Nicotine Patches, Gum and Other Delivery Forms

The same molecule behaves very differently depending on how it enters the body: a patch gives a slow, steady level, gum and lozenges a gentler rise, and inhaled forms a fast spike. This page collects the published research on how nicotine is absorbed from each delivery form, each paper summarised in plain language with its PubMed record.

This collection is research only: papers found on PubMed, each described as its own abstract reports it. Cell and animal results are labelled as such, and harms are listed beside benefits. It is not medical advice.

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The Papers (25)

Newest first. Study types on this page — Human trial: 6 · Review: 15 · Animal study: 3 · Other: 1. Each summary is written from the paper’s own abstract; follow the PubMed link for the full record.

Flavors Enhance Nicotine Vapor Self-administration in Male Mice

Animal study, 2021. Researchers studied adult male mice that could choose to inhale e-cigarette vapor containing nicotine (6 mg/mL), either plain or with a menthol or green apple flavor added. The mice given flavored liquids increased how much nicotine vapor they took faster than mice given unflavored liquid, and they kept working harder for it when getting each dose took more effort. The mice also chose to inhale green apple flavored vapor that had no nicotine at all. The authors conclude that flavors increase how quickly vaping starts and how strongly it reinforces itself, which they say suggests a higher risk of addiction-related behavior; these results come from mice only.

Cooper SY, Akers AT, Henderson BJ (2021). Flavors Enhance Nicotine Vapor Self-administration in Male Mice. Nicotine Tob Res. — PubMed PMID: 32860507 · doi:10.1093/ntr/ntaa165

Perinatal exposure to nicotine disrupts circadian locomotor and learning efficiency rhythms in juvenile mice

Animal study, 2020. Researchers studied young male mice whose mothers were given nicotine during pregnancy and while nursing. Compared with unexposed mice, these offspring had weaker daily (circadian) rhythms in their movement. The time of day when they learned best was shifted later, and they failed a long-term memory test after 8 days of training. The authors conclude that nicotine exposure in the womb changes how the body clock regulates memory and movement, a result shown so far only in mice.

Fuentes-Cano MA, Bustamante-Valdez DJ, Durán P (2020). Perinatal exposure to nicotine disrupts circadian locomotor and learning efficiency rhythms in juvenile mice. Brain Struct Funct. — PubMed PMID: 32789697 · doi:10.1007/s00429-020-02126-2

Relating Nicotine Plasma Concentration to Momentary Craving Across Four Nicotine Replacement Therapy Formulations

Human trial, 2020. Researchers pooled data from 17 clinical studies covering 1,077 adult smokers and 39,802 craving ratings to link the level of nicotine in the blood to moment-by-moment craving across four nicotine replacement forms: a lozenge, a gum, a mouth spray and a skin patch. Their model found that all four forms reduced craving about equally well, but the patch needed about four times as much nicotine in the blood to have the same effect. The body also built up short-term tolerance to nicotine's effect on craving. Women got a bigger maximum craving reduction from nicotine than men.

Germovsek E, Hansson A, Kjellsson MC et al. (2020). Relating Nicotine Plasma Concentration to Momentary Craving Across Four Nicotine Replacement Therapy Formulations. Clin Pharmacol Ther. — PubMed PMID: 31355455 · doi:10.1002/cpt.1595

Beliefs and reality of e-cigarette smoking

Other, 2018. This is a case report about one person who became addicted to nicotine after long-term use of electronic cigarettes. The authors say many people, especially teenagers and young adults, believe vaping has no side effects. They report that teenagers who start using e-cigarettes young are twice as likely to try regular cigarettes later, because of nicotine dependence or social factors. They also note that recent studies have found long-term side effects across the body from vaping, whether or not the person ever smoked regular cigarettes.

Menakuru S, Inzamam Ali M (2018). Beliefs and reality of e-cigarette smoking. BMJ Case Rep. — PubMed PMID: 30279252 · doi:10.1136/bcr-2018-225683

Combination nicotine replacement therapy: strategies for initiation and tapering

Review, 2017. This review looks at combination nicotine replacement therapy, meaning using two forms of nicotine replacement together, for people who want to quit smoking. The authors note that several studies and meta-analyses have shown combination therapy works, but there is little guidance on how to start it or how to taper off it. They review the evidence and reasoning behind combination therapy, list the doses used in studies of it, and propose a step-by-step plan for lowering the doses over time along with behavioral strategies.

Hsia SL, Myers MG, Chen TC (2017). Combination nicotine replacement therapy: strategies for initiation and tapering. Prev Med. — PubMed PMID: 28257667 · doi:10.1016/j.ypmed.2016.12.039

Nicotine replacement products: poisoning in children

Review, 2014. This article reviews poisoning in young children who swallowed or handled nicotine products, including stop-smoking aids such as gum, lozenges, patches, inhalers and mouth sprays. French poison centres recorded 318 children under 10 exposed to nicotine replacement products between 2000 and 2010; 62 of them had symptoms, and about two-thirds of those were under 4 years old. A separate U.S. analysis found 1768 poisonings involving smokeless tobacco products in children under 6 between 2006 and 2008, and 84% of those children were under 3. The first signs of nicotine poisoning are vomiting, diarrhoea, a fast heartbeat, high blood pressure and trembling hands, and higher doses can quickly lead to loss of consciousness, seizures or breathing failure. A dose of 1 mg of nicotine per kilogram of body weight can poison a child, and a dose that size is sometimes fatal in adults. Most patch poisonings happened when a child found an unused patch, a used patch thrown away carelessly, or a patch that had come off an adult's skin, so the authors say adults using these products should be warned that they are dangerous.

(2014). Nicotine replacement products: poisoning in children. Prescrire Int. — PubMed PMID: 24926513

Nicotine promotes tumor growth and metastasis in mouse models of lung cancer

Animal study, 2009. Researchers tested whether nicotine, given by injection or through skin patches, affects lung tumors that already exist in mice. Nicotine made implanted lung tumors grow markedly larger. After the tumors were surgically removed, they came back in 59.7% of nicotine-treated mice compared with 19.5% of untreated mice, and spread to the lungs increased 9-fold. In mice whose lung tumors were started by a tobacco carcinogen, nicotine increased the size and number of tumors; the authors conclude that nicotine has limited ability to start cancer but can help tumors already started by tobacco carcinogens grow and spread, a result shown only in mice.

Davis R, Rizwani W, Banerjee S et al. (2009). Nicotine promotes tumor growth and metastasis in mouse models of lung cancer. PLoS One. — PubMed PMID: 19841737 · doi:10.1371/journal.pone.0007524

Pharmacotherapy for tobacco dependence

Review, 2009. This review looks at the medicines approved to help people stop smoking. These are nicotine replacement products (a patch, gum, a lozenge, a tablet that dissolves under the tongue, an inhaler and a nasal spray), the antidepressant bupropion, and varenicline, a drug that partly activates the same nicotinic receptors in the brain that nicotine acts on. The authors explain how these medicines work in the body and which of their properties may affect how well they work, how safe they are and how likely they are to be misused. They also discuss how this knowledge could be used to improve current medicines and develop new ones.

Fant RV, Buchhalter AR, Buchman AC et al. (2009). Pharmacotherapy for tobacco dependence. Handb Exp Pharmacol. — PubMed PMID: 19184660 · doi:10.1007/978-3-540-69248-5_17

Update on pharmacologic options for smoking cessation treatment

Review, 2008. This review looks at the medicines available in 2008 to help people stop smoking. It describes nicotine dependence as resembling other addictions, and says people may need several attempts and long-term treatment to stay quit. First-line options were nicotine replacement therapy (a patch, gum, nasal spray, inhaler or lozenge), the antidepressant bupropion, and varenicline, a drug that partly activates one type of nicotine receptor. Except for varenicline, which had shown better quit rates than bupropion, the treatments appeared similarly effective; the authors also note that nicotine vaccines were being studied and looked promising, especially for preventing relapse.

Nides M (2008). Update on pharmacologic options for smoking cessation treatment. Am J Med. — PubMed PMID: 18342163 · doi:10.1016/j.amjmed.2008.01.016

Preferences among four combination nicotine treatments

Human trial, 2006. This small randomized crossover study had 27 smokers try four different combinations of nicotine replacement products over 5 days: a 15-mg nicotine patch combined with nicotine gum, nicotine lozenges, a nicotine inhaler, or a second 10-mg patch. Two patches together were ranked highest for ease of use, safety and use in public. For help with quitting, however, 70% preferred a patch combined with a fast-acting product, compared with 30% who chose the double patch, and for use under stress 93% preferred the fast-acting combinations. The authors concluded that all four combinations were acceptable in brief testing, and that combined use is workable and should be made known and accessible to smokers.

Schneider NG, Koury MA, Cortner C et al. (2006). Preferences among four combination nicotine treatments. Psychopharmacology (Berl). — PubMed PMID: 16896965 · doi:10.1007/s00213-006-0449-5

Developments in pharmacotherapy for tobacco dependence: past, present and future

Review, 2006. This review looks at how medicines for quitting smoking have developed since the mid-1970s, when no effective drug treatments existed. It describes nicotine gum as a major advance that also helped researchers understand tobacco dependence, and lists eight treatments found effective: nicotine gum, patch, nasal spray, inhaler and lozenge or tablet, plus three non-nicotine drugs (bupropion, nortriptyline and clonidine). Other non-nicotine options were still being studied at the time, including glucose, rimonabant, selegiline and varenicline. The authors call for research on long-term combined treatment with better counselling support, and for studies in young people, pregnant smokers and smokers with mental health conditions.

Foulds J, Steinberg MB, Williams JM et al. (2006). Developments in pharmacotherapy for tobacco dependence: past, present and future. Drug Alcohol Rev. — PubMed PMID: 16492578 · doi:10.1080/09595230500459529

Nicotine delivery systems

Review, 2005. This review describes the medicinal nicotine products used to help people stop smoking: the nicotine patch, gum, lozenge, nasal spray, inhaler and under-the-tongue tablet, including how the body absorbs each one and their recommended doses. It reports that over the past 20 years medicinal nicotine has led to a significant increase in the number of smokers who successfully quit. The authors also describe newer delivery methods that could raise quit rates further, such as high-dose patches, faster-release gum, a patch combined with a fast-acting form, and new formats including a nicotine drink, straw, lollipop and a lung inhaler. They suggest possible new uses, including preventing relapse, long-term nicotine maintenance, managing temporary withdrawal, cutting down on smoking and quitting gradually.

Shiffman S, Fant RV, Buchhalter AR et al. (2005). Nicotine delivery systems. Expert Opin Drug Deliv. — PubMed PMID: 16296775 · doi:10.1517/17425247.2.3.563

Pharmacotherapy for nicotine dependence

Review, 2005. This review looks at medicines that help people stop smoking. It says that about 50% of long-term smokers die early from smoking-related illness, and that quitting at any stage lowers this risk, with bigger benefits the earlier a person quits. Approved treatments include nicotine replacement medicines in several forms (gum, skin patch, lozenge, tablet under the tongue, nasal spray and inhaler), plus one approved non-nicotine medicine, bupropion. The authors add that combining treatments, using them for longer, harm-reduction approaches and newer medicines such as varenicline and rimonabant may help more people quit.

Henningfield JE, Fant RV, Buchhalter AR et al. (2005). Pharmacotherapy for nicotine dependence. CA Cancer J Clin. — PubMed PMID: 16166074 · doi:10.3322/canjclin.55.5.281

Prolonged nicotine patch use in quitters with past abstinence-induced depressed mood

Human trial, 2003. This randomized trial included 55 smokers who had felt depressed in earlier attempts to quit. After an initial high-dose nicotine patch phase, one group stayed on a 21 mg nicotine patch for 8 more weeks and the other group followed the usual schedule of tapering the dose down. The group that stayed on the full dose reported less craving, but withdrawal symptoms did not differ, and neither did continuous abstinence or relapse rates. The full-dose group had lower relapse rates only when people who dropped out without relapsing were counted as successes, and the authors suggest any benefit of staying on the full dose may last only as long as the dosing continues.

Pomerleau OF, Pomerleau CS, Marks JL et al. (2003). Prolonged nicotine patch use in quitters with past abstinence-induced depressed mood. J Subst Abuse Treat. — PubMed PMID: 12646326 · doi:10.1016/s0740-5472(02)00320-3

Managing nicotine addiction

Review, 2002. This review describes nicotine addiction, which it calls the main reason tobacco use continues so widely, and the medicines used to treat it. The authors report that several medicines roughly double long-term quit rates and are recommended as first-line treatment in US clinical practice guidelines: nicotine replacement therapy in the forms then available (gum, patch, nasal spray and inhaler) and the antidepressant bupropion. Two other drugs, nortriptyline and clonidine, also showed some benefit, and every medicine worked best when combined with behavioral therapy. The review also describes approaches still being studied, including new ways to deliver nicotine, a vaccine meant to stop nicotine from reaching the brain, and drugs that change how the body breaks nicotine down.

Kotlyar M, Hatsukami DK (2002). Managing nicotine addiction. J Dent Educ. — PubMed PMID: 12374267

Using nicotine replacement therapy in treating nicotine addiction in adolescents

Review, 2001. This review article for school nurses looks at medicines that help teenagers addicted to nicotine quit smoking. It covers nicotine replacement products (nicotine gum, nicotine patches, a nicotine inhaler and a nicotine nasal spray, plus their generic versions) and a non-nicotine prescription quit-smoking medicine, along with how nicotine withdrawal symptoms develop over time. It also describes a standard questionnaire for measuring how dependent a person is on nicotine, and offers a framework nurses can use to help students quit. The article notes that more than 3,000 children in the United States start smoking each day.

Maharaj K, Ternullo S (2001). Using nicotine replacement therapy in treating nicotine addiction in adolescents. J Sch Nurs. — PubMed PMID: 11885345 · doi:10.1177/10598405010170050801

Nicotine replacement therapy

Review, 1999. This review article explains how nicotine replacement medicines help people quit smoking. It describes the forms that were available at the time: gum, a skin patch, a nasal spray and a vapor inhaler. The authors explain that these medicines ease the body's withdrawal symptoms when a person stops smoking. Because they do not deliver the many toxins and cancer-causing chemicals found in cigarettes, the authors consider them safe when used as directed, and they also discuss the public health benefits of these medicines.

Fant RV, Owen LL, Henningfield JE (1999). Nicotine replacement therapy. Prim Care. — PubMed PMID: 10436291 · doi:10.1016/s0095-4543(05)70121-4

Transdermal nicotine effects on attention

Human trial, 1998. This study tested whether a nicotine skin patch could improve attention in non-smoking adults who had no attention problems. The abstract does not say how many people took part. Each person wore a 7 mg/day nicotine patch for 4.5 hours one morning and a placebo patch on another, and neither they nor the researchers knew which patch was which. With the nicotine patch, people said they felt more vigorous, and on a computer attention test they missed fewer targets, with no rise in wrong responses and no change in reaction time. Their reaction times were also more consistent, and their overall attention score improved.

Levin ED, Conners CK, Silva D et al. (1998). Transdermal nicotine effects on attention. Psychopharmacology (Berl). — PubMed PMID: 9860103 · doi:10.1007/s002130050750

Pharmacology of nicotine: addiction and therapeutics

Review, 1996. This review describes how nicotine works in the body, both as the substance that keeps people addicted to tobacco and as a medicine to help people quit smoking. Nicotine acts on nicotinic receptors in the nervous system, and its effects depend on how fast and by what route it is taken and on tolerance; a few people have been described who break down nicotine unusually slowly and make little cotinine. The authors note that nicotine affects most organ systems, but its contribution to smoking-related disease is still unclear. At the time, nicotine medicines were available as a gum, a skin patch and a nasal spray for quitting smoking, and nicotine was being studied for ulcerative colitis, Alzheimer's disease, Parkinson's disease, Tourette's syndrome, sleep apnea and attention deficit disorder.

Benowitz NL (1996). Pharmacology of nicotine: addiction and therapeutics. Annu Rev Pharmacol Toxicol. — PubMed PMID: 8725403 · doi:10.1146/annurev.pa.36.040196.003121

Nicotine addiction and treatment

Review, 1996. This review article explains that people keep smoking, even when they know the health risks, because they are addicted to nicotine, and that most attempts to quit without help fail. It covers treatments that ease withdrawal symptoms and help people stay off cigarettes. These include nicotine gum, skin patches, nasal sprays and inhalers, and medicines such as mecamylamine, clonidine, buspirone and the antidepressant bupropion. It also discusses a non-drug approach that uses cigarette substitutes to copy the feeling smoke gives in the airways.

Rose JE (1996). Nicotine addiction and treatment. Annu Rev Med. — PubMed PMID: 8712799 · doi:10.1146/annurev.med.47.1.493

Efficacy of a nicotine nasal spray in smoking cessation: a placebo-controlled, double-blind trial

Human trial, 1995. This study tested whether a fast-acting nicotine nasal spray helps people quit smoking. Researchers randomly gave 255 smokers either the nicotine spray or a placebo spray made with piperine (a pepper extract), used for up to 6 months, and followed them for 1 year. More people stayed completely smoke-free with the nicotine spray than with the placebo at every check-up, including 43% vs. 20% at 6 weeks, 25% vs. 10% at 6 months and 18% vs. 8% at 1 year. Side effects were common but tolerable, the spray replaced about 30% of the nicotine people got from smoking, and the authors concluded it is a safe and effective option for quitting smoking.

Schneider NG, Olmstead R, Mody FV et al. (1995). Efficacy of a nicotine nasal spray in smoking cessation: a placebo-controlled, double-blind trial. Addiction. — PubMed PMID: 8555958 · doi:10.1046/j.1360-0443.1995.901216719.x

Nicotine chewing gum and nicotine patch

Review, 1995. This review compares two forms of nicotine replacement used to help people stop smoking: nicotine chewing gum and the nicotine patch. Gum lets the user adjust how much nicotine they take, but it needs proper instructions and guidance to be used well, while the patch gives a fixed dose that cannot be changed. The authors suggest the patch may be the first choice in general practice because it is convenient, while gum may work better in a specialist stop-smoking clinic. Using both together, the patch gives a steady base level of nicotine that is often not enough on its own, and adding gum helps control the urge to smoke better.

Fagerström KO, Tönnesen P (1995). Nicotine chewing gum and nicotine patch. Wien Med Wochenschr. — PubMed PMID: 7778323

Treatment of nicotine dependence

Review, 1995. This review looks at drug and non-drug treatments for nicotine dependence, which the authors describe as the reason most smokers find it extremely hard to quit. Non-drug approaches, such as behavioral therapy, setting a quit date, counseling, self-help, hypnosis and acupuncture, ranged in effectiveness from substantial to almost nil. At the time, nicotine was the only drug approved by the FDA for quitting smoking, and nicotine replacement (a skin patch or chewing gum) used alongside non-drug support roughly doubled quit rates compared with placebo. The authors call the patch the first-line choice because it is easier to use than gum and works with minimal extra support, and they say clonidine, antidepressants and buspirone need more study.

Haxby DG (1995). Treatment of nicotine dependence. Am J Health Syst Pharm. — PubMed PMID: 7749954 · doi:10.1093/ajhp/52.3.265

Nicotine-replacement products in smoking cessation: a review

Review, 1993. This review looked at nicotine-replacement products used to help people stop smoking, focusing on recent clinical trials of nicotine gum and the nicotine skin patch. The authors explain that most quit attempts fail mainly because nicotine is addictive and causes withdrawal symptoms when the body goes without it, and that nicotine-replacement products are meant to ease that withdrawal. Of the two products reviewed, the authors found that the skin patch appeared to deliver nicotine to the body more favorably and caused fewer side effects than the gum, and they suggested it may be the better choice.

Alsagoff F, Lee HP (1993). Nicotine-replacement products in smoking cessation: a review. Singapore Med J. — PubMed PMID: 8153711

Transdermal nicotine facilitates smoking cessation

Human trial, 1990. This randomized, double-blind trial tested a nicotine skin patch against a placebo patch in 65 heavily dependent smokers, all of whom also attended a behavioral quit-smoking program. More people on the nicotine patch stayed completely off cigarettes, both at first (55% versus 34%) and at 3 weeks (18% versus 6%). The patch eased some withdrawal symptoms, such as low mood and low alertness, and there was a trend toward less craving, but it did not affect hunger or the urge to keep the smoking habit. The main side effect was skin irritation, and the authors suggest that adding other methods to nicotine replacement may work better for symptoms such as craving.

Rose JE, Levin ED, Behm FM et al. (1990). Transdermal nicotine facilitates smoking cessation. Clin Pharmacol Ther. — PubMed PMID: 2178852 · doi:10.1038/clpt.1990.35

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