NRT products were first approved for use in the United States in 1984. Nicotine replacement products are available as
generic medication.
Medicines In 2015, the
United States Public Health Service listed seven agents for the stopping of tobacco, which included five nicotine replacement treatments (nicotine patches, gum, lozenges, inhalers, and nasal sprays) and two oral medications (
bupropion and
varenicline). Other NRT options are available, including nicotine mouth sprays and sublingual tablets.
Dosing The dose of nicotine replacement therapy products is generally based on if the user is considered a heavy, average, or light smoker. The inhaler may be preferred in individuals who want to satisfy the hand-to-mouth ritual that smoking provides. but they have not received FDA approval as smoking-cessation therapy aids that are safe and effective.
Snus and
nasal snuff also allow for nicotine administration outside of tobacco smoking.
Nicotine pouches are described as similar to or a tobacco-free variant of snus. They are pre-portioned and are held in the user's lip or cheek allowing for sublingual or buccal delivery of flavors and high doses of nicotine. The small pouches are not like
chewing tobacco, as the user does not need to spit since the contents of the pouches stay inside during use. Swedish pouches have been available on the American consumer market since at least 2016 but their popularity and controversy surged in 2019 and 2020. In the US and UK concerns have been raised that nicotine pouches are seemingly too similar to banned snus products, is aimed at teenagers, further complicating the youth vaping trend, falling into the hands of adolescents easily, and are discrete enough to easily pass for regular gums or lozenges. Nicotine infused toothpicks are another product that has been available in the United States since at least 2013. They can have a total nicotine delivery that is comparable to that of nicotine gum. In spite of these similarities, as of 2018 they have been a subject of controversy. Online retailers have been under scrutiny for allowing their products to be too easily purchased by youth. Various news outlets and school districts have expressed the concern that these products have a high appeal to minors wanting to experiment with nicotine due to; the multitude of sweet flavors offered, ease & speed of use, seeming innocuous, and having a discreet nature. In 2015, NRT sales fell for the first time since 2008 while sales for
e-cigarettes or electronic nicotine delivery systems (ENDS) continued to increase at a substantial rate. The evidence is that UK smokers are trying to quit with e-cigarettes rather than NRT methods. E-cigarettes are often, although not always, designed to look and feel like cigarettes. They have been marketed as less harmful alternatives to cigarettes, but
very few are as yet approved as NRTs in any jurisdiction. Some electronic cigarettes have coarsely adjustable nicotine levels. Some healthcare groups have
hesitated to recommend e-cigarettes for
quitting smoking, because of limited evidence of effectiveness and safety. A 2014 study concluded that e-cigarettes appear to help smokers who were unable to stop smoking altogether to reduce their cigarette consumption when compared with placebo e-cigarettes and nicotine patches. Several studies have shown e-cigarettes to be the more effective tobacco smoking cessation tool in comparison to NRTs. The U.S.
Food and Drug Administration (FDA) has a list of additional tobacco products they are seeking to regulate, including electronic cigarettes. Most approved NRT products have been approved for over 20 years, however the FDA has also approved
nicotine inhalers as a form of NRT. In 2024, the FDA cleared an investigational new drug (IND) application for a fast-acting inhalable NRT, which delivers nicotine without combustion or heating. 2025, the inhaler was successful in a first clinical trial, aiming to get approved by the FDA as the first smoking cessation drug since 2006. Future approaches of NRT could include nicotine preloading, a true pulmonary inhaler, and
nicotine vaccines. Nicotine preloading, otherwise known as pre-cessation or pre-quitting NRT, has found that using the patch for a few weeks before the quit date produces significantly higher quit rates than if it was started on the quit day. The true pulmonary inhaler would deliver nicotine to the lungs in a manner that more resembles cigarette smoking, which would provide better relief of background cravings as well as acute cravings. Nicotine vaccines are under investigation as a method to treat tobacco dependence through priming the body to mount an immune response against nicotine. == References ==