Nicotine — Drug Monograph

Brand names: NicoDerm CQ, Nicorette, Nicotrol, Nicotrol NS, Nicotrol Inhaler, Habitrol

Drug class: Supportive Care Agent

Mechanism of Action

Nicotine replacement therapy (NRT) delivers controlled, therapeutic doses of nicotine that bind α4β2 nicotinic acetylcholine receptors in the CNS, blunting the physical withdrawal symptoms and cravings of tobacco abstinence without the harmful combustion products of cigarette smoke. Different formulations provide either a steady baseline level (transdermal patch) or rapid, on-demand relief for breakthrough cravings (gum, lozenge, inhaler, nasal spray). Combining a long-acting patch with a short-acting form is more effective than either alone.

FDA Indications

• Smoking cessation — to reduce nicotine withdrawal symptoms, including cravings, in adults quitting tobacco

Common Side Effects

• Local skin irritation or erythema at patch site
• Mouth/throat soreness, hiccups, dyspepsia (gum, lozenge, inhaler)
• Nasal and throat irritation, rhinorrhea, watering eyes (nasal spray)
• Nausea
• Headache
• Insomnia or vivid dreams (patch worn overnight)
• Jaw ache (gum)

Clinical Pearl

Match the delivery form to the craving pattern: a long-acting patch controls the chronic background craving, while a fast-acting gum, lozenge, inhaler, or nasal spray rescues acute breakthrough urges. Combination NRT (patch + a short-acting form) outperforms monotherapy and is the pragmatic default for heavier smokers.

Related Therapies & Mechanisms

• Aprepitant (Emend) — Supportive Care Agent
• Avatrombopag (Doptelet) — Supportive Care Agent
• Darbepoetin Alfa (Aranesp) — Supportive Care Agent
• Defibrotide (Defitelio) — Supportive Care Agent