By now, we all know smoking cigarettes is bad for our health. The habit is the cause of one in five deaths in the U.S. annually, according to the Centers for Disease Control and Prevention.
The good news: Quitting smoking, at any age, significantly increases your lifespan.
The downside is that for many people, quitting involves battling through physical dependence and a slew of uncomfortable withdrawal symptoms. Even “light” smokers often fit the criteria for nicotine addiction (also called “tobacco use disorder”) and have a hard time giving the habit up.
Nicotine replacement therapies (NRTs), which are available both with a prescription and over-the-counter, are the best ways to quit smoking. They work one of two ways: By delivering nicotine to your body without the other harmful chemicals in cigarettes to help ease withdrawal symptoms and the urge to smoke, or they affect the craving center of the brain directly.
Abisola Olulade, MD, a family medicine physician based in San Diego told Insider that nicotine replacement in any form has been shown to increase the rate of successfully quitting by 50 to 70%. That’s because it helps with withdrawal symptoms, she added.
What doesn’t help you quit smoking: E-cigarettes are often promoted as a tool to help you wean off nicotine because, yes, they are less toxic than smoking tobacco. But they come with their own health hazards and studies show taking up vaping to quit smoking actually makes you less likely to quit; instead, most people just start smoking both.
All our docs agreed that nicotine patches, lozenges, and gum are the best way to quit smoking because they’re proven to be the most effective. Nicotine gum in particular has been shown to reduce cravings and the urge to smoke, even in the low 2mg dose.
Nicorette gum and its generics delivers a hit of nicotine without the harmful chemicals in cigarettes. You’re meant to slowly wean your dependency on the chemical over the course of 12 weeks by chewing a piece of gum every 1-2 hours. Then, after six weeks you cut down to every 2-4 hours, then 4-6 hours. If you’re not ready to go off the nicotine after 12 weeks, the FDA has said that it’s safe to use NRTs for longer.
The gum comes in 2mg and 4mg pieces, and the best dose depends on your current smoking habits. Though you should start at these lower doses, a 2019 study found when smokers chewed a higher 6mg gum, they saw faster relief and had fewer nicotine cravings compared to when they only chewed 4mg gum.
Keep in mind side effects of nicotine gum include a risk of mouth irritation and jaw soreness, heartburn, hiccups, and nausea, and folks with TMJ or who wear dentures may want to steer clear.
Like its gum, Nicorette’s lozenges are a form of NRT that delivers the nicotine without the harmful stuff in cigarettes. The lozenges are ideal if you have a muscular or dental condition or just prefer not to chew gum.
Like gum, the lozenges are meant to be used for 12 weeks (though if necessary, longer is okay) as you gradually wean yourself off. The dosage is virtually identical to the gum but you shouldn’t have more than 20 lozenges a day (compared to gum’s 24 piece limit).
Nicotine lozenges can also cause gastrointestinal side effects like heartburn, hiccups, and nausea. If used improperly — i.e., if you crunch the lozenge instead of letting it dissolve slowly — you may feel these side effects more severely, plus an added risk of lightheadedness.
Transdermal nicotine patches, often just called “the patch,” are one of the most scientifically-backed over-the-counter nicotine replacement therapies.
There’s strong clinical evidence behind all of these over-the-counter NRTs. But the nicotine patch might even have some advantages over the rest: “The patches provide a steady stream of nicotine for most people and work over a longer period of time throughout the day,” Dr. Olulade told Insider.
In her opinion, it’s also the easiest option: You just stick it on and you’re set for 24 hours. It’s meant to help you wean yourself off of nicotine over the span of 8-10 weeks.
It’s also the cheaper option of NRTs, our medical reviewer, Dr. Jason McKnight, pointed out. “If you chew a lot of the gum, a box only lasts about 6 days, whereas for the same cost you can get 14 days of patches.”
What’s more, research out of Great Britain reports that using a nicotine patch alongside other fast-acting NRTs (gum, lozenges, or nasal spray) ups your chances of quitting nicotine altogether by 25% compared to using any of them alone. Both Dr. Olulade and Dr. Sachin Nagrani, medical director at telemedicine service Heal, support this strategy of dual-use, too.
The nicotine patch side effects do include skin irritation, dizziness, racing heartbeat, sleep disturbances, nausea, muscle aches, and headaches, just FYI.
Like the above options, the Nicotrol inhaler and nasal spray products are forms of nicotine replacement therapy. The difference is that unlike the others, the nasal spray and inhaler require a doctor’s prescription. If your doctor recommends one of these products to you, be sure to follow the drugs’ instructions carefully to ensure proper use.
Bupropion, sold under the brand name Zyban or Wellbutrin, is another approach to smoking cessation that requires a prescription. It’s a psychiatric medication in the form of a pill, but it acts on the dopamine receptors in the brain that affects your “reward system,” which is tied to addiction and dependence.
In clinical trials, bupropion has been found to be twice as effective for smoking cessation as a placebo.
One advantage of bupropion is that it may help offset the weight gain that often happens when a person quits smoking. But note it’s not recommended for folks who have a history of bulimia or anorexia nervosa because of its potential to interfere with appetite. It can also help with some of the underlying anxiety and symptoms that may be contributing to the nicotine addiction, Dr. McKnight pointed out.
Unlike nicotine replacement, doctors recommend starting bupropion a week or two before you actually stop smoking.
Varenicline, sold under the brand name Chantix, is the newest type of treatment to be approved for smoking cessation. And according to some researchers, it’s the most effective.
Normally, when you smoke a cigarette, nicotine binds to certain receptors in your brain and produces dopamine, which creates a rewarding or pleasurable feeling. Varenicline, as a pill, works by blocking those receptors from receiving the nicotine and thus preventing the dopamine release. Smoking no longer causes a pleasant sensation. It also helps reduce withdrawal symptoms.
Like bupropion, varenicline therapy is meant to start about a week before you stop smoking. Because it’s also prescription-only, you’ll have to talk to your doctor about whether varenicline is an appropriate option for you.
If you’re looking for ways to quit smoking outside of the above products, you’ll certainly stumble across (or be bombarded with targeted ads for) some others. Our expert sources helped cut through the marketing claims to make sense of what’s out there.
Like Nicorette, the young startup Lucy makes nicotine replacement products in the form of gum and lozenges. It’s the same idea and same 4mg dose as the more traditional products but the brand boasts that its products contain “clean” and “more effective” nicotine.
Dr. Olulade cautioned that despite claims made by the company’s founder, nicotine — no matter how “clean” — is still an addictive substance that can narrow artery walls and increase the risk of heart attack, among other bad health effects. For these reasons, she questions the brand’s credibility and encourages patients to go with Nicorette, or its generics, instead of Lucy nicotine gum.
For some, nicotine reliance is only part of the difficulty with quitting tobacco — the physical act of smoking a cigarette can also be a hard habit to break. Füm seeks to replace that habit with an ostensibly less-harmful one: an inhaler filled with essential oils like black pepper or peppermint.
Some scientific attention has been paid to the potential use of alternative and complementary medicine to aid in smoking cessation. But at the moment, there’s more enthusiasm than there is knowledge.
Some evidence does support using black pepper oil as a substitute for smoking. But the only study we found on the subject is fairly small and nearly 30 years old, so it’s probably best taken with a grain of salt.
Dr. Olulade said there isn’t enough current clinical support to recommend a product like Füm. And she warned that it may not be without problems of its own, since lesser-researched products, especially an oil inhaler, can have their own risks and potentially cause irritation of the respiratory tract.
Dr. Nagrani said it’s certainly possible for natural or herbal products to help someone quit smoking. But he echoed Dr. Olulade about its lack of evidence and potential risks if you plan to experiment with them.
“I recommend discussing these options with your doctor before starting treatment, as natural remedies also have the potential to interact with medications or other medical conditions,” he said.
Dr. Nagrani pointed out that “any individual intervention,” be it nicotine replacement therapy, bupropion, or varenicline, “increases the likelihood by 1.25 to 2.24 times more to quit compared to placebo.”
As cheesy as it sounds, though, some of the most effective quitting tools can’t be bought with money.
Dr. Nagrani highlighted how useful social and behavioral support can be. These can be anything from support lines like 1-800-QUIT-NOW, to text lines like SmokefreeTXT, to more personal interventions like speaking with your primary care doctor.
He added that his best example of the power of behavioral support was with one patient who wanted to quit smoking once she became a grandmother. She didn’t want the baby to experience any level of exposure to secondhand smoke.
“We used a combination of prescription medication and quitline support and succeeded in quitting smoking but we both knew the most powerful intervention was holding her granddaughter every morning,” Dr. Nagrani said.
Nicotine replacement therapies, like the nicotine patch and nicotine gum, are the best way to quit smoking.
Dr. Abisola Olulade, MD, a family medicine physician based in San Diego shares that nicotine replacement in any form can increase the success rate of quitting by 50 to 70%. That’s mainly because it helps with withdrawals. Nicotine patches and nicotine gum deliver a hit of nicotine in a controlled amount (without all the harmful chemicals in cigarettes), and you slowly wean yourself off it.
Dr. Olulade adds that the nicotine patch may be the best choice of all because it delivers a steady stream of nicotine and works over a longer period of time throughout the day.
And combining NRTs with other quitting methods, like a bupropion prescription, boosts the efficacy of the other tool, research shows.
The best way to quit smoking on your own is to use a nicotine patch or nicotine gum. Research shows these nicotine replacement therapies increase the success rate of quitting by 50-70%.
Either the patch or nicotine gum will help deliver the substance your body is addicted to (nicotine) in small, controlled doses. Over time (usually 12 weeks), you should reduce the gum or nicotine patch dosage or how often you use one. This will help wean your body off the addiction with fewer withdrawal symptoms.
After the first 12 hours, your blood pressure and blood flow start to improve — but withdrawal symptoms also will start to set in. You can expect feelings of irritability, lack of concentration, headaches, hunger, and frustration.
After the first day of going without cigarettes, you may be coughing more as your body tries to clear out the lungs. After 48 hours, your sense of taste and smell start to come back, but cravings and withdrawal symptoms start to get worse.
Nicotine cravings typically start to get better after a week, along with coughing — so that first week is the hardest part.
After one month, your lung function will be back up (by a whopping 30%!) and it’ll probably start to feel easier to exercise. At this point, you’ll likely have next to no nicotine cravings or urges to smoke. From here, your heart health and lung health will only get better. (Learn more in What happens when you quit smoking.)
Nicotine gum delivers small doses of nicotine (usually 4mg or 6mg) to your body. If you are a smoker or are trying to quit, the small dose this gum provides is generally considered safe. Nicotine gum does have the potential side effects of mouth or jaw soreness, stomach discomfort, nausea, light-headedness, and throat and mouth irritation.
And, just like with all forms of nicotine ingestion, nicotine gum does still raise your blood pressure, increase your heart rate, and constrict blood vessels. Together, these can put you at higher risk for , which is why you’ll ideally use nicotine gum to wean yourself off the drug over 12 weeks. If you’re still using it long-term (four to six months), talk to your doctor about other tools to help you quit smoking.