dosage and can pop a piece of nicotine gum to help deal with a particularly bad craving.
- The nicotine is more quickly absorbed into the body than nicotine in a patch, providing quicker relief.
However, there are several drawbacks to nicotine gum:
- If you swallow the gum or use it improperly, you could have hiccups, dizziness, nausea, or upset stomach.
- You could end up getting hooked on the nicotine gum. Studies have found that 15 to 20 percent of smokers who use nicotine gum to successfully quit keep using the gum for a year or longer. Most doctors want you to limit your use of nicotine gum to six months, although it’s likely that even if you continue beyond that point, using the gum is still safer than going back to smoking.
- Pregnant women should not use nicotine gum because the nicotine could harm the fetus.
Do not smoke while using the gum or you could end up with a nicotine overdose. You should talk with your doctor before using nicotine gum if you’ve ever had heart problems, high blood pressure, ulcers, an overactive thyroid, or dentures or some other types of dental work.
Nicotine gum may offer the help you need to quit smoking. As long as you use it correctly, you might achieve the success you’ve been hoping for.
FDA Approves Perrigo’s Coated Nicotine Gum
The Perrigo Co., of Allen, Mich., has received approval from the U. S. Food and Drug Administration to market over-the-counter coated nicotine polacrilex gum, similar to Nicorette, under store-brand labels.
“Perrigo is committed to providing retail customers key new products for their store brand programs, and this approval is consistent with our strategy to invest in new product development,” said John T. Hendrickson, executive vice president and general manager, Perrigo Consumer Healthcare. “We are pleased with this important addition to our store brand nicotine replacement therapy product offering, even though some sales may come at the expense of our uncoated gum products. First shipments are expected to begin in the fourth quarter of 2006.
Retail sales for Nicorette coated gum were approximately $100 million in the past 12 months.
The Perrigo Co. is a leading global healthcare supplier and the world’s largest manufacturer of over-the-counter pharmaceutical and nutritional products for the store-brand market.
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Medically reviewed by, Russell Braun RPH
Trying to quit smoking? Finally had enough but now you need to understand how to use nicotine replacement?
You are not alone, according to the Centers for Disease Control (CDC) in 2017, 14% of U.S. adults over 18 smoked. Smoking is the leading cause of preventable death in the U.S. accounting for nearly 20% of all deaths!
The good news
The CDC also states that smoking has declined from ~21% of the adult population in 2005 to 14% in 2017. That means other people have been able to quit, and so can you. Remember, more people in the U.S. have quit smoking than currently smoke today.
The body will become dependent on nicotine and the act of smoking itself after being a smoker for even a small amount of time.
There are many reasons people smoke. Stress, busy lives, multiple responsibilities, needing a break are some of the most common reasons given. At first cigarettes can provide relief from these “problems”, but over time the dependance on the nicotine in the cigarettes drive anxiety. This causes patients to think they are having one of these issues when really they are dependent on nicotine.
What are your smoking habits? Do you only smoke with a friend or multiple friends? Do you smoke when drinking? Or maybe you smoke when you have a break from work.
Do your best to try and break these habits up.
Can you walk with that friend instead of smoke? Is it possible to stay away from spots where you smoke if you are drinking, or not drink? Can you find something to do on your break that is away from the smoking area?
Today the majority of businesses, public places and homes in the U.S. do not allow smoking. This makes it easier for you to avoid the temptation to smoke by seeing others who are smoking. Do your best to avoid those places where other smokers are congregated so you can avoid a powerful trigger.
Click here to see Easy Way to Stop Smoking
A book called Easy Ways to Stop Smoking is a great resource to help you move from bad habits and into ones that will let you stop smoking.
Nicotine gum has been around since the late 1970’s and was the first option for smoking cessation. For years gum was only available with a prescription. In 1996 the Food and Drug Administration (FDA) approved nicotine gum available for sale over the counter. Now it can be bought over the counter at most pharmacies and on many online websites.
Today nicotine gum is sold under many different brand names, such as:
- Various store brands
The gum is sugar free and come in several different flavors.
With nicotine gum, the patient controls the dosage based on urges to smoke. This is different than the nicotine patch another common form of nicotine replacement. The gum also acts more quickly in the body than the patch due to the way it enters the bloodstream directly from the mouth.
2mg typically best for 1 pack per day smokers or less
4mg typically best for over 1 pack per day smokers
Here are some general equivalents
1mg nicotine (For almost all brands/types) = 1 cigarette
5mg nicotine = 1 Cigar
1 pipe = 5mg nicotine
It take an average of 7 minutes to smoke 1 cigarette. The gum on the other hand lasts for 30 minutes and in that time you are getting either 2mg or 4mg of nicotine
1 pack of cigarettes has 20 cigarettes, if you were smoking 1 pack per day you were taking 20mg of nicotine. That comes out 10 of the 2mg pieces or 5 of the 4mg pieces per day.
It is very important that you make sure you figure out how much nicotine you were getting while smoking. If you want to be successful with your attempt to quit then getting full nicotine replacement is a must.
Use the gum correctly, don’t waste your money
Since nicotine products can be bought over the counter, most people do not get adequate advice on using the products from their doctor or pharmacist. This results in not getting the proper dose of nicotine from the gum to replace what they were getting from smoking.
I want to make sure that doesn’t happen to you so please follow these instructions.
- Place gum in your mouth and chew slowly, soon you will notice a tingling sensation in your mouth. You will notice this in 5-10 chews.
- Once you notice tingling stop chewing.
- Place or “park” the gum between your cheek and gums usually on the lower jawline on either side of your mouth.
- After roughly one minute, you will notice that the tingling sensation is gone.
- Once the tingling is gone you can start to chew the gum again, the tingling will return in another 5-10 chews.
- When tingling returns park the gum between your cheek and gums on the side of your mouth again.
- You will continue to repeat this process until the gum no longer make a tingling sensation when you chew it.
- This typically take about 30 minutes, at that point you have removed all the nicotine from the gum and you can dispose of it.
What if I forget and just chew this like regular gum?
The nicotine from the gum is released in your mouth. The area where you park the gum between your cheek and gums is a very good place to absorb certain drugs. Nicotine is one of the drugs that is very well absorbed from your mouth. The word absorbed in this case means the drug is able to make it into your bloodstream where it provides the effect you feel from it like you would a cigarette.
If you chew the nicotine and don’t stop to park it you are essentially having the nicotine get washed away into your esophagus and then stomach as you chew since you are making saliva to wash down your food your body thinks you are chewing up. Your mouth doesn’t realize you are chewing gum vs eating food you are trying to digest and creating saliva is step one in digestion that comes along with chewing food.
Nicotine not well absorbed in stomach. The reason is that the acid that is released in your stomach prevents nicotine from being absorbed. This means that if you swallow the nicotine you are essentially wasting your money because it will not be absorbed and not help with your nicotine cravings.
If you notice a strong, unpleasant taste and lots of tingling you are chewing too fast and will waste the gum. This can also cause:
- Nauseous feelings
- Throat irritation
- Small ulcers in the mouth
- Jaw aches
- Headaches or dizziness
Other things to keep in mind
The stomach is not the only place where acidic substance can cause issues with the gum. You should make sure that you space out chewing the gum from other beverages that are acidic. Drinks such as coffee, drinks with lemon juice and soft drinks can cause reduced absorption of the nicotine from your mouth. You should try to space them out by at least 15 minutes from when you plan to chew the gum.
Look at the costs
Comparing nicotine replacement therapy to the cost of smoking makes another strong point for trying to quit. Look at the example below:
Cost of 1 pack of cigarettes in U.S. according to Fairreporters.net in 2017 was $7
If you smoke 1 pack per day that comes out to $49 per week.
To replace 1 pack per day you would need 10 of the 2mg pieces of gum per day. That comes out to 70 pieces. If you using the best deal I found (listed below) 384 pieces cost $59 that comes out to 0.15 cents per piece.
70 pieces per week x 0.15 cents per piece = $10.50 per week.
That saves you $38.50 per week over smoking!
You just got a $2000 per year raise, plus you will eventually use less gum and then stop it completely.
Keep in mind that Medicare does not cover nicotine replacement so you will have to pay out of pocket. Most commercial insurers follow what Medicare does and will not cover this. Below are prices found at various locations for nicotine gum.
Nicorette 2mg, 160 pieces $55
Click here for Nicorette
Equate 2mg, 160 pieces $42.26
Click here for Equate
Also, many employers offer wellness programs that allow you to save on your medical costs overall if you stop smoking. Enroll in that program as another motivator to quit smoking.
You can do it!
How long should nicotine gum be used?
The amount of time it take to become a non-smoker will depend on the person. Many people will have urges and cravings for years after they quit. That being said, it is important you do not try to stop nicotine replacement treatments too soon.
At least 3 months after you have stopped smoking would be the earliest you should try start to wean yourself down off of the gum. Most manufacturers do not recommend going past 12 weeks however, most doctors agree there is no harm in longer term nicotine replacement therapy. Especially if you are doing well and feeling that you no longer need cigarettes.
Typically if you are going to use nicotine replacement therapy for more than 6 months, talking to your doctor or pharmacist about your plans is warranted.
Tips for quitting
Once you taper yourself down to just a few pieces or no gum per day, don’t be afraid to keep some on hand for when you get those thoughts of “just one cigarette will be fine.” Fight the urge and use the gum!
The way you should use the gum should mirror the way you smoked. If you smoked only in the morning, at lunch and after dinner then you should only look to use the gum during those time. If you smoked 1 pack per day and more consistently during the day a good plan for gum usage and tapering is:
First through fourth week, one 2mg piece every 2 waking hours
Fifth through eighth week, one 2mg piece every 4 waking hours
Ninth through twelve week, one 2mg piece every 6-8 waking hours
Don’t be afraid to extend past 12 weeks or have more gum per hour during stressful times or when urges are strong.
Another taper option
If you like to chew the gum because it gives you “something to do” the way smoking did then you can try a different method to taper off the gum.
Chew the same amount of gum per day, but instead of chewing it until the nicotine is gone (typically 30 minutes) try throwing the gum away after 25 minutes.
If you do this for two weeks, then drop to 20 minutes for two weeks you will eventually need less nicotine as you will be getting less from the gum.
Eventually you can remove one piece of gum per day altogether and keep tapering down (SLOWLY) from there.
Other Nicotine products:
There are a few other dosage forms that you may want to look into if gum doesn’t seem right for you.
Combine gum with patches?
Nicotine patches are another form of nicotine replacement. They have been show effective at leveling off cravings as they provide a constant level of nicotine throughout the day from a patch that you place on your skin.
The patches come in 21mg, 14mg and 7mg doses so you can start with about 1 pack per day (21mg dose) and then taper off to 14mg and finally 7mg before stoping completely.
Many people like patches better than gum since they do not have to chew and have that “gross taste” that can result when people don’t use the gum correctly.
The problem with patches is that they are not effective at giving you a boost in your dose when you are having a strong craving. Thus many patients don’t have adequate support at this time and will smoke to satisfy the urge. If you find yourself having this issue, I recommend you try combining the gum with your patch.
Having the gum or the oral inhaler to fall back on when you have a craving gives you a physical touch and feel sensation similar to smoking. You are doing something with your hands to curb your craving and providing your body with a burst of nicotine.
Many patients find this to be highly effective and allows the a way to taper down the patches as directed and still have the gum as a backup. This is also recommended by the U.S. government clinical practice guidelines for smoking cessation.
Some other non nicotine ideas:
- Suck on ice cubes at home or work
- Avoid other smokers, get them to quit with you and do something like walking with them instead of smoking
- Practice deep breathing or meditation, there are many great apps for this on your phone that can be used for a quick diversion
Remember the choice is up to you
Nicotine replacement therapies are a great way to level out the nicotine cravings you have when you stop smoking. However, they will not make quitting smoking easy, but they can make it more bearable if used correctly.
to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
Have you used Nicotine gum? How well did it work for you? Please chime in below with your comments and thoughts below
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You chew nicotine gum as a way to help yourself quit using tobacco. The gum contains nicotine and feels and looks like chewing gum. When you chew the gum, the nicotine begins to slowly release into your mouth. Then you hold the gum in your mouth between your cheek and gums.
Cigarette smoke passes nicotine almost instantly into the blood through the lining of the lungs, and the blood takes it to the brain in a few seconds. The nicotine in the gum takes several minutes to reach the brain. This makes the “hit” less rapid with the gum than with a cigarette. Nicotine gum also delivers much less nicotine to your body than a cigarette would.
Nicotine gum comes in several flavors and in two strengths: 2 mg and 4 mg. Start with the 4 mg strength if you smoke 25 or more cigarettes a day or if your doctor recommends it.
Do not chew nicotine gum like normal gum. Instead, use the “chew and park” method:
- Use one piece of gum at a time.
- Put a piece of gum into your mouth, and chew it slowly a few times to break it down. Chewing will release a “peppery” taste. Next, park the gum between your gums and cheek, and leave it there.
- Repeat the process of chewing and parking for about 15 to 30 minutes, or until there is no more peppery taste released by chewing. The gum is used up at that point. The nicotine from the gum makes its way into your system through the blood vessels that line your mouth.
- If you chew the gum without parking it, the nicotine will be released directly into the saliva in your mouth and you will swallow it. This may cause a stomachache, hiccups, or heartburn. Also, it may take longer for the nicotine to get into your bloodstream.
Other tips for using nicotine gum
- Avoid drinking beverages, especially acidic ones (such as coffee, juices, and soda pop), for 15 minutes before and after you chew. Your body may not absorb the nicotine well because of the acid in these drinks.
- Follow the written instructions that come with the gum for how many pieces you can use per day. Most people use 10 to 15 pieces a day. (Do not chew more than 30 pieces of the 2 mg gum or 20 pieces of the 4 mg gum a day.)
- Consider using the other materials provided with the nicotine gum. These can help you change your smoking behavior.
- Avoid the common mistakes of chewing too little gum or stopping use too early. Using too little of the gum will result in withdrawal symptoms similar to those caused by abruptly stopping smoking.
- As the urge to smoke decreases, use fewer pieces of gum each day. When you are using only 1 or 2 pieces a day, stop using the gum completely. However, you may want to keep some nicotine gum with you in case you find yourself in a potential relapse situation.
It is possible to become dependent on nicotine gum, but this is rare.
Nicotine gum does have side effects. Read the package insert before you use this medicine.
Nicotine patches, gum and lozenges
- You are pregnant or breastfeeding
- You are a diabetic on insulin
- You are taking medication for a mental health condition
- You weigh less than 45 kilos (7 stone)
- You have had a heart attack, stroke or severe angina in the last two weeks.
How To Order
You can order subsidised nicotine patches, gum and lozenges by calling us on 0800 778 778, texting us on 4006 or online when you register. We’ll send you a Quitcard to take to redeem at your local pharmacy.
A 4 week supply of one of these products costs around $5 with the option of a free repeat. Without the subsidy an 8 week supply of these products could cost you over $200.
To see how to use patches, gum and lozenges watch these clips:
How to use gum
- The gum shouldn’t be chewed like normal gum or you might get hiccups or a sore stomach and the gum won’t work properly to help your cravings.
- Once you start using gum, do not smoke.
- Instead, bite down 1-2 times to release the hot, peppery taste and then ‘park’ it between your gums and cheek to release the nicotine. Some people don’t like the taste at first, but you do get used to it.
- Repeat this 5-6 times over a 30 minute period.
- Do not drink when using the gum, or for up to 15 minutes afterwards because you can also get a sore stomach and hiccups this way. The gum also won’t work properly help your cravings.
- Most people use 8-12 pieces in a 24 hour period. If you need more you can use up to 25 pieces of 2mg gum and 15 pieces of 4mg gum within a 24 hour period.
- Throw the gum away after 30 minutes, safely out of the reach of children and pets.