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?

Stopping without medicines is preferred. If this is unsuccessful, professionally supervised NRT can be 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. Duration and reassessment depend on the named product; do not assume an unlimited course for every formulation.

Nicotine Replacement Therapy (NRT) to Stop Smoking

What is 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. WHO recommends NRT for smoking cessation; WHO does not grant medicine marketing authorisations. Individual products have their own national authorisations.

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.

How does 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: People who need background nicotine replacement; the product determines overnight use
Product distinction: NiQuitin Clear releases 7 mg, 14 mg or 21 mg over 24 hours. These are not interchangeable with the strengths or schedule of a 16-hour patch.

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 and 4 mg; selection depends on nicotine dependence and the specific product

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.

Who is 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 for people who do not have nicotine dependence. People who have stopped smoking may continue a planned NRT course to sustain abstinence.

Dosage

The following adult monotherapy example is specifically Spain’s NiQuitin Clear 24-hour patch, not a universal NRT schedule:

Adult group	Initial stage	Next stage	Final stage
Standard course	21 mg/24 hours for 6 weeks	14 mg/24 hours for 2 weeks	7 mg/24 hours for 2 weeks
Fewer than 10 cigarettes/day	14 mg/24 hours for 6 weeks	7 mg/24 hours for 2 weeks	—

Apply a new patch daily. The usual full courses are 10 or 8 weeks respectively. The label allows longer use if needed to stay smoke-free, with professional help advised beyond 9 months. Combination treatment has separate oral-product limits; this table does not prescribe that combination or apply to adolescents.

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.

Side effects

Effects depend on formulation

Side effects 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	Evidence distinction
NRT (combination)	Nicotine replacement	Product-dependent	More effective than single-form NRT
Champix (varenicline)	Partial nicotinic agonist	Yes	No clear quit-rate difference versus combination NRT
Zyban (bupropion)	Non-nicotine medicine	Yes	WHO-recommended option

Online assessment for Nicotine Replacement Therapy (NRT)

Most NRT products are available over the counter in EU countries without a prescription. However, product selection and combination treatment may require professional assessment.

For prescription smoking cessation medicines such as Champix (varenicline) or Zyban (bupropion), Prescrivia operates as a technology intermediary connecting patients with independent doctors. We do not prescribe medicines, employ doctors, or sell medicines directly.

Important: Prescrivia does not guarantee that a prescription will be issued. All clinical decisions are made independently by qualified medical professionals.

Important safety information

Do not use NRT if you:

Do not have nicotine dependence
Have an allergy to nicotine or any ingredient in the selected product

Use with caution if you have:

Recent heart attack or unstable angina (seek medical advice first)
Uncontrolled hypertension
Severe renal or hepatic impairment

Smoking and nicotine exposure: NiQuitin Clear users should make every effort to stop smoking during treatment. Other products may have different reduction indications. Do not add nicotine products outside the selected regimen; seek professional advice after a lapse or symptoms of excess nicotine. Keep all products, including used patches, away from children. Generalised redness, swelling or persistent rash requires stopping the patch and professional advice.

Selected NiQuitin Clear precautions: discuss diabetes (monitor glucose more closely), active gastrointestinal disease, uncontrolled hyperthyroidism, phaeochromocytoma, seizures and skin disease. Smoking cessation can change levels of medicines such as clozapine or theophylline; a clinician may need to adjust them. Combining patches and oral NRT requires benefit/risk assessment in cardiovascular disease. During pregnancy or breastfeeding, first try to stop without NRT; a professional can assess NRT if unsuccessful. Pregnancy patches must be removed before sleep. Combination NRT is not recommended in pregnancy or breastfeeding unless a professional considers it necessary.

In Spain, distance sale of prescription medicines is prohibited under Article 3.5 of Royal Legislative Decree 1/2015. An online assessment does not remove this restriction. Dispensing and access depend on the exact product and applicable national rules.

Sources

Medical information on this page is based on the following sources:

This overview does not replace the selected product information. 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.

Nicotine Replacement Therapy (NRT)

Assessment availability

Strengths and types