Nicotine Replacement Therapy: Several OTC nicotine-replacement products are available in the form of:
- Chewing gums
- Lozenges
- Sublingual tablets
- Transdermal patches
- Sprays and inhalers.
All these products treat nicotine dependence as a step to help you stop smoking. When you use these products properly you’ll gradually reduce the dose of nicotine you have over several weeks, help easing withdrawal symptoms and ultimately breaking the physical nicotine dependence.
It is usual for a treatment course of 3 months to be recommended and it’s important not to smoke any cigarettes during this time.
Nicotine replacement is not recommended for pregnant or breastfeeding women and should not be given to children. Those with cardiovascular disease should consult a GP.
Side effects of nicotine therapy include exacerbation of the symptoms of peptic ulceration and gastritis.
Nicotine Transdermal patches: These are small, self-adhesive patches that deliver nicotine into the bloodstream through the skin, over the course of several hours. Depending on the type used, a fresh patch is applied daily  for 16 or 24 hours over a period of 3 months.
The patches come in different strengths and  nicotine intake is reduced by progressively switching to lower-strength patches over a treatment period.
Although the patches produce lower levels of nicotine than a cigarette, blood levels are sufficient to overcome cravings and withdrawal symptoms such as restlessness and anxiety.
Local irritation can occur where the patch is on the skin, so try to apply the patch to different areas of skin.
Nicotine Gum: Nicotine is released from the gum as it is chewed; it is absorbed through the lining of the mouth. Nicotine gum should be chewed correctly for maximum effectiveness and fewer side effects. It should be chewed when there is an urge to smoke. Once a strong taste is experienced, the gum should be placed between the gum and cheek until the taste has gone. The gum should be chewed again until the taste subsides. This is repeated over a 30-minute period.Nicotine gum is available in 2mg and 4mg strengths. The stronger gum is recommended for those who smoke more than 20 cigarettes per day and are therefore more highly dependent on nicotine.
Adverse effects associated with chewing gum include: jaw pain; tooth trouble; throat irritation and mouth ulcers.
Nicotine lozenges and sublingual tablets: Oral nicotine replacement therapy is now also available as a lozenge (containing 1mg of nicotine) and sublingual tablet (containing 2mg nicotine).
Lozenges should be sucked every 1-2 hours when you feel the urge to smoke, usually. 8-12 lozenges per day. The recommended dose for sublingual tablets is one tablet per hour (8-12 tablets per day) for those smoking less than 20 cigarettes a day, and 2 tablets per hour (16-24 tablets per day) for those smoking more than 20 cigarettes a day.
Adverse effects include tooth trouble, throat irritation and mouth ulcers.
Nicotine Inhaler: A nicotine inhaler comprises a mouthpiece containing a replaceable cartridge with 10mg of nicotine. This type of cessation therapy helps to overcome the behavioural dependence on cigarettes and, in particular, the habitual hand-to-mouth activity. This product is therefore most suitable for people who have a high behavioural dependenceAnd who smoke less than 20 cigarettes a day.
The nicotine from the inhalation device is absorbed through the lining of the mouth. An inhaler produces approximately one-third of the nicotine levels achieved from cigarette smoking, which is adequate to suppress withdrawal symptoms. The nicotine vapour is inhaled by shallow puffing or deeply inhaling, but the amount absorbed is similar whichever technique is used.
To make sure enough nicotine is inhaled to depress the withdrawal symptoms, 6-12 cartridges should be used each day for the first 8 weeks. The number of cartridges is then halved over the next two weeks and then halved daily until none are used by week 12.
Side effects diminish with use and include cough, hiccups, sinusitis, irritation in the mouth and a sore throat.
For OTC products, read Smoking Cessation

There are several steps you can take to help yourself control psychological dependence on – and physical craving for – cigarettes:
Take one day at a time: Stopping smoking is hard. Aim to get through the day.
Keep a positive attitude: Remain determined and remind yourself why you want to stop smoking
Keep busy: Physical activity will take your mind off the craving
Change Routine: Do something you don’t normally do; something you won’t associate with smoking.
Avoid temptation: Don’t allow yourself to get into difficult situations where you might be tempted to smoke; just one cigarette can upset all your efforts
Eat the right food: If you feel more hungry than usual try to eat more raw fruit and vegetables and avoid snacking on high-calorie foods.
Ask for help if you need it: Visit your pharmacy or GP – or use a help-line for extra support. Join a support group, or talk to a friend who has succeeded.
Get a buddy: Stopping along with someone else can help provide motivation. Tell your friends you have stopped as well as they will try to help you.

At low doses nicotine acts like a stimulant, can ‘sharpen’ the senses and improve the ability to concentrate. However, higher doses can cause a calming and soothing effect. Habitual smokers can readily adjust their nicotine dose to achieve the desired effect: e.g. when anxious the smoker will draw heavily o a cigarette to get the higher dose needed to feel calmer.
In addition to its central affects on the brain, nicotine has other effects on the body:
- Relaxation of the gut
- Relaxation of skeletal muscles, sometimes causing tremor
- Increased secretion of certain hormones
- Increased heart rate and raised blood pressure
- Reduction in blood-flow, causing poor circulation.
Regular smokers become physically and psychologically dependent on nicotine. Physical dependence arises because the body develops a tolerance to nicotine so that increasing amounts are needed to produce the same pleasurable effects. The smoker must inhale must inhale more deeply, or smoke more cigarettes to get the desired effect. Psychological dependence on tobacco occurs because smoking becomes a habit and it becomes sociable and pleasurable.
Cigarette smoke: the ingredients Dangerous ingredients – apart from nicotine – of cigarette smoke include:
Carbon monoxide: prevents oxygen from binding to red blood cells, damages blood cells
Hydrogen cyanide: affects respiration and other body functions, damages blood vessels
Formaldehyde: irritant to membranes, is carcinogenic
Hydrocarbons and nitrosamines: carcinogenic, particularly in lung tissue
Amines: carcinogenic (casually associated with bladder cancer in men)
- Heavy metals (arsenic, cadmium, lead, nickel) are all poisons.
Health effects of smoking
- Increases risk of certain types of cancer (lung, mouth, throat, oesophagus, stomach, bladder, kidney, pancreas and cervix)
- The risk of dying from lung cancer is 22 times higher for male smokers and 12 times higher for female smokers – compared with non-smokers
- The risk of developing lung cancer increases with the number of cigarettes smoked daily
- Smoking causes a 5-fold increase in the risk of dying from lung problems such as chronic bronchitis or emphysema
- Smoking causes a 2-4-fold increase in risk of death from diseases of the heart and coronary arteries; more smokers die from coronary heart disease than from lung cancer.
- The risk of stroke is increased by about 50% in 20-a-day smokers
- Smokers are more likely to get duodenal ulcers – and these are more likely to take longer than normal to heal
- Can cause premature and underweight babies to be born to pregnant women who smoke. Can also cause miscarriage and foetal malformation.
THE GOOD NEWS IS THAT STUDIES IN EX-SMOKERS SHOW THAT THEIR RISK OF DYING FROM SMOKING-RELATED DISEASE DECREASES WITH EACH YEAR OF ABSTINENCE:
- After 3 years of not smoking, the risk of having a heart attack is reduced to that of a life-long non-smoker
- After 10 cigarette-free years the risk of lung-cancer is halved
- 15 years after stopping smoking, the risk of developing almost any smoking-related disease is reduced to little more than that of a life-long non-smoker