The most successful smoking cessation models combine brief counselling, support, and pharmacotherapy. The use of pharmacotherapy is widely accepted as an effective means to reduce the symptoms of nicotine withdrawal and aid in successful cessation.

There are currently seven FDA approved first-line medications used for smoking cessation: nicotine replacement therapy (NRT), and bupropion (Zyban) and varenicline (Chantix). Second-line pharmacotherapies include nortriptyline and clonidine.

What is nicotine replacement therapy?

Nicotine replacement therapy is a medically approved way to reduce withdrawal feelings and cigarette cravings by giving tobacco users a small, controlled amount of nicotine but none of the other dangerous chemicals found in cigarettes. This small amount of nicotine helps satisfy cravings and reduces the urge to smoke.

Many smokers find NRT helpful. Every person is different. But research shows that use of NRT can double the chances of successful quitting.

A variety of FDA-approved NRT products are available and are generally considered over the counter (OTC) medications (see information below). However, a smoker may need a prescription to have some NRT products covered by their health insurance plan.

How is NRT used?

NRT patches provide a slow, steady amount of nicotine over an extended period of time. Other NRT products, such as gum, lozenges and inhaler, give a fast burst of nicotine that can help get past short, strong cravings.

 Many people find that combining the two – using patches in combination with a fast- acting form of NRT – offers the best chance of success. 

Is NRT appropriate for everyone?

No. For persons with some serious medical conditions, NRT may not be appropriate.  Talk with your health care provider.

Research and Guidelines

According to the National Institute on Drug Abuse, the majority of cigarette smokers would like to stop smoking, and each year about half will attempt to do so. Sadly, only about six percent are successful in a given year. 

Research has shown that healthcare providers who intervene with smokers can have a positive impact on their cigarette-smoking behavior. Even brief advice and interaction with a physician – as short as three minutes – can make it much more likely that a patient will attempt to quit – and ultimately succeed! 

Even so, providers may hesitate to initiate these discussions because of a seemingly low success rate with smokers. Moreover, some conversations may feel uncomfortable.    

Research and guidelines can help healthcare providers become more conversant and confident when facilitating smoking cessation discussions. To this end, we offer the following authoritative references:       

Nicotine Replacement Therapy/Prescription Medication

American Academy of Family Physicians (AAFP)

Interventions for Smoking Cessation and Treatment for Nicotine Dependence


Combination Treatment for One Year Doubles Smokers’ Quit Rate | NIDA Archives ( 

Archives of Internal Medicine 

Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial – PubMed (


High-dose nicotine patch therapy. Percentage of replacement and smoking cessation – PubMed (


Psychological Dependence

Harvard Mental Health Newsletter


Children and Adolescents

American Academy of Pediatrics 

Safety and Efficacy of the Nicotine Patch and Gum for the Treatment of Adolescent Tobacco Addiction

e407.full.pdf (

US Preventive Services 

Recommendation: Prevention and Cessation of Tobacco Use in Children and Adolescents: Primary Care Interventions | United States Preventive Services Taskforce (


Pediatricians’ Use of the 5 A’s and Nicotine Replacement Therapy with Adolescent Smokers   

Pediatricians’ use of the 5 A’s and nicotine replacement therapy with adolescent smokers – PubMed (


Women’s Health and Pregnancy

American College of Obstetricians and Gynecologists   

Tobacco and Nicotine Cessation During Pregnancy | ACOG

March of Dimes 

Smoking during pregnancy ( 

Yale School of Medicine  

The Science Behind Quitting Smoking < Women’s Health Research at Yale


nicotine-gum-pregnant-smokers.pdf (


Behavioral Health

University of Wisconsin Center for Tobacco Research and Intervention 

Research on Behavioral Health and Smoking – UW-CTRI – UW–Madison (

American Academy of Family Physicians (AAFP) 

Behavioral Health and Tobacco Cessation (


Secondhand Smoke

CDC (Centers for Disease Control and Prevention)



Johns Hopkins Medicine

American Heart Association