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Nicotine Replacement Therapy (NRT)

What it is

NRT supplies nicotine without tobacco smoke, in controlled doses, through a patch, gum, lozenge, inhaler or nasal spray. The patch provides slow, steady delivery; gum and lozenge deliver faster, on-demand relief.

How it works

It reduces withdrawal symptoms and cravings while the person breaks the behavioural habit of smoking. Because the dose is lower and delivered without the rapid nicotine spike of a cigarette, dependence is typically easier to step down.

What the evidence shows

  • The Cochrane review of NRT (Stead et al.) found NRT in any form increases quit rates by roughly 50–70% versus placebo — see R-001.
  • In the EAGLES trial, the nicotine patch showed no increase in moderate-to-severe neuropsychiatric adverse events versus placebo — see R-015.
  • WHO (2024), USPSTF (2021) and NICE (NG209) all recommend NRT; in the UK, combining a patch with a fast-acting form (gum or lozenge) is standard practice.

Common considerations

  • Local irritation (patch), jaw discomfort (gum), throat/mouth irritation (lozenge) are commonly reported and usually mild.
  • Vivid dreams or disturbed sleep can occur with 24-hour patch use; many people remove the patch at night.
  • NRT is widely available without prescription in many countries, which makes it the most accessible first-line option.

Questions to ask a healthcare professional

  • Which form or combination suits my smoking pattern?
  • How long should I continue NRT, and how should I taper?
  • Are there reasons NRT is less suitable for me (pregnancy, cardiovascular history, recent heart attack)?

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