Vad är Nicotine Replacement Therapy (NRT)?
Nicotine Replacement Therapy (NRT) is a group of products designed to help people quit smoking by providing controlled doses of nicotine — without the thousands of harmful combustion products present in cigarette smoke. NRT products are approved by the Europeiska läkemedelsmyndigheten (EMA) and the Världshälsoorganisationen (WHO) as effective aids for smoking cessation.
Unlike Champix (varenicline) and Zyban (bupropion), NRT works by replacing the nicotine from cigarettes rather than blocking or modifying brain receptor responses to nicotine. By maintaining nicotine levels in the body, NRT reduces the discomfort of withdrawal, making it easier to focus on breaking the behavioural and psychological habits associated with smoking.
Hur fungerar NRT work?
Nicotine in tobacco products acts on nicotinic acetylcholine receptors in the brain, producing effects including dopamine release, which creates the pleasurable and reinforcing sensations associated with smoking. When smokers stop, the absence of nicotine causes withdrawal symptoms including cravings, irritability, anxiety, difficulty concentrating, and disturbed sleep.
NRT works by:
- Maintaining nicotine levels: Providing enough nicotine to reduce withdrawal severity without the peak-and-trough pattern of cigarette smoking
- Breaking the tobacco habit separately from nicotine dependence: Allows the user to address the behavioural component of smoking addiction without simultaneously experiencing full withdrawal
- Gradual reduction: Many NRT programmes involve stepping down to lower nicotine doses over time, allowing the body to adjust incrementally
Types of NRT
Patches (transdermal)
Nicotine patches are applied to the skin and release nicotine slowly and continuously throughout the day. They are available in 16-hour (removed at bedtime) and 24-hour formulations.
- Best for: Smokers who need consistent background nicotine levels; those without significant morning cravings
- Strengths available: Typically 7 mg, 14 mg, and 21 mg — matched to daily cigarette consumption
Gum
Nicotine gum is chewed to release nicotine, which is absorbed through the mouth lining. It should be used with the “chew and park” technique — chew briefly, then rest the gum against the cheek.
- Best for: Managing acute cravings; those who prefer an active coping mechanism
- Strengths: 2 mg (for lighter smokers) and 4 mg (for heavier smokers)
Lozenges
Dissolved slowly in the mouth, releasing nicotine through the oral mucosa.
- Best for: Discreet use in settings where gum is not appropriate
Inhalers
A plastic cartridge containing nicotine is inhaled through a mouthpiece. Nicotine is absorbed in the mouth and throat rather than the lungs.
- Best for: Smokers who miss the hand-to-mouth ritual of smoking
Nasal sprays and sublingual tablets
Faster-acting forms delivering rapid nicotine relief — useful for managing intense, sudden cravings.
Vem är NRT for?
NRT is suitable for the majority of adult smokers who want to stop smoking. It is one of the most widely recommended first-line treatments for smoking cessation and can be used by:
- Most adult smokers, including those with cardiovascular disease (under medical guidance)
- Smokers who prefer a non-prescription approach
- Those who have tried to quit without support and not succeeded
- Pregnant and breastfeeding women (under medical supervision and with appropriate product selection)
NRT is not appropriate for non-smokers and should not be used by people who have completely stopped using tobacco products.
Dosering
NRT dosing is typically matched to the patient’s level of tobacco dependence:
| Daily Cigarette Consumption | Recommended Starting Dose |
|---|---|
| More than 20 cigarettes/day | High-dose patch (21 mg) + fast-acting form |
| 10–20 cigarettes/day | Medium-dose patch (14 mg) or 4 mg gum/lozenge |
| Fewer than 10 cigarettes/day | Low-dose patch (7 mg) or 2 mg gum/lozenge |
Combination NRT (a patch plus a fast-acting form) is supported by evidence as more effective than single-product NRT for moderate-to-heavy smokers.
Biverkningar
Vanliga biverkningar
Biverkningar vary by NRT type:
Patches:
- Local skin irritation, redness, or itching at the application site
- Vivid dreams (with 24-hour patches — switching to 16-hour patches may help)
- Headache
- Nausea
Gum and lozenges:
- Mouth soreness or throat irritation (especially if chewed incorrectly)
- Hiccups
- Nausea
- Heartburn (indigestion)
Inhalers:
- Throat or mouth irritation
- Coughing
Important considerations
- NRT is significantly safer than continued smoking; the risks of NRT must be considered against the well-documented health risks of tobacco use
- Nicotine from NRT can increase heart rate and blood pressure; patients with severe cardiovascular disease should use NRT under medical supervision
NRT vs other smoking cessation treatments
| Treatment | Type | Prescription | Efficacy vs unaided quit | Notes |
|---|---|---|---|---|
| NRT (combination) | Nicotine replacement | No | ~2–3x more likely to quit | Most suitable for broad population |
| Champix (Varenicline) | Partial nicotinic agonist | Yes | ~3–4x more likely to quit | Highest pharmacological efficacy |
| Zyban (Bupropion) | Antidepressant | Yes | ~2x more likely to quit | Non-nicotine; prescription only |
Hur får man tillgång till smoking cessation support online i Europa
Most NRT products are available over the counter in EU countries without a prescription. However, prescription-strength NRT or combination treatments may require a consultation with a healthcare professional.
For prescription smoking cessation medicines such as Champix (varenicline) or Zyban (bupropion), Prescrivia operates as a technology intermediary connecting patients with independent EU-registered doctors. We do not prescribe medicines, employ doctors, or sell medicines directly.
Important: Prescrivia garanterar inte that a prescription will be issued. All clinical decisions are made independently by qualified medical professionals.
Viktig säkerhetsinformation
Använd inte NRT if you:
- Are a non-smoker
- Have a nicotine allergy
Use with caution if you have:
- Recent heart attack or unstable angina (seek medical advice first)
- Uncontrolled hypertension
- Severe renal or hepatic impairment
Avoid smoking while using NRT: Combining NRT with cigarettes can result in higher nicotine levels than intended. If you smoke while on NRT, inform your pharmacist or doctor.
Källor
Medical information on this page is based on the following sources:
- Europeiska läkemedelsmyndigheten (EMA). Guideline on the clinical investigation of medicinal products for smoking cessation. EMA/CHMP/2013.
- Världshälsoorganisationen (WHO). WHO Framework Convention on Tobacco Control — Cessation of tobacco use. who.int
- Hartmann-Boyce J, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 2018;5:CD000146.
This content is reviewed periodically to reflect updated clinical guidance. It is provided for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for advice relevant to your individual health circumstances.
Frequently asked questions
- Vad är Nicotine Replacement Therapy?
- Nicotine Replacement Therapy (NRT) is a range of products that deliver controlled, lower doses of nicotine to the body without the harmful combustion products of tobacco smoke. The goal is to relieve cravings and withdrawal symptoms while you break the behavioural habit of smoking, allowing you to gradually reduce nicotine dependence.
- What types of NRT are available?
- NRT is available in several forms: patches (worn on the skin, releasing nicotine over 16 or 24 hours), gum (chewed when cravings strike), lozenges (dissolved in the mouth), inhalers (nicotine cartridges mimicking the hand-to-mouth action of smoking), nasal sprays, and sublingual tablets. Each form suits different preferences and smoking patterns.
- Is NRT safe to use during pregnancy?
- NRT is generally considered preferable to continued smoking during pregnancy, as cigarette smoke is significantly more harmful to the developing foetus than medicinal nicotine alone. However, NRT should only be used in pregnancy under medical supervision, with careful consideration of the type and dose used. Intermittent forms (gum, lozenges) are often preferred over 24-hour patches in pregnancy.
- Can I use more than one type of NRT at the same time?
- Yes. Combination NRT — typically a longer-acting patch to provide a consistent background nicotine level, combined with a faster-acting form (gum, lozenge, or inhaler) for breakthrough cravings — is supported by clinical evidence and recommended in many EU smoking cessation guidelines as more effective than single-form NRT.
- How long should I use NRT?
- Most NRT guidelines recommend a course of 8 to 12 weeks, with gradual dose reduction where possible. Some patients may benefit from longer treatment to prevent relapse. There is no fixed maximum duration — the goal is to use NRT as a tool to become tobacco-free, and it can be continued under medical supervision if it is helping.
Prescrivia er kun en formidlingsplattform. Vi leverer ikke medisinske tjenester, forskriver ikke behandlinger og utleverer ikke legemidler. Alle medisinske beslutninger tas av uavhengige EU-registrerte leger. Alle legemidler utleveres av lisensierte EU-apotek. Denne plattformen legger til rette for kontakt mellom pasienter og helsepersonell.