Navigating Nicotine Replacement: What are the options available?

[NDC_Team]

When it comes to choosing nicotine replacement, there are several over the counter (OTC) and prescription only options available. Nicotine patches, gum and lozenges are available OTC. Nicotine patches are available in 21 mg, 14 mg, and 7 mg of nicotine per dose. Nasal spray is available via prescription only from a healthcare provider. Each cartridge in the Nicotrol inhaler delivers on average 4 mg of nicotine. Each nasal spray bottle contains 100 mg of nicotine and an average of 40 sprays per bottle at 1 mg per dose (1 spray in each nostril).

The Nicotrol inhaler, another form of NRT, was discontinued in 2023. The product was discontinued due to unavailability of an essential resin used to produce the inhaler mouthpiece.

A cigarette on average delivers 2-3 mg of nicotine. Your body needs around this much nicotine replacement for every cigarette smoked to help relieve withdrawal symptoms and cravings after quitting smoking.

[3 mg nicotine x average number of cigarettes smoked per day = ___ amount of nicotine replacement needed per day]

Using this formula, a person who smokes on average 10 cigarettes daily and looking to use nicotine replacement would need 30 mg of nicotine replacement every day after quitting for the first few weeks to manage cravings and withdrawal symptoms. This could look like having one 14 mg patch on and taking eight 2 mg nicotine lozenges or a combination of different nicotine replacement products that add up to a total of around 30 mg of nicotine daily. Underdosing with nicotine has been shown to be associated with higher risk for relapse to smoking.

Your health care provider might take into consideration other variables such as blood pressure, existing medical conditions, and any current medication which may alter the amount of nicotine replacement recommended for you daily by your provider. If you are preparing for surgeries or any procedures, some physicians do ask that you refrain from all nicotine products so please consult with your health care provider to determine what might be the ideal amount of nicotine replacement for you. If you are getting too much nicotine, the symptoms you would notice are dizziness and nauseousness - which would just tell you that you need to decrease your dosage of nicotine replacement.

When it comes to choosing the right nicotine replacement, it really comes down to what you would find effective in helping manage cravings. For example, some like the gum and or lozenges while others might not want anything in their mouth and would prefer patches only. Cost might be another factor that goes into helping you decide which option works best. It certainly is not a one size fits all scenario, so it’s important to try different products to figure out if one suits you better than another.

What nicotine replacement products have you used to help with quitting?

Dhivyaa Manickam, M. A.
Counselor / CTTS
Photo by Nic Y-C

[Barbscloud]

@NDC_Team  This a great guide to using nicotine replacement.  Quitters need to learn about the specifics.  Lots of numbers get tossed around.

I've probably tried them all over 50 years including acupuncture and hypnotism.   For my final quit I used Welbutrin and nicotrol inhalers.

I'm aware of  the success rate when using an aid to quit, but I support a quitters choice.  I learned when I found the Ex that I had also had  work to do!

Barb

[theresamireles1]

Im having a hard time 

[CommunityAdmin]

@theresamireles1 

Sorry to hear that. Is it specifically about dosing of nicotine replacement therapy or quitting in general? If the latter, I recommend you instead Post a Journal or Ask for Support and elaborate a bit more to provide more specifics. This will help you get responses that will probably be more helpful to your situation.

@theresamireles1 wrote:
Im having a hard time

[Nuttybooker]

I've used patches in the past and found they only semi effective I tried lots and just once but the restriction on when you can drink do not work for me I have a dry mouth due to medication I take and I can't always stay away from liquids to have one I'm thinking of trying the nasal sprays

[Barbscloud]

@Nuttybooker What did you tried that you couldn't drink?  You talk about trying the patch.

Barb

[Barbscloud]

@theresamireles1 Welcome to the Ex.   What's going on?   Are you still  quit?  How can we help?

Barb

[DhivyaaManickam]

@Nuttybooker Drinks (especially acidic juices like orange juice, soda or coffee) can alter the pH of your mouth which affects the absorption of nicotine from the lozenges. This is the reason it is recommended that you don't drink any liquids before using them and during, to ensure that you absorb all the nicotine from the lozenge into your system. That being said you can drink water and even sip on it while you have a lozenge in your mouth as water doesnt affect your pH as much as some other drinks would. 

The nasal spray is a great option as well! 

[LG2003LG]

March 13 was my quit date.  I'm hanging on but it's certainly a rough road.  I'm not as anxious as I was. Hopefully each day will be easier.

[DhivyaaManickam]

@LG2003LG  Congratulations on your first week of being quit! What are some strategies you have found helpful in coping with your cravings? 

[Barbscloud]

@LG2003LG So glad you're still working on your quit (quit date buddy).   Congrats on completing hell week.  It is rough, so stick to your commitment.  You only have to do  this one day at a time for now.   It will definitely get easier, but be patient with yourself.  It will take some time.   Our bodies and minds take time to heal.

So proud of you.

Barb

[zenmamasan]

@DhivyaaManickam I used patches for about six months in decreasing doses (my state, vermont, very generous) then after a month on lowest patch, nic gum at trigger timed, but felt I only needed that as occasional nicotine gum. I still pop a 4mg nicotine gum maybe every few weeks or so if I get triggered,  which still happens after almost 1.5 years. I never thought the gum would help, but it does. The patches, and meditation app, and melodrama kdramas did it for me. 😄That was my plan. In addition to medications, I HAD to find a way to clock out, turn in,check out,  in any situation. Like autism tools for self-regulation when confronted with rapid changes. It worked. 

[ColbyWells25]

im using nicotine pouches, im switching to the gum tomorrow im so excited

[zenmamasan]

This is a big deal! And manageable. I'll leave the suggestions to the experts, but I was surprised how less of "pull" I had from when I first quit and was on the patches. But I was told those first weeks on gum to make sure to be regular with the gum  - like I used to pop it when riding to work in my car - big trigger.

Now I am a year or two out, and just do gum when anxiety hits and I can't deal.

Congrats, keep going, you will NOT regret the effort you put into this to be smoke-free.

[DhivyaaManickam]

@zenmamasan That's wonderful that you found nicotine patches and gum to be very helpful along with the meditation app and kdramas! Congrats on being quit for over 1.5 years! 🙂

Self-regulation tools and alternative coping mechanisms are also very important because they help sustain the quit by being there to alleviate stress, anxiety, boredom and any situations as they come up to reduce the chances of relapse. Thank you for sharing! 

[DhivyaaManickam]

@ColbyWells25 That is exciting! You'll have to share with us how things go 🙂 and I agree with @zenmamasan that it helps to regularly use the gum the first few weeks of use.

It can be beneficial to use the gum before a craving might be triggered as it will be more effective in helping cope with the trigger (since it takes a few minutes to absorb the nicotine into your system.) 

[Silenthunderp]

I’ll take the patches  and gum

[Barbscloud]

@Silenthunderp Welcome to the Ex.  Welcome to the Ex and congrats on your decision to quit.  Glad you found us.  

No matter how you choose to quit, cold turkey or with aids, you need to educate yourself about nicotine addiction and have a quit plan. I used Welbutrin and nicotrol inhalers and have very little physical withdrawal symptoms.

Many have found success with knowledge and preparation. It took me 50 years and many attempts to finally get it. I went into my quits blindly and was never successful. In addition to some aids for my final quit, I found the Ex a week prior to my quit. For the first time I learned how to quit and had the support that was always lacking.

This link is a great place to start.

https://www.becomeanex.org/guides/?cid=footer_community_linktobex

Make the commitment and you can do this too. We're here to support you on your journey. So reach out anytime you need help, want to share your experience or to support fellow quitters. We're all in this together.

Start your day by taking the Daily Pledge. It's a great way to stay on track on day at a time.

Look forward to celebrating with you on the 1st.  Stay busy and stay close.
Barb

[dpetras]

None.i can't afford them at the moment.

[Barbscloud]

@dpetras Contract your state quit line to obtain free NRT.  1-800-QUIT-NOW

Barb

[57cheryl]

I have wonderful success with the patch, I just can't afford them and I need to use them longer period of time to become free. I've been smoke free 3 time's but I just can't afford to keep purchasing to get free for good and I relapse. Cigarettes can be purchased by pack whice I can come up with but patches are no less than 35.00 at a time. This is so frustrating. I hate smoking and I've smoked over 50 years 

[zenmamasan]

I got the patches through 1.800.quit.now in my state, and although I was anxious about when that ran out, I really learned how to use and work with the nicotine gum, which I hated from before. (But I came to find out that I wasn't using correctly, or mindfully.) I still use occasionally after a 2 year quit. It will work for you too. Nicotine is doing the talking when you say "I can't do this".  Pop in that gum, chew until you sense a tingle, then PARK it between cheek and gum. Don't chew more, or it'll make you nauseous. Then WAIT. The gum calms down those cravings until you can move on. Cravings are nicotine luring you in, you can beat them by waiting them out.

[Barbscloud]

@57cheryl Welcome.   Did you see this from @zenmamasan ? 

Call 1-800-QUIT-NOW to obtain free aids.

Follow the instructions to wean yourself off the patch.

Barb

[NoMoreBy24]

Chantix it did not go well.

[Barbscloud]

@NoMoreBy24 Welcome to the Ex and congrats on your decision to quit.  Are you saying that Chantix didn't help with your quit?  I used Welbutrin and nicotrol inhalers the physical withdrawal was nihl.

No matter how you choose to quit, cold turkey or with aids, you need to educate yourself about nicotine addiction and have a quit plan. Many have found success with knowledge and preparation. It took me 50 years and many attempts to finally get it. I went into my quits blindly and was never successful. In addition to some aids for my final quit, I found the Ex a week prior to my quit. For the first time I learned how to quit and had the support that was always lacking.

This link is a great place to start.
https://www.becomeanex.org/guides/?cid=footer_community_linktobex

Make the commitment and you can do this too. We're here to support you on your journey. So reach out anytime you need help, want to share your experience or to support fellow quitters. We're all in this together.

Join  many of us on the the Daily Pledge. It's a great way to stay on track on day at a time.

Look forward to celebrating with you on the 2nd if not sooner.

Stay busy and stay close.

Barb

[jgreathouse66]

Patches only

[Barbscloud]

@jgreathouse66 Welcome to the ex.

Barb

[Ealberts]

I'm trying to quit smoking 

[Barbscloud]

@Ealberts Welcome to the Ex and congrats on your decision to quit.   Please consider posting your own post to Post My Journal/Blog to introduce yourself to the community and receive some well deserved support.

No matter how you choose to quit, cold turkey or with aids, you need to educate yourself about nicotine addiction and have a quit plan. Many have found success with knowledge and preparation. It took me 50 years and many attempts to finally get it. I went into my quits blindly and was never successful. In addition to some aids for my final quit, I found the Ex a week prior to my quit. For the first time I learned how to quit and had the support that was always lacking.

This link is a great place to start.

https://www.becomeanex.org/guides/?cid=footer_community_linktobex

Make the commitment and you can do this too. We're here to support you on your journey. So reach out anytime you need help, want to share your experience or to support fellow quitters. We're all in this together.

Start your day by taking the Daily Pledge. It's a great way to stay on track on day at a time.

Stay busy and stay close.

Barb

[Elbayne]

Gum and patches 

[CommunityAdmin]

@Elbayne that's great that you're using those replacements, keep it up! And if you're amenable, keep us posted on your quit journey!

- Danielle, EX Team

[MollyLeis]

@57cheryl 

In my experience, most insurance companies cover cost of patches.  Medicare supplements sometimes do not however, which is frustrating!    

[Barbscloud]

@MollyLeis If you have Medicare part D (prescription coverage) it should be covered.

[MollyLeis]

@Barbscloud  

Yes, it should be!  Because of the Affordable Care Act, insurance companies are supposed to pay for the cessation medications.   Somehow, Medicare part D got out of paying for patches, gum and lozenges because they are available over the counter.  Medicare part D should pay for nasal spray, Bupropion and Chantix prescriptions, however.  Here is a link to Tobacco Cessation Coverage for Medicare patients from the American Lung Association.

Tobacco Cessation Coverage: Medicare (lung.org)      

[Barbscloud]

@MollyLeisI checked my medicare supplement.  They do cover gum and lozenges, but not patches.  Wonder why they excluded patches. .   Many advantage plans now have a yearly amount that can be used to cover OTC meds.  My friends advantage plan allocates a $1000 a year for OTC meds.   Medicare Part D did  cover my Welbutrin and nicotrol inhalers.   Of course you can obtain free aids from your state.

Barb

[MollyLeis]

@Barbscloud 

It's interesting that the law excluded part D from having to cover them.  It seems they can pick what and if they want to cover.  All the plans are so different, it's impossible to know unless you check your plan. 🙂  Thanks for checking on that!!  

[rgn378]

My doctor wants me to try Wellbutrin to help with cravings. I am thinking about getting some patches as well just to help with the urge to smoke in certain situations. 

[Barbscloud]

@rgn378 Welcome to the Ex and congrats on your decision to quit.  I used Welbutrin and nicotrol inhalers for my final quit.   You can use combination therapy.  The made the physical withdrawal so much easier for me.  

No matter how you choose to quit, cold turkey or with aids, you need to educate yourself about nicotine addiction and have a quit plan. Many have found success with knowledge and preparation. It took me 50 years and many attempts to finally get it. I went into my quits blindly and was never successful. In addition to some aids for my final quit, I found the Ex a week prior to my quit. For the first time I learned how to quit and had the support that was always lacking.

This link is a great place to start.

https://www.becomeanex.org/guides/?cid=footer_community_linktobex

Make the commitment and you can do this too. We're here to support you on your journey. So reach out anytime you need help, want to share your experience or to support fellow quitters. We're all in this together.

Start your day by taking the Daily Pledge. It's a great way to stay on track on day at a time.

Stay busy and stay close.

Please consider creating your own post to Post to My Journal/Blog to introduce yourself to the community and receive lots of support.

Barbs

[Ealberts]

Trying to quit

[Stargazer522]

I have not tried any 

[Stargazer522]

My first time trying to quit so I have not had any nicotine replacements

[Barbscloud]

@Stargazer522 Welcome to the Ex.   Are you contemplating quitting?   Aids can make the physical withdrawal symptoms much easier.  There are lots of options, some are OTC, while some require a prescription.  I used Welbutrin and nicotrol inhalers.

How can we help?

Barb

[zenmamasan]

@Stargazer522  and @Ealberts Kudos for putting your health first!  I love the comment stay busy and stay close! I quit using patches, nic gum and a meditation app called Lojong. Heavy on the self-compassion practices got me in the right mindset to keep at it. Now been almost 2.5 years. You can do this, and develop some love and compassion for yourself for wanting to take care of yourself. I'm cheering for you!

[Barbscloud]

@zenmamasan Congrats on 2.5 years.  That's fabulous.  

Barb

[mabed88]

kudos

[mabed88]

kudos

[Langus]

Very insightful

[zenmamasan]

@Barbscloudthanks for the congrats and I totally agree-you HAVE to have a plan! It took me 30 years and like five quits to finish the job. And this time was different because I had a plan for every trigger, every emotion, every person. And if I slipped, (started new job after a 4 month quit-[please read the article on "The nasty threes"] lotsa young smokers there) there was a plan too, which was use it to learn about myself, have some compassion with myself about it, and choose *me* and move around it.

The self-compassion came through with the meditation app. It allowed me to say to myself "Oy, there is that nasty nicotine f*ckin with your brain again." Seriously, the Lojong app literally changed/saved my life.

[gj174376]

I am going to try to quit with gum. Wish me luck

[MollyLeis]

@gj174376 good luck!  Use what you need to get through the craving, or even try getting ahead of the craving if you know it is when you normally would use tobacco, or even an upcoming potential stressor.  You will then be more prepared.  🙂    

[Barbscloud]

@gj174376 Welcome to the Ex.  Quit aids have helped many of us be successful.

No matter how you choose to quit, cold turkey or with aids, you need to educate yourself about nicotine addiction and have a quit plan. Many have found success with knowledge and preparation. It took me 50 years and many attempts to finally get it. I went into my quits blindly and was never successful. In addition to some aids for my final quit, I found the Ex a week prior to my quit. For the first time I learned how to quit and had the support that was always lacking.

This link is a great place to start.

https://www.becomeanex.org/guides/?cid=footer_community_linktobex

Make the commitment and you can do this too. We're here to support you on your journey. So reach out anytime you need help, want to share your experience or to support fellow quitters. We're all in this together.

Happy to see you on the Daily Pledge. It's a great way to stay on track on day at a time.

Stay busy and stay close.

Barb