Version May 2024
| Drug | OTC? (United States) | Dosing | Administration* | Common adverse effects | Advantages | Disadvantages and precautions | Other notes |
| Nicotine patch | Yes | 21 mg for >10 cigarettes/day 14 mg for ≤10 cigarettes/day | Apply 1 new patch daily May start patch before quit date Rotate application site Tapering dose is not required | Skin irritation, insomnia, vivid dreams | Provides steady nicotine level Easiest nicotine product to use | User cannot alter nicotine level in case of craving | If removed before bedtime, takes 30 minutes to 3 hours after reapplication to reach effective levels |
| Nicotine gum | Yes | 2 mg if first cigarette ≥ 30 minutes after waking 4 mg if first cigarette <30 minutes after waking | 1 piece every hour as needed Maximum: ≤24 pieces/day No food or drink for 30 minutes before and during use | Mouth irritation, jaw soreness, heartburn, hiccups, or nausea (gastrointestinal side effects usually due to overly vigorous chewing) | User controls nicotine dose Oral substitute for cigarettes | Unpleasant taste Can damage dental work Difficult for denture wearers to use | Proper chewing technique required ("chew and park") |
| Nicotine lozenge | Yes | 2 mg if first cigarette ≥30 minutes after waking 4 mg if first cigarette <30 minutes after waking | 1 piece every 1 to 2 hours as needed Maximum:
| Mouth irritation, hiccups, heartburn, or nausea | User controls nicotine dose Oral substitute for cigarettes Can be used by smokers with poor dentition or dentures | Unpleasant taste | |
| Nicotine inhaler | No | 10 mg per cartridge | Inhale as needed (eg, every 1 to 2 hours) Maximum: 16 cartridges/day | Mouth and throat irritation | User controls nicotine dose Oral substitute for cigarettes | Device visible when being used Use caution in reactive airway disease | Frequent puffing required to obtain adequate nicotine delivery |
| Nicotine nasal spray | No | 0.5 mg per spray (10 mg/mL) | Apply 1 spray to each nostril every 1 to 2 hours as needed Maximum:
| Nasal and throat irritation, rhinitis, sneezing, cough, or teary eyes | User controls nicotine dose Most rapid delivery of nicotine among nicotine-replacement products | Local irritation to nasal mucosa is difficult for many to tolerate | |
| Varenicline | No | 0.5 mg pill to start, then titrate up to 1 mg pill | 0.5 mg/day for 3 days, then 0.5 mg twice a day for 4 days, then 1 mg twice a day Start 1 to 2 weeks before quit date May be started up to 5 weeks prior to quit date Abruptly quitting smoking is preferred. Gradual smoking reduction is an alternative: reduce smoking by 50% by week 4, another 50% by week 8, quit by week 12 | Nausea, insomnia, abnormal (vivid, unusual, or strange) dreams, headache, skin rash (≤3%) | Dual action: relieves nicotine withdrawal and blocks reward from smoking Oral agent (pill) | Reduced dose in severe renal insufficiency Avoid in patients with unstable psychiatric status or history of suicidal ideation or PTSD Monitor for neuropsychiatric symptoms¶ | |
| Bupropion sustained release | No | 150 mg pill | 150 mg/day for 3 days, then 150 mg twice a day Start 1 to 2 weeks before quit date Abruptly quitting smoking is preferred. Gradual smoking reduction is an alternative: reduce smoking by 50% by week 4, another 50% by week 8, quit by week 12 | Insomnia, agitation, dry mouth, headache | Blunts postcessation weight gain while being used Oral agent (pill) | Monitor for neuropsychiatric symptoms¶ Contraindicated in patients with seizure disorder or predisposition | A lower dose of 150 mg/day is an option for patients who do not tolerate the full dose |
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