Nicotine Replacement Therapy - The choice of an NRT product should be individualized — based on patient preference, tolerance of adverse effects, and smoking habits. Higher doses are more likely to be effective but also to produce more adverse effects. Increasingly, patients with severe nicotine addiction are prescribed combination NRT — a patch plus one of the short-acting formulations. Higher-than-recommended doses may be indicated in smokers with severe addiction, and failure to respond may reflect inadequate dosage, incorrect usage, or both. All NRT contain Nicotine, with risk of dependency.

The nicotine patch - is emerging as a mainstay for pharmacological treatment of smoking cessation, often in combination with other forms of nicotine replacement and psychotropic medications. Its major disadvantages include insomnia (greater with the 24-hour patch), inability to titrate dose, allergic reactions to the patch adhesive (patients with dermatological conditions are advised against its use), and morning nicotine cravings with the 16-hour release form. In general, greater levels of smoking call for higher-dose patches, and morning cravings necessitate the use of the 24-hour formulation. Patch sites should be rotated to avoid skin reactions. Most patients can tolerate the skin irritation, which topical corticosteroids can ameliorate.

The nicotine gum - Its major disadvantages include that its use may not be socially acceptable, it may adhere to dental work such as fillings and bridges, and it must be used properly to be effective.

The nicotine lozenge - Heavy users may experience adverse effects of hiccups, nausea, dyspepsia, and flatulence.

The nasal spray - Disadvantages include a high rate of nasal and throat irritation (generally tolerated by users), the risk of dependence, and the need to wait up to 5 minutes before driving because of local reactions and sneezing. Patients with chronic nasal disorders or reactive airway disease should not use the spray.

The nicotine inhaler - Like the nasal spray, mimics the act of smoking and permits titration of nicotine levels. It also can cause local irritation and should be used cautiously in patients with bronchospastic disease.