Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Nicotine Replacement Therapy

Nicotine Replacement Therapy (NRT) medications are effective smoking cessation treatments that patients should be encouraged to use.1

Overview of NRT

  • Nicotine replacement therapy (NRT) provides nicotine – in the form of gum, patches, inhalers or lozenges – without the other harmful components of tobacco and combusted tobacco products like cigarettes.
  • NRT largely deals with the physical aspects of tobacco dependence and is not intended to be the only method used to help individuals quit smoking. NRT should be combined with other smoking cessation methods that address the behavioral and psychological component of smoking, particularly Quitlines that offer FREE telephone counseling and sometimes provide NRT.
  • Nicotine replacement therapy should not be used if individuals plan to continue to smoke or use another tobacco product as he/she may be exposing themselve to higher doses of nicotine.
  • As a provider, discussion with your client/patient about the proper use of NRTs, including enhancing awareness of possible immediate reactions, preferences of types of NRTs, etc. improves the efficacy of this form of smoking cessation treatment.

Forms of Nicotine Replacement Therapy

Form of NRT

Strength of Evidencea

Availability

Nicotine Patches

A

OTC, QL

Nicotine Gum

A

OTC, QL

Nicotine Nasal Spray

A

Rx

Nicotine Inhalers

A

Rx

Nicotine Lozenges

B

OTC

OTC = over the counter

QL = provided FREE from the Maryland Quitline

Rx = prescription only

aStrength of Evidence Guidelines: The Department of Health and Human Services’ Treating Tobacco Use and Dependence (TTUD) Clinical Practice Guidelines 2008 Update includes a comprehensive review of cessation effectiveness research based on the following guidelines.

Strength of Evidence A = Multiple well-designed randomized clinical trials, directly relevant to the recommendation, yielded a consistent pattern of findings.

Strength of Evidence B = Some evidence from randomized clinical trials supported the recommendation, but the scientific support was not optimal.

Strength of Evidence C = Reserved from important clinical situations in which the Panel achieved consensus on the recommendation in the absence of relevant randomized controlled trials.

 

Review Studies on Nicotine Replacement Therapy

Nicotine & Tobacco Research (2011): A 2011 review examined recent studies of NRT as well as additional pharmacological treatments of nicotine addiction4. The review findings were largely consistent with those of the Clinical Practice Guidelines 2008 Update1, with a conclusion that nicotine replacement therapy can significantly increase the likelihood of long-term abstinence from smoking. The article also stated that using NRT can help to manage the weight gain that typically occurs following cessation.4

Current Pharmaceutical Design (2011): Another 2011 review examined nonrandomized trials of over-the-counter NRT examined, among other things, the quit rate of NRT users compared to non-users in smokers looking to quit3. Approximately half of the studies found that NRT users had significantly higher quit rates than non-NRT users. The review also found that many studies involved selection bias (due to the use of nonrandomized trials) that might have distorted the results.

Cochrane Reviews (2007): Prior to the publication of the TTUD 2008 Update, Cochrane Reviews published a 2007 review of 132 trials of NRT which included a total of over 40,000 participants. They found evidence to suggest that all forms of NRT studied increased the likelihood that individuals would have successful quit attempts; likelihood of quitting smoking was increased by 50-70% with the use of any NRT product. In contrast to the different strength of evidence ratings for NRT products provided in the TTUD 2008 Update, the 2007 Cochrane Review did not find evidence for differences in effectiveness between the various types of nicotine replacement therapy.2

 

References: 

1. Fiore, M. C., Jaen, C. R., Baker, T. B., & al., e. (2008). Treating Tobacco Use and Dependence 2008 Update.  Clinical Practice Guideline. In U.S. Department of Health and Human Services (Ed.). Rockville, MD: U.S. Department of Health and Human Services. http://www.ahrq.gov/professionals/clinicians-providers/

2. Stead, L.F., Perera, R., Bullen, C., Mant, D., Lancaster, T. (2007). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue 4.

3. Hughes, J., Peters, E., & Naud, S. (2011). Effectiveness of over-the-counter nicotine replacement therapy: a qualitative review of nonrandomized trials. Nicotine & Tobacco Research, 13(7), 512-522.

4. Aubin, H., Karila, L., & Reynaud, M. (2011). Pharmacotherapy for smoking cessation: present and future. Current Pharmaceutical Design, 17(14), 1343-1350.