What is nicotine replacement therapy (NRT) for smoking cessation?

Updated: May 25, 2018
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The Department of Veterans Affairs (VA)/Department of Defense (DoD) have adopted the DHHS guidelines for use with all adults. Additionally, the VA/DoD considers that first-line treatment is combination nicotine replacement therapy (NRT), which is the use of a long-acting nicotine formulation (patch) in combination with a short-acting formulation (gum, lozenge, inhaler, or nasal spray).

NRT offers constant levels of nicotine replacement provided by the patch and prevents the onset of severe withdrawal symptoms. The short-acting nicotine replacement delivers nicotine at a faster rate and is used as needed to control breakthrough cravings and withdrawal symptoms that may occur during potential relapse situations (eg, after meals).

Alternatively, the combination of a nicotine patch with bupropion SR has also been shown to be more effective in increasing long-term abstinence than either agent alone. Although varenicline is an effective treatment that can increase rates of abstinence, it is a second-line agent because of safety concerns. [15]

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