Stephen J. Schueler, M.D.

Overview Incidence Symptoms Evaluation Treatment nicotine substitutes specialist Home Care diet warning signs Prevention Outlook Underlying Cause

Cigarette Withdrawal Nicotine Substitutes

Alternative sources for nicotine include time-release patches (Habitrol, NicoDerm, and ProStep), and nicotine gum. These products release nicotine into the bloodstream and satisfy part of the urge to smoke. This method can gradually diminish the body's urge for nicotine. They are effective only when used as part of a smoking cessation program.

Nicotine Patches
A nicotine patch adheres to your skin and releases nicotine into your bloodstream. There are different strengths of patches and many are now available without a prescription. Some come in different levels of nicotine and are usually worn on the skin for 16 to 24 hours a day.

Nicoderm CQ includes patches that come in three strengths 21, 14, and 7 mg, which are used in a step-down program over a period of 8 to 10 weeks. Many users have experienced redness, itching, or burning of the skin with patches, causing some to discontinue use. The quit rate for patch users is around 20% after six months. This is roughly twice the rate of those who try to quit smoking cold turkey.


Nicotine Gum
This works the same as the nicotine patch and is also available without a prescription. Chewing gum may also help to curb some of the oral urge. The gum is chewed briefly to release nicotine, and then rests in your mouth. The dose of nicotine can be more controlled by the individual.

The released nicotine is absorbed into the blood through your mouth and gums. An effective program involves using the gum no more than once per hour in the beginning, then gradually reducing the dosage over six months.

  • Caffeine interferes with the absorption of nicotine. Wait at least 15 minutes after having a cup of coffee before chewing the gum.
  • Nicotine gum can cause headache, nausea, upset stomach, and dizziness.
  • People with dentures should avoid the gum and use another method.
  • Some find the gum tastes bad and may upset the stomach.

Nicotine Sprays and Inhalers
A nicotine spray delivers small doses of nicotine into the nasal passages, reducing the urge for nicotine. This method may work better in a highly dependent smoker. A similar product is the Nicotrol Inhaler. In this case the majority of the nicotine is absorbed through the mouth. Both of these forms of therapy are only available through your doctor.

  • Many patients using the nicotine nasal spray reported moderate to severe nasal irritation at the onset of usage.
  • Other common side effects that have been reported are runny nose, throat irritation, watering eyes, sneezing, and cough.

Continue to Cigarette Withdrawal Specialist

Last Updated: Dec 21, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
Copyright DSHI Systems, Inc. Powered by: FreeMD - Your Virtual Doctor

PubMed Cigarette Withdrawal References
  1. Berrettini WH, Lerman CE. Pharmacotherapy and pharmacogenetics of nicotine dependence. Am J Psychiatry. 2005 Aug;162(8):1441-51. [16055765]
  2. Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, Watsky EJ, Gong J, Williams KE, Reeves KR; Varenicline Phase 3 Study Group. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA. 2006 Jul 5;296(1):47-55. [16820546]
  3. Mooney ME, Sofuoglu M. Bupropion for the treatment of nicotine withdrawal and craving. Expert Rev Neurother. 2006 Jul;6(7):965-81. [16831112]
  4. Shiffman S, Fant RV, Buchhalter AR, Gitchell JG, Henningfield JE. Nicotine delivery systems. Expert Opin Drug Deliv. 2005 May;2(3):563-77. [16296775]
FreeMD is provided for information purposes only and should not be used as a substitute for evaluation and treatment by a physician. Please review our terms of use.