Smoking Cessation

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Cessation of smoking sometimes requires more than self-determination. The main over-the-counter (OTC) medication available for smoking cessation contains nicotine. These medications must be used under a doctor’s supervision in case of individuals with heart disorders and pregnant women. These medications must be kept away from children.1,2

OTC Medications

Smoking becomes a habit owing to nicotine dependence that develops in chronic smokers. Nicotine, a major constituent of tobacco acts in the mid-brain resulting in creation of dependence and causes unpleasant mood and symptoms when one abstains from smoking. This phenomenon is used in the formation of OTC medicines, which contain nicotine in variable quantities and helps in reducing the urge of smoking over a period of time. The different forms in which nicotine is available as OTC medication are:

  • Nicotine patches.
  • Nicotine gums.
  • Nicotine lozenges.

Nicotine Patches

These patches are available in various designs and different amount of dosages (7, 14, 15 and 21 mg). These patches are required to be worn continuously for 16–24 h based on its dosage. The duration of this therapy ranges between 6 and 8 weeks.


The dosage patterns vary with the number of cigarette smoked every day.

In individuals who smoke >10 cigarettes/day:

  • Nicotine patch 21 mg every 24 h for 6–8 weeks,
  • step down to 14 mg every 24 h for 2–4 weeks and
  • then to 7 mg every 24 h for 2–4 weeks.

In individuals who smoke ≤10 cigarettes/day:

  • Nicotine patch 15 mg every 16 h for 6 weeks.


  • Local skin irritation and sensitivity.
  • Sleep disturbance.

These are more common with 24-h patches and can be reduced by applying the patches to a different area each day or using a 16-h patch.

Individuals who do not stop smoking even while using the patches may feel various symptoms such as nausea, pain in the abdomen, diarrhoea, vomiting, profuse perspiring, hearing and vision disturbances, confusion, rapid heart beat and hypotension.


  • Acute myocardial infarction.
  • Individuals undergoing surgical procedures related to the heart

Nicotine Gum

The nicotine gums are available in the strengths of the 2 or 4 mg.


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In individuals who smoke <15 cigarettes/day:

  • One 2-mg pieces of gum every 1–2 h.

In individuals who smoke ≥15 cigarettes/day:

  • One 4-mg pieces of gum every 1–2 h.


  • Rapid chewing of the gum may result in abdominal discomfort and headaches.
  • Unappealing flavor.
  • Jaw fatigue, jaw and mouth soreness because of excessive chewing.


  • Acute myocardial infarction
  • Individuals undergoing surgical procedures related to the heart.
  • Individuals with dental problems or temporomandibular joint syndrome.

Nicotine Lozenges  

The nicotine lozenges are similar to nicotine gums and are indicated in individuals who cannot tolerate the use of gums and also in cases of individuals with jaw problems. Other side-effects and contraindications are similar to that of nicotine gums. The lozenges are available in the strengths of the 2 or 4 mg.


  • Weeks 1–6: One lozenge every 1–2 h.
  • Weeks 7–9: One lozenge every 2–4 h.
  • Weeks 10–12: One lozenge every 4–8 h.

Individuals who smoke very frequently should use 4-mg dose while others can use the 2-mg dose.

When to Seek Medical Help

Prompt medical attention should be sought in the following cases:

  • Smoking cessation is not possible even after using the OTC medication for 6–8 weeks.
  • In case of adverse reactions.


  1. Frishman WH. Smoking cessation pharmacotherapy—Nicotine and non-nicotine preparations. Prev Cardiol. 2007; 10(2 Suppl 1): 10–22.
  2. Frishman WH, Ky T, Ismail A. Tobacco smoking, nicotine, and nicotine and non-nicotine smoking cessation therapies. In: Frishman WH, Sonnenblick EH, Sica DA, (eds). Cardiovascular Pharmacotherapeutics. 2nd edn. New York, NY: McGraw-Hill, 2003, pp. 369–380.
  3. Shiffman S, Dresler CM, Hajek P, Gilburt SJA, Targett DA, Strahs KR. Efficacy of a nicotine lozenge for smoking cessation. Arch Intern Med. 2002; 162: 1267–1276.
  4. Okuyemi KS, Nollen NL, Ahluwalia JS. Interventions to facilitate smoking cessation. Am Fam Physician. 2006; 74: 262–271, 276.
  5. Aveyard P, West R. Managing smoking cessation. BMJ. 2007; 335; 37–41.

Written by: team
Date last updated: May 12, 2015

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