Pharmacology · Smoking cessation medicines
Nicotine (replacement therapy) !
Nicotine without the smoke, as patches, gum, lozenges or sprays, to ease craving and withdrawal while quitting tobacco.
Updated 2026-11-01
Also called: Nicotine replacement therapy (NRT), Nicotine polacrilex
The figure shows nicotine itself bound to the human α4β2 nicotinic acetylcholine receptor.
Mechanism of action
Nicotine is a full agonist at nicotinic acetylcholine receptors, including the α4β2 receptors of the brain's reward pathway. Replacement products deliver it more slowly and steadily than a cigarette, without tar or carbon monoxide, which softens withdrawal while the person breaks the smoking habit.
- Patch, gum or lozenge releases nicotine slowly
- Nicotine stimulates α4β2 nicotinic receptors
- Craving and withdrawal soften without smoke
Pharmacokinetics
- Absorption
- Through the skin (patch) or the lining of the mouth (gum, lozenge)
- Metabolism
- Mostly in the liver; cotinine is the main metabolite
- Elimination
- Nicotine and its metabolites leave quickly through the kidneys
Indications
- Relief of craving and withdrawal when quitting tobacco Tobacco use disorder →
Adverse effects
Common
- Skin redness or swelling at the patch site
- Dizziness, headache and nausea
- Vivid dreams or sleep disturbance with the patch at night
Contraindications
- Caution (medical advice first): recent heart attack, irregular heartbeat, uncontrolled high blood pressure
- Caution: stomach ulcer, diabetes, history of seizures, adhesive allergy (patch)
Key interactions
- Smoking or other nicotine products at the same time
- Risk of nicotine overdose
- Varenicline
- More adverse effects when combined
- Theophylline, warfarin, insulin (effect of quitting smoking)
- Their effects may change after stopping smoking; doses may need review
What is monitored
- Heart rate and rhythm in people with heart disease
- Skin at the patch sites
- Smoking status and signs of nicotine excess
Administration and safety
- Patch on clean, dry, hairless skin, changing the site each time
- Patch can be removed at bedtime if dreams or sleep problems occur
- Used patches folded sticky sides together and discarded out of reach of children and pets
- No smoking while using it
Nursing care
- Ask about heart disease and recent heart attack
- Teach signs of nicotine overdose
- Teach rotation of patch sites and skin checks
- Teach safe disposal away from children and pets
Pregnancy and breastfeeding
Used in pregnancy only on a clinician's advice; smoking itself seriously harms the baby.
Test yourself
Think of the answer, then tap the question to see it.
Why should someone using a nicotine patch not keep smoking?
Nicotine from both sources can cause an overdose.
Why are used nicotine patches folded and discarded carefully?
They still contain enough nicotine to poison children and pets.
What can be done if the patch causes vivid dreams?
It can be removed at bedtime.
Related drugs
Related conditions
← Back to the class: Smoking cessation medicines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - NICOTINE TRANSDERMAL SYSTEM patch (DailyMed (U.S. National Library of Medicine), 2026); Nicotine Transdermal Patch: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 13 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.