How to Choose a Smoking Cessation Product That’s Right for You

Smoking cessation products approved or cleared by the U.S. Food and Drug Administration are shown to help people quit smoking and can even double your chance of quitting successfully.

Are you or a loved one among those American adults who smoke cigarettes and want to quit? Whether this is your first attempt to quit smoking, or you’ve already tried several times, know that there are FDA-approved and FDA-cleared products that can assist you on your journey to becoming smoke-free.

If you’re considering using a smoking cessation product and are under age 18, speak to a doctor before using these products.

Benefits of Quitting Smoking

No matter how much you smoke—or for how long—quitting will benefit you.

Quitting smoking can lower risk of:

• Various cancers, including lung cancer
• Heart disease, stroke, emphysema, vision loss, and other serious diseases
• Disease and cancer in family members including children, and pets, who otherwise would be exposed to your secondhand smoke

Although there are benefits to quitting at any age, it is important to quit as soon as possible so your body can begin to recover from the damage caused by smoking. For instance, on average, 12 hours after you quit smoking the carbon monoxide level in your blood drops to normal. Carbon monoxide is harmful because it displaces oxygen in the blood and deprives your heart, brain, and other vital organs of oxygen.

Don’t know what to expect when you first quit smoking? Learn more about what it’s like to quit smoking.

What is Nicotine Replacement Therapy (NRT)?

Nicotine is a highly addictive chemical compound present in a tobacco plant. Tobacco products are addictive because they contain nicotine. Nicotine keeps people using tobacco products, even when they want to stop.

Nicotine replacement therapy, also known as NRT, helps you quit smoking by gradually providing the body with smaller doses of nicotine over time, without exposing you to the toxic chemicals found in cigarette smoke. In conjunction with a behavioral program, NRTs have been found to increase the success of smoking cessation and are available over-the-counter and by prescription.

Over-the-counter NRTs are approved for sale to people age 18 and older. They include:

• Skin patches (also called “transdermal nicotine patches”). These patches are placed on the skin, similar to how you would apply an adhesive bandage.
• Chewing gum (also called “nicotine gum”). This gum must be chewed according to the labeled instructions to be effective.
• Lozenges (also called “nicotine lozenges”). You use these products by dissolving them in your mouth.

Prescription Smoking Cessation Products That Contain Nicotine

• Nicotine spray
• Nicotine inhaler

Prescription Smoking Cessation Products That Do Not Contain Nicotine

Two FDA-approved smoking cessation products do not contain nicotine:

• Varenicline tartrate
• Bupropion hydrochloride

Both are available in tablet form by prescription only. The FDA evaluated these drugs and found that the benefits outweigh the risks. For users taking these products, risks include changes in behavior, depressed mood, hostility, aggression, and suicidal thoughts or actions.

The most common side effects of varenicline tartrate include nausea; constipation; gas; vomiting; and trouble sleeping or vivid, unusual, or strange dreams. Varenicline tartrate also may change how you react to alcohol, so talk to your health care provider about your drinking habits (if you drink alcohol) and whether these habits need to change. Varenicline tartrate is not recommended for use in patients 16 years of age or younger.

The most commonly observed side effects consistently associated with the use of bupropion hydrochloride are dry mouth and insomnia. Because bupropion hydrochloride contains the same active ingredient as the antidepressant bupropion, the FDA encourages people who use bupropion hydrochloride —and those who are considering it—to talk to their health care providers about the risks of treatment with antidepressant drugs. Bupropion hydrochloride has not been studied in children under the age of 18 and is not approved for use in children and teenagers.

Other Smoking Cessation Therapies

The FDA has also given marketing clearance to a device using Transcranial Magnetic Stimulation (TMS) as an aid for short-term smoking cessation in adults.

Talk to Your Health Care Provider

Talk to your health care provider to determine the best course of treatment and which smoking cessation products might work best for you. Your health care provider may need to take into consideration your age, whether you’re pregnant or breastfeeding, and medical history, such as heart disease, diabetes, depression, asthma, blood pressure, and more.

You can also read the labels to better understand how the products work and what side effects they may cause.

Many people use quit smoking medications to help reduce withdrawal feelings and cigarette cravings. Quit smoking medications can double your chances of quitting for good.

Nicotine replacement therapy (NRT) is the most commonly used family of quit smoking medications. NRT reduces withdrawal feelings by giving you a small controlled amount of nicotine─but none of the other dangerous chemicals found in cigarettes. This small amount of nicotine helps satisfy your craving for nicotine and reduces the urge to smoke. 

Doctors and other medical experts think NRT is the one of the most helpful tools smokers can use to quit. Some smokers have mild to moderate side effects. However, research shows that NRT is safe and effective. NRT can be an important part of almost every smoker’s quit smoking strategy.

NRT comes in a variety of forms that are used in different ways. You can choose which forms you like best. Some NRT products work better than others for some people. Some people might prefer certain NRT products instead of others.

Types of NRT

Combining NRT with Other Strategies

NRT can’t do all the work. It can help with withdrawal and cravings, but it won’t completely take away the urge to smoke. Even if you use NRT to help you stop smoking, quitting can still be hard. Combining NRT with other strategies can improve your chances of quitting and staying quit. A personalized quit plan can help you find tools and strategies that work together to help you quit and stay quit. It can also help you to stay focused, confident, and motivated to quit.

To give yourself the best chance for success, explore other quit methods you can combine with medication.

Nicotine patches come in different shapes and sizes. They are thin and stick to your skin. You put one nicotine patch on your skin in the morning and leave it in place all day. It releases nicotine throughout the day which is absorbed through your skin.

Pros:

• Put it on at the beginning of the day, then forget about it.
• Put it on under clothing, so it is hidden.
• Can be used with other nicotine replacement medicines such as lozenge and gum.
• Provides a steady dose of nicotine all day.
• Can be kept on in the shower.
• Available in several strengths which you can reduce over time to ease you through nicotine withdrawal.
• Side effects are generally minor and can be managed.
• Available without a prescription (over-the-counter)

Cons:

• You can’t change how much nicotine gets released. If you have withdrawal symptoms you may need to increase your dose or add another medicine.
• May be irritating if you have sensitive skin.

Possible Side Effects (and what you can do about them):

• Skin redness, itching, or burning (rotate the patch to a different site each day).
• Headache (try a lower dose patch).
• Sleep disturbances such as difficulty sleeping and vivid dreams (remove patch at night).

Nicotine Patch Precautions (If any of these apply to you, talk to your doctor or other healthcare provider before starting to use the patch.):

• A heart attack in the last two weeks.
• A serious heart rhythm problem.
• Pain in your heart (angina) that is serious or getting worse.
• Allergy to adhesive tape or other serious skin problems like psoriasis and eczema.
• Could be pregnant or are breastfeeding
• Less than 18 years old.

Nicotine lozenges look like small hard candies. You put one in your mouth between your gums and your cheek. You may feel a warm or tingling sensation as it slowly dissolves. Do not chew or swallow the lozenge. The nicotine is absorbed mostly in your mouth.

Pros:

• Can be used regularly and when you feel withdrawal symptoms or urges coming on.
• Acts faster than nicotine patch or quit-smoking pills.
• Can be used with the patch to deal with breakthrough urges.
• You control how often you use it, so you won’t get more nicotine than you want.
• May help delay weight gain associated with quitting.
• Comes in two sizes, regular and mini. Each of these is available in two strengths.
• May help substitute for a cigarette because you put it in your mouth.
• May be easier to use than gum.
• Available without a prescription (over-the-counter).

Cons:

• You have to remember to use it regularly and often.
• You should not eat or drink for 15 minutes before using or when it is in your mouth.
• Some people don’t like the taste of nicotine lozenges (the mini size may work better).
• Can cause stomach upset.

Possible Side Effects (and what you can do about them):

• Nausea, hiccups, or heartburn (do not chew, suck or swallow; try lower dose or wait longer between doses).
• Trouble sleeping (don’t use for several hours before bedtime).
• Headache or cough (try lower dose or wait longer between doses).

Nicotine Lozenge Precautions (If any of these apply to you, talk to your doctor or other healthcare provider before starting to use the lozenge.):

• A heart attack in the last two weeks.
• A serious heart rhythm problem.
• Pain in your heart (angina) that is serious or getting worse.
• Could be pregnant or are breastfeeding.
• Less than 18 years old.

Nicotine gum is not used like ordinary chewing gum. You chew it a few times and then “park” it between your cheek and the space below your teeth. The nicotine is absorbed mostly in your mouth.

Pros:

• Can be used regularly and when you feel withdrawal symptoms or urges coming on.
• Acts faster than nicotine patch or quit-smoking pills.
• Can be used with the patch to deal with breakthrough urges.
• You control how often you use it so you won’t get more nicotine than you want.
• May help delay weight gain associated with quitting.
• Comes in two strengths.
• May help substitute for a cigarette because you put it in your mouth.
• Available without a prescription (over-the-counter).

Cons:

• You have to remember to use it regularly and often.
• You should not eat or drink for 15 minutes before using or when it is in your mouth.
• Some people don’t like the taste or feel of nicotine gum.
• May be hard to use if you have dentures or other dental work.
• Requires learning how to use properly to work and to avoid side effects.
• Can cause stomach upset.

Possible Side Effects (and what you can do about them):

• Mouth or jaw soreness (don’t chew it like gum).
• Stomach discomfort, hiccups, and too much saliva (do not chew, suck or swallow; try lower dose or wait longer between doses).
• Light-headedness, nausea/vomiting, throat and mouth irritation from getting too much nicotine too fast (review use instructions – don’t chew like gum).

Nicotine Gum Precautions (If any of these apply to you, talk to your doctor or other healthcare provider before starting to use gum.):

• A heart attack in the last two weeks.
• A serious heart rhythm problem.
• Pain in your heart (angina) that is serious or getting worse.
• TMJ disease (bad pain in your jaw especially when eating).
• Could be pregnant or are breastfeeding.
• Less than 18 years old.

The nicotine oral inhaler is a small plastic tube shaped like a fat cigarette. You puff frequently on it with shallow puffs throughout the day. Unlike an asthma inhaler, the medicine is not inhaled into the lungs. The nicotine is absorbed mostly in the back of your throat.

Pros:

• Can be used regularly and when you feel withdrawal symptoms or urges coming on.
• Acts faster than nicotine patch or quit-smoking pills.
• Can be used with the patch to deal with breakthrough urges.
• You control how often you use it, so you won’t get more nicotine than you want.
• May help substitute for a cigarette because you put it in your mouth.

Cons:

• You have to remember to use it regularly and often.
• Doesn’t work as well in cold weather.
• You should not eat or drink for 15 minutes before using or during use.
• May be visible to people around you when using.
• Requires a prescription.

Possible Side Effects (and what you can do about them):

• Mouth and throat irritation (very common, but may lessen with continued use).
• Runny nose, cough (often people get used to these. Talk to your doctor if they continue to bother you).
• Headache (Consider waiting longer between doses and talk to your doctor).
• Hiccups or stomach discomfort (try lower dose or wait longer between doses).

Oral Inhaler Precautions (If any of these apply to you, talk to your doctor or other healthcare provider before starting to use inhaler.):

• A heart attack in the last two weeks.
• A serious heart rhythm problem.
• Pain in your heart (angina) that is serious or getting worse.
• Asthma and chronic lung disease.
• Could be pregnant or are breastfeeding.
• Less than 18 years old.

Nicotine nasal spray comes in a hand-held sprayer bottle. You use one spray in each nostril frequently throughout the day. The medicine is not inhaled. The nicotine is absorbed mostly in your nose. It is usually prescribed to people with severe nicotine addiction.

Pros:

• Can be used regularly and when you feel withdrawal symptoms or urges coming on.
• Delivers nicotine most rapidly of all nicotine replacement medicines (NRTs).
• Can be used with the patch to deal with breakthrough urges.
• You control how often you use it, so you won’t get more nicotine than you want.

Cons:

• Usually takes several days to get used to nose irritation.
• You have to remember to use it regularly and often.
• Some people don’t like having to spray medicine into their nose.
• It’s more addictive than other forms of NRT but still safer and less addictive than smoking cigarettes.
• May be visible to people around you when using.
• Requires a prescription.

Possible Side Effects (and what you can do about them):

• Nose and throat irritation; hot, peppery, burning feeling (very common, but may lessen with continued use).
• Tearing, runny nose, sneezing, or cough (often people get used to these. Talk to your doctor if they continue to bother you).
• Headache (Consider waiting longer between doses and talk with your doctor).

Nasal Spray Precautions (If any of these apply to you, talk to your doctor or other healthcare provider before starting to use spray.):

• A heart attack in the last two weeks.
• A serious heart rhythm problem.
• Pain in your heart (angina) that is serious or getting worse.
• Problems in your nose or sinuses.
• Severe breathing problems like asthma.
• Could be pregnant or are breastfeeding.
• Less than 18 years old.

Using combination NRT starts with putting on a patch each morning to get a steady level of nicotine all day. Then you also use a nicotine medicine like the lozenge or gum that works more quickly to help deal with urges or cravings when you feel them coming on. You can also talk with your healthcare provider about other combinations of quit smoking medicines that may improve your chances of quitting for good.

Pros:

• Using two nicotine replacement medicines (NRTs) together is more likely to help you quit successfully than using one alone.
• Patch will reduce your withdrawal symptoms throughout the day while lozenge or gum will quickly help deal with any breakthrough cravings.
• You control how often you use the lozenge or gum, so you won’t get more nicotine than you want.
• You have added flexibility lowering the amount of nicotine you get when you are ready to stop using NRT.
• May be able to use a lower dose or amount of lozenge or gum than you would if you were using them without the patch.
• Available without a prescription (over-the-counter).

Cons:

• If you are paying for the medicines yourself, using two medicines will cost more than using one.

Possible Side Effects (and what you can do about them):

• You can get the same side-effects using combination NRT that you get from the individual medicines (you can try lower doses to minimize side effects).

Precautions:

• Before starting combination therapy, check out the precautions for each individual medicine.

Myth: Nicotine replacement therapy (NRT) doesn’t work.
Truth: NRT works. NRT can double a smoker’s chances of quitting smoking for good.

Many smokers find NRT helpful for quitting. Every person is different. It might be worth trying NRT to see if it’s right for you. Even if you tried NRT before, it might be worth trying again. NRT will help you the most if you follow directions carefully. Use enough and use it for the recommended time. Other medications and strategies also are available to help you quit smoking.

Myth: If I use NRT, I won’t have withdrawal symptoms or cravings from quitting smoking.

Truth: You may still have withdrawal symptoms or cravings while using NRT. Try to be patient. Most people find withdrawal symptoms especially difficult the first week or two after quitting. Most smokers find withdrawal symptoms less intense when using NRT. If withdrawal symptoms continue a few days after you start using NRT, talk to your doctor or pharmacist about different NRT products that can help.

Follow NRT product directions carefully. Some NRT products (gum, lozenge, inhaler) work better if they are not used at the same time as high-acid drinks, such as sodas and fruit juices. It is safe to continue using NRT even if you slip and smoke one or two cigarettes. Staying on NRT increases your chances of getting back on track for quitting.

Myth: If I use one NRT product, I can’t use others.

Truth: NRT products can be used safely together. For example, you might use long-acting NRT such as the patch with short-acting NRT such as a lozenge. Some people find both a long-acting patch and short-acting gum to be useful when cravings are high to handle withdrawal symptoms and fight off cravings.

Myth: NRT is too expensive.

Truth: Many states in the United States offer free NRT through their state quitlines. The North American Quitline Consortium has a quitline map to help you find free quit smoking support and other resources near you.

People eligible for Medicare or Medicaid also may be eligible for free NRT. In recent years, insurance coverage for NRT has expanded under many private insurance plans. Check your insurance plan to learn if you are eligible for coverage. 

Even if NRT is not covered through your insurance or state quitline, the cost of NRT for several weeks will still be less than the cost of buying cigarettes.

Myth: Some people should not use NRT.

Truth: NRT has been available for more than 30 years. A great deal of research has been done on NRT. The research shows that NRT is safe and effective for almost all adults for quitting smoking. For most people, there is no need to talk to a doctor or health care provider before using NRT.

Pregnant women, teens, and people with serious health issues should talk to their doctor before using NRT. Serious health issues can include lung disease and heart problems. People with these problems still might be able to use NRT, but should talk to their doctor first.

1. Using some medicines together can help a lot.
   • The nicotine patch can be combined with short-acting medicines like the nicotine gum, lozenge, inhaler, or spray to better relieve withdrawal symptoms and combat cravings.
2. Use the right amount of medicine.
   • Some medicines come in different doses. Picking the right dose is important to make sure your body gets the right amount of nicotine to help relieve withdrawal symptoms. Use the nicotine replacement medicine dosing tool to help you pick the right starting dose and talk with your healthcare provider for more help with dosing.
3. Use the medicines for a long enough time.
   • Many people don’t use quit-smoking medicines for long enough. Most medicines are most effective when used for 6 to 12 weeks or longer, depending on the medicine and your quit plan. Using the medicines for long enough can improve your chances of quitting for good.
4. Get some coaching to help you quit.
   • Looking for ways to deal with urges and cravings? Wondering how to manage situations that make you feel like smoking again? Having problems using a medication and not sure what to do? Connect with your state tobacco quitline (1-800-QUIT-NOW) for free coaching and support or talk with your healthcare provider. Combining medication with coaching support will give you the best chance to quit for good.
5. Start some quit-smoking medicines before you quit.
   • It’s OK to start nicotine patches, gum, or lozenges a week or two before you quit smoking. This can help you get ready and may help you cut down on your smoking before you start your quit attempt. But be sure to quit in a week or two.
   • Quit-smoking pills (varenicline and bupropion) should usually be started a week or more before quitting. Your prescribing healthcare provider will discuss the best time to start when you get your prescription.
6. Make sure you use your medicine correctly.
   • Did you know the nicotine gum isn’t used like regular chewing gum, the nicotine lozenge isn’t used like a hard candy, and the nicotine oral inhaler isn’t used like an asthma inhaler? For the best chance of quitting, learn how to use your medicine correctly. Read the medication label and explore below for tips.