Nip smoking in the ‘butt’! Find out which types of nicotine replacement therapy work best

The Bottom Line

  • Nicotine replacement therapy or NRT (patches, gums, lozenges, inhalers, and sprays) can help people quit smoking, but different forms of NRT may be more effective than others. 
  • In smokers who smoke approximately 20 or more cigarettes a day and want to quit, fast-acting NRTs (like gums or lozenges) are as effective as long-lasting NRTs (like patches) in helping people quit. 
  • Combining a fast-acting NRT with a long-acting NRT improves the chances of success, compared to using a single NRT.
  • Higher dose nicotine gums increase the odds of quitting, but effectiveness may be impacted by the level of nicotine dependence. 

Finding reasons to quit smoking is not difficult. Tobacco use—a major risk factor for cancer, diabetes, heart problems, and eye problems, to name a few—is the leading cause of illness and death worldwide (1-3). But despite the clear-cut benefits of quitting, many smokers struggle to break their physical and mental dependence on smoking (2;4).

This is where nicotine replacement therapy (NRT) can help!

NRT works by replacing the nicotine in cigarettes with other sources of nicotine, eliminating exposure to the harmful ingredients found in tobacco (2;5) and the dangers that come along with inhaling toxic cigarette smoke (6). From gums to sprays to patches, NRT comes in many different forms. Some of these NRT options include:

Long-acting NRTs:

  • Nicotine patches, which deliver between 5 mg and 52.5 mg of nicotine slowly through the skin for 16 to 24 hours a day.

Fast-acting NRTs:

  • Nicotine gum, which delivers 2 to 4 mg of nicotine;
  • Nicotine lozenges, which come in 1.5 mg, 2 mg, and 4 mg doses;
  • Nicotine inhalers, which deliver nicotine quickly into your mouth; and
  • Nicotine sprays, which deliver nicotine quickly into your nose (2).

We already know that nicotine replacement therapy can help people quit smoking, but with so many varieties to choose from, which approach works best?

What the research tells us

A recent systematic review found that some NRT strategies may work better than others in smokers (generally adults) who want to quit and who smoke approximately 20 or more cigarettes a day.

Three conclusive findings emerged from this review. First, fast-acting NRTs (such as gums or lozenges) are equally as effective as long-acting NRTs (such as patches) in helping people quit smoking. Second, combining a fast-acting NRT with a long-acting NRT is more effective than using just one type of NRT. Finally, gum that contains a higher dose of nicotine (4 mg) works better than gum containing a lower dose of nicotine (2 mg), but effectiveness may vary depending on the person’s level of nicotine dependence.

The findings also suggest that higher doses of nicotine in nicotine patches (42/44 mg patch worn for 24-hours) are not more effective than moderate doses (21/22 mg patch worn for 24-hours) in helping people quit smoking, but that moderate doses are more effective than low doses (14 mg patch worn for 24-hours). However, due to some limitations in how these studies were conducted, more research is needed to prove if this is really true.

Now, you’re probably wondering whether when you start using NRT matters. Interestingly, it turns out the answer is…maybe, with evidence showing that beginning before your designated “quit day” might increase your chances of success, compared to starting on your “quit day”. This finding does need to be looked into further before it’s confirmed. Side effects are likely another worry. While most doctors agree that NRT is generally safe and well-tolerated, not many studies in the review adequately reported on safety. This means more research is needed to understand how the side effects of different NRTs stack up (7).

If it’s quitting time for you, there are a number of effective NRTs to choose from. Consider your goals, preferences, safety, and tolerability of different products when making your decision. Seeking advice from a health care professional is also always a great place to start!

Featured Resources

Get the latest content first. Sign up for free weekly email alerts.
Author Details


  1. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388(10053):1659-1724. doi: 10.1016/S0140-6736(16)31679-8.
  2. Lindson N, Chepkin SC, Ye W, et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019; 4:CD013308. doi: 10.1002/14651858.CD013308. 
  3. Mayo Clinic. Nicotine dependence. [Internet] 2018. [cited September 2019]. Available from 
  4. Babb S, Malarcher A, Schauer G, et al. Quitting smoking among adults-United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017; 65(52):1457-1464.
  5. McNeill A, Robson D. A man before his time: Russell’s insights into nicotine, smoking, treatment and curbing the smoking problem. Addiction. 2017; 113(4):759-763. doi: 10.1111/add.14043.
  6. Hartmann-Boyce J, McRobbie H, Bullen C, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016; 9:CD010216. doi: 10.1002/14651858.CD010216.pub3. 
  7. Theodoulou A, Chepkin SC, Ye W, et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2023; 6:CD013308. doi: 10.1002/14651858.CD013308.pub2. 

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.