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

Nicotine Gum

How it works: 1

  • Nicotine gum is a fast-acting form of replacement therapy that acts through the mucous membrane of the mouth. The gum is chewed slowly until a "peppery" taste is detected, then "parked" against the inside of the cheek, with intermittent chewing on and off for about 30 minutes.
  • The gum is packaged in 2 mg and 4 mg strengths. Those who smoke more than a pack per day should start off with the 4 mg strength, using no more than 20 pieces per day. Maximum recommended usage is 6 months.
  • Nicotine gum may be preferred over the patch for those with sensitive skin.

What the evidence says:

  • Strength of Evidence: A The Clinical Practice Guideline states that the gum is, “appropriate as a first-line medication for treating tobacco use” with precautions for pregnant women and individuals with cardiovascular disease risks (DHHS, 2008, p. 48).
  • Quitting rates:
    • Smoking abstinence success rates among participants using over-the-counter nicotine gum have been found to be consistently higher than those using prescription gum.2 Sixteen percent of over-the-counter gum users were abstinent at 6-weeks compared to 7% of prescription gum users. These differences may be explained by a variety of psychological factors, including patient motivation.
  • Coping with Cravings:
    • One study reported both nicotine gum and a placebo gum were equally effective at reducing acute cravings for cigarettes.3
    • Researchers tested a prototype rapid-release nicotine gum and found it to be more effective at reducing cue-provoked cravings than the standard nicotine gum.4

Possible Side Effects:

  • Bad taste
  • Throat irritation
  • Mouth sores
  • Hiccups
  • Nausea
  • Indigestion
  • Jaw discomfort
  • Racing heartbeat

Where to get it:

  • Nicotine gum can be purchased over-the-counter without a prescription.
  • The Maryland Quitline provides free gum to callers who enroll in free telephone counseling for cessation.
  • Commercial brands include

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.

2. Shiffman, S., et al. (2002). Real-world efficacy of prescription and over-the-counter nicotine replacement therapy. Addiction, 97, 505-516.

3. Davies, G.M., et al. (2004). Influence of nicotine gum on acute cravings for cigarettes. Psychopharmacology, 18, 83-7.

4. Niaura, R., et al. (2005). Comparative efficacy of rapid-release nicotine gum versus nicotine polacrilex gum in relieving smoking cue-provoked craving. Addiction, 100, 1720-30.