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[Pharmacology](https://durgical.com/en/pharmacology/) · [Smoking cessation medicines](https://durgical.com/en/pharmacology/classes/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

- Class: [Smoking cessation medicines](https://durgical.com/en/pharmacology/classes/smoking-cessation-medicines/)
- Receptor: Nicotinic acetylcholine receptor α4β2
- ATC code: N07BA01
- WHO Model List of Essential Medicines

Also called: Nicotine replacement therapy (NRT), Nicotine polacrilex

◎**Nicotinic acetylcholine receptor α4β2**Nicotine (replacement therapy)

ⓘ The figure shows nicotine itself bound to the human α4β2 nicotinic acetylcholine receptor.

**Target in 3D:** Nicotinic acetylcholine receptor α4β2. PDB structure 6CNJ (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/6CNJ) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- Irregular heartbeat or palpitations
- Nicotine overdose (nausea, vomiting, dizziness, weakness, fast heartbeat), especially if smoking continues
- Poisoning of children or pets by new or used patches

## 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.

## Memory aid

Nicotine replacement: «Nicotine without the smoke» – steady dose, no tar; never smoke on top, fold used patches.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/nicotine/)

## Related drugs

- [Varenicline](https://durgical.com/en/pharmacology/varenicline/)
- [Cytisine](https://durgical.com/en/pharmacology/cytisine/)

## Related conditions

- [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/)

[← Back to the class: Smoking cessation medicines](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0c25e8b8-7202-459b-85ac-0d757f344b34) (DailyMed (U.S. National Library of Medicine), 2026); [Nicotine Transdermal Patch: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a601084.html) (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](https://atcddd.fhi.no/atc_ddd_index/?code=N07BA01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/nicotine/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/nicotine/