Nicotine Replacement Therapy

Nicotine is a drug that is inhaled from the tobacco in cigarettes. It gets into the bloodstream and stimulates the brain. Most regular smokers are addicted to nicotine.


If you are a smoker when the blood level of nicotine falls, you usually develop withdrawal symptoms such as restlessness, increased appetite, inability to concentrate, irritability, dizziness, constipation, nicotine craving or just feeling awful. These symptoms get worse. If you do not smoke any more cigarettes, the withdrawal symptoms peak after about 24 hours and then, gradually ease over about 2-4 weeks. So, most smokers smoke regularly to feel normal and to prevent withdrawal symptoms. Most smokers want to stop smoking. About 1 in 3 smokers intend to give up within a year but without help, many fail to succeed. The main reason why so few smokers succeed, even though they want to stop smoking is because nicotine addiction is strong and difficult to break.


NRT is a way of getting nicotine into the bloodstream without smoking. There are nicotine gums, patches, inhalers, tablets, lozenges and sprays.

As a lung specialist, I had been working with Smoking Addiction for the past 10 years. I had introduced NRT as a way of treatment in my Non profit clinic KASH – Kolkata Action on Smoking and Health.


NRT stops or reduces the symptoms of nicotine withdrawal. This helps you to stop smoking but without having unpleasant withdrawal symptoms. NRT DOES NOT ‘MAKE’ YOU STOP SMOKING. You still need determination to succeed in breaking the smoking habit.

  • Set a date to start. Stop smoking and start NRT straight away
  • You should use NRT regularly at first and not ‘now and then’
  • Use an adequate dose of NRT. The higher doses are used if you smoked more than 18-20 per day
  • Use NRT for at least 8-12 weeks for the best chance of stopping smoking long term
  • The dose of NRT is typically reduced in the later part of the course and then stopped.

This was the first NRT and is the most commonly used. Two strengths are available – 2mg and 4mg. You should use the 4mg strength if you smoked 18 or more cigarettes a day. You need about 12-15 pieces gum per day to start with (about 1 per hour). To release the nicotine, chew the gum slowly until the taste is strong. Then, rest it between the cheek and the gum to allow absorption of nicotine into the bloodstream. Chew the gum again when the taste fades and rest it again when the taste is strong, etc. Use a fresh piece of gum after about an hour.

Gradually, decrease the intake of gum until you can stop it completely. The disadvantage of gum is that some people do not like the taste.

  • Apart from causing addiction, nicotine is not thought to cause disease
  • The dose of nicotine in NRT is not as high as in cigarettes. So, NRT is not a perfect replacement. Symptoms of withdrawal are reduced with NRT but may not be stopped completely
  • Do not smoke at the same time as taking NRT.
** This site is for patient information only **