Nicotine substitutes (or NRT, nicotine replacement therapy) are the first line of medical aid to quit smoking. They are effective, cheap, reimbursed in most European countries, and far smarter to use than what you usually read about them.

Here is everything you need to choose, dose and combine them correctly.

How it works

When you smoke, your brain gets a nicotine shot in 7 to 10 seconds. When you stop abruptly, withdrawal sets in within 4 to 24 hours and triggers the withdrawal syndrome (irritability, anxiety, strong cravings).

Nicotine substitutes deliver nicotine alone, without the 7,000 other substances in smoke — no tar, no carbon monoxide, no fine particles. Your brain gets what it asks for, your body is no longer poisoned.

The different forms: patch, gum, lozenge, spray, inhaler

Find the right dose: do not underdose

The most frequent mistake: starting with a dose too low out of fear or guilt. Result: withdrawal persists, you crack, you relapse, and you conclude 'patches do not work'. They do — it was the dose that was wrong.

The winning combo: patch + fast form

This is the strategy validated by the Cochrane meta-analyses (review of more than 130 studies, 64,000 smokers).

Why? The patch keeps a stable nicotine background. The fast form (gum, lozenge, spray) handles one-off craving spikes — after coffee, in the car, in a stressful situation. Without the fast form, those spikes are not covered by the patch and often trigger a relapse.

How long to use a substitute?

1. Before quit day Starting the patch 2 to 4 weeks before your quit date increases the chances of success (Cochrane study). You smoke in parallel, no fear.
2. D0 to 8 weeks Full dose. You have no reason to lower the dose if cravings persist.
3. Weeks 8-12 Gradual reduction (step down to a lower dose). Not mandatory if it destabilises you.
4. Beyond No evidence that going beyond 8-12 weeks adds extra benefit, but no documented risk either if you need it for 6 months or more.

Possible side effects

NRT is among the best-tolerated medicines.

• Patch — skin irritation in about 1 in 5 people (changing the area each day usually solves it). Insomnia / vivid dreams with the 24h patch (switch to 16h then).

• Gum — hiccups, throat burn, bloating (technique: 'chew a few times, park between cheek and gum, chew again when the urge returns'). Never swallow saliva like a normal chewing gum.

• Lozenge — let it dissolve, do not chew. Same minor issues as the gum.

• Spray — burning sensation in the mouth, sometimes sneezing.

If side effects bother you: change format, do not stop the treatment.

Common myths to forget

Special cases

• Pregnancy and breastfeeding — NRT allowed when unaided cessation has failed (see dedicated article). 16h patches preferred over 24h. Bupropion and varenicline contraindicated.

• Heart disease — NRT is less risky than continuing to smoke. Discuss with the cardiologist but no absolute contraindication.

• Adolescents — prescription should come after age 15, with support. Younger: specialist advice.

• Very high dependence (3+ packs/day) — a tobaccologist can prescribe doses higher than standard protocols.

How to get them

• On prescription from a doctor, midwife, dentist, nurse, physiotherapist, or pharmacist (depending on country).

• Free on the NHS in the UK via Stop Smoking Services, and reimbursed in many European countries (in France: 65 % with no annual cap since 2018).

• Without prescription: also available over the counter at pharmacies, but without reimbursement.

Your questions