Nicotine Replacement Therapy

Additional information

Nicotine replacement therapy: a calm, expert guide to quitting smoking

What this page covers

This is a friendly, evidence-led guide to nicotine replacement therapy (NRT) for anyone in the UK who is thinking about stopping smoking. We cover what NRT actually is, how the different products work, which combinations boost your chances of quitting, what to expect in the first few weeks, and how Courier Pharmacy can help you find the right plan for you. Written for real people who are trying to make a real change, not for clinicians.

Five key takeaways

• Nicotine replacement therapy supplies controlled doses of nicotine without the thousands of harmful chemicals in cigarette smoke.
• NICE recommends NRT alongside behavioural support as one of the most effective ways to stop smoking, especially when used as combination therapy.
• A long-acting patch plus a fast-acting product like gum, lozenge, or spray roughly doubles your chance of quitting compared with a single product alone.
• NRT is generally taken for 8 to 12 weeks, with the dose stepped down as cravings ease.
• Even though most NRT can be bought without a prescription, Courier Pharmacy can still help you build a personalised plan that actually work

Service highlights

• Online nicotine replacement therapy guidance from a UK-qualified pharmacist
• Personalised NRT plans built around your smoking pattern, not a generic protocol
• Patches, gum, lozenges, mouth sprays, and inhalators from trusted UK brands
• Practical guidance on combination therapy, dose stepping, and managing withdrawal
• Prescription-only medicines such as Zyban, vareniciline and cytisine available after an online consultation/questionnaire
• Friendly follow-up support and access to our free community talks

What you should know about nicotine replacement therapy

Nicotine replacement therapy is a way of giving your body the nicotine it has come to expect, without lighting anything on fire. Nicotine is not the dangerous part of smoking. The smoke is. Tobacco smoke contains thousands of chemicals, dozens of which are known to cause cancer.

Nicotine on its own, used in a measured way through patches, gum, lozenges, sprays, or inhalators, is a much safer way to manage withdrawal while you break the habit. That is the entire point of NRT. It buys you time and breathing room while you change a behaviour that has often been built up over decades.

On this page you’ll find:

• A plain-English overview of what NRT is and how it works
• The different types of NRT, and who each suits
• Why combination NRT often works best
• What to expect in the first few weeks of quitting
• How Courier Pharmacy personalises your plan

Nicotine replacement therapy overview

Smoking is the leading cause of preventable illness and premature death in the UK, and around half of long-term smokers will die early from a smoking-related condition. The good news is that quitting at any age genuinely helps. Within hours, your circulation starts to improve. Within a year, your risk of heart disease drops sharply. Within ten to fifteen years, your lung cancer risk approaches that of a non-smoker.

Most people who smoke want to quit. Around 60% of UK smokers say so, and most have tried at least once. The trouble is that nicotine is properly addictive, and willpower alone has a low success rate. NRT exists because the evidence shows that nicotine substitution, used correctly, gives you a much better chance.

NICE, the UK body that sets clinical guidance, lists NRT alongside varenicline, cytisine, and nicotine-containing e-cigarettes as the options most likely to help someone successfully stop when combined with behavioural support. None of these is a magic wand. However, used properly, they shift the odds dramatically in your favour.

The biggest barrier most people meet isn’t a lack of motivation. It’s that they try one product, use it inconsistently, get hammered by cravings, and conclude it doesn’t work. The truth is usually that the wrong product, the wrong dose, or no follow-up support stacked the deck against them. A proper plan changes that.

What is nicotine replacement therapy?

Nicotine replacement therapy is a group of medicines that deliver nicotine to your body through a route other than smoking. Each product is designed to manage cravings and withdrawal symptoms while you break the smoking habit itself.

The main NRT formats are:

• Patches: a sticky pad worn on the skin that releases nicotine slowly over 16 or 24 hours
• Chewing gum: nicotine is released as you chew, then absorbed through the lining of the mouth
• Lozenges: dissolved slowly in the mouth, also absorbed through the oral lining
• Mouth spray: a quick burst of nicotine sprayed under the tongue or inside the cheek
• Inhalator: a plastic mouthpiece with a nicotine cartridge, mimicking the hand-to-mouth action of smoking
• Nasal spray: a faster-acting spray for heavier smokers, less commonly used in the UK

Each one delivers nicotine at a different speed. Patches give a steady background level. Gum, lozenges, sprays, and inhalators kick in quickly to handle sudden cravings. The right product, or combination, depends on your smoking pattern, your preferences, and what you’ve tried before.

Is nicotine replacement therapy a prescription medicine?

It depends on the specific product and where you buy it. Nicotine replacement therapy in the UK is available across three different legal categories.

Most NRT products on general sale (patches, gum, lozenges, mouth sprays, and inhalators sold in supermarkets and online) are General Sales List (GSL) medicines. That means you can buy them without a prescription and without speaking to a pharmacist if you don’t want to.

Some NRT products are classified as Pharmacy (P) medicines. These can be supplied without a prescription, but only from a registered pharmacy and only after a brief check by a pharmacist. This category often applies to higher-strength formulations, certain mouth sprays, or products supplied as part of a structured stop smoking service. The check is short and easy. It’s there to make sure the product is right for you before you take it home.

A small number of smoking cessation options are Prescription Only Medicines (POM), such as varenicline, cytisine, or Zyban. In those cases, a prescriber needs to issue a prescription before the medicine can be dispensed.

That said, just because much of NRT can be bought off the shelf doesn’t mean you’ll get the most out of it that way. Most people who try NRT alone, with no guidance, end up using too low a dose, the wrong product for their smoking pattern, or no fast-acting product to handle breakthrough cravings. That’s where a quick chat with a pharmacist makes a genuine difference.

At Courier Pharmacy, every NRT and prescription smoking cessation product is available after completing a quick online consultation form. The form is the same gateway whether you’re ordering a GSL nicotine patch, a Pharmacy (P) classified mouth spray, or a Prescription Only Medicine such as varenicline, cytisine, or Zyban. It only takes a few minutes, and it ensures whatever you receive actually fits your medical history, your smoking pattern, and any medicines you’re already taking.

For GSL and P classified NRT products, your answers are reviewed by a UK-qualified pharmacist before supply, exactly as they would be in any high-street pharmacy. For prescription smoking cessation medicines, your answers are reviewed by a UK-qualified prescriber, who will issue a prescription if appropriate and pass it to our pharmacy team to dispense and deliver discreetly.

You can also speak to a UK-qualified pharmacist for free, before or after you order, if you’d like a personalised plan, want to talk through the options, or are unsure which product is the best fit for you. If a prescription smoking cessation medicine such as varenicline, cytisine, or Zyban would suit you better than NRT alone, we’ll explain why and help you access the right route. If your local NHS Stop Smoking Service would be a better fit, we’ll say so honestly.

Whichever option fits your situation, you’ll get better support than picking a box off a shelf, and you won’t have to wonder whether you’ve chosen the right product, the right strength, or the right combination on your own.

How common is smoking in the UK?

Smoking has been falling in the UK for years, but it’s still one of the country’s biggest public-health challenges. In 2024, around 10.6% of UK adults aged 18 and over were current smokers, the lowest figure since records began in 2011. That equates to around 5.3 million people who still smoke.

Behind that headline, the picture varies. People aged 25 to 34 have the highest smoking rate at 12.6%, and smoking is far more common in routine and manual occupations than in professional ones. Around one in four adults with a long-term mental health condition smokes, and four in ten adults with serious mental illness do.

Despite the falling numbers, smoking still kills around 75,000 people a year in England alone and costs the country roughly £49 billion every year. The UK government’s target is a smoke-free England by 2030, defined as fewer than 5% of adults smoking. Reaching that goal will require many more people to quit successfully, and NRT is one of the main tools for helping them do so.

What causes nicotine dependence?

Nicotine dependence has both a chemical and a behavioural side. The chemical side is straightforward. Nicotine binds to receptors in the brain and triggers a rapid release of dopamine, which feels rewarding. Repeated exposure over weeks and months gradually rewires the brain’s reward system, so that not having nicotine starts to feel actively unpleasant.

The behavioural side is just as important, sometimes more so. Smokers often associate cigarettes with specific moments. Morning coffee. Stress at work. The end of a meal. A pint with friends. A car journey. Each of those moments becomes a cue that triggers a craving, even years after the chemical addiction has eased.

That’s why effective quitting programmes don’t just replace nicotine. They also give you tools to break the behavioural triggers. NRT handles the chemistry. Behavioural support, which can be as simple as a weekly check-in, handles the rest.

What happens in the body when you use NRT?

When you smoke a cigarette, nicotine reaches your brain within about 10 seconds. That rapid spike is part of what makes smoking so addictive. NRT delivers nicotine more slowly. Patches release a steady level over many hours, and gum, lozenges, sprays, and inhalators take a few minutes to reach a useful blood level.

Slower delivery sounds like a downside, but it’s a feature, not a bug. The slower spike means NRT is far less reinforcing and addictive than smoking. It gives you enough nicotine to take the edge off withdrawal, without the dopamine rush that drives compulsive smoking.

Common withdrawal symptoms include irritability, low mood, restlessness, poor concentration, increased appetite, and disturbed sleep. NRT does not eliminate them, but it substantially reduces them. That makes the early weeks of quitting feel less like a marathon up a mountain.

The other thing that happens is in the lungs. Within 24 hours of stopping, carbon monoxide leaves your bloodstream. Within 72 hours, your bronchial tubes start to relax, and breathing becomes easier. Over the following months, lung function and circulation continue to improve. NRT supports your willpower while your body does the rest.

Working out how much support you need

There’s no blood test or scan for nicotine dependence. The assessment is based on your smoking pattern. Two simple questions tell a pharmacist most of what they need to know: how many cigarettes do you smoke a day, and how soon after waking up do you have your first one?

If you smoke within 30 minutes of waking, or smoke 10 or more cigarettes a day, you’re likely to be moderately to highly nicotine-dependent. That tells the pharmacist that you’re likely to benefit from a higher-strength patch, combination NRT, or a longer course of treatment. Lighter smokers may do well with a single short-acting product.

The Heaviness of Smoking Index, used in many UK NHS Stop Smoking Services, formalises these two questions into a quick score. At Courier Pharmacy, our online tools and our pharmacist team do the same thing in plain English, then match you with a treatment plan that fits.

Managing nicotine dependence: current treatments

Several evidence-based options are available to people in the UK who want to stop smoking.

Medicine-based options include:

• Nicotine replacement therapy: patches, gum, lozenges, mouth spray, inhalator, available without a prescription
• Combination NRT: a patch plus a fast-acting product, recommended by NICE for moderate-to-heavy smokers
• Varenicline: a prescription tablet that reduces both cravings and the rewarding effects of smoking
• Cytisine: a newer plant-derived prescription tablet that works on the same receptors as varenicline, made available in the UK in January 2024
• Zyban (bupropion): a prescription tablet that acts on dopamine and noradrenaline rather than on nicotine receptors

Non-medicine options include:

• Behavioural support from a UK Stop Smoking Service, often weekly for several weeks
• Mobile apps and text-message programmes
• Group sessions or one-to-one counselling
• Nicotine-containing e-cigarettes are used as a quitting aid, commercially available but not currently licensed as a medicine

A 2023 Cochrane network meta-analysis ranked nicotine e-cigarettes, varenicline, and cytisine as the most effective single options, with NRT close behind (Lindson et al., 2023). However, real-world UK data and the National Centre for Smoking Cessation and Training (NCSCT) consistently show that combination NRT, used alongside behavioural support, is one of the most successful approaches. It roughly doubles quit rates compared with placebo and outperforms any single NRT product used alone.

NRT is usually used for 8 to 12 weeks, with the dose stepped down as cravings settle. Some people benefit from a longer course, particularly heavier smokers or those with a history of relapse.

Varenicline and cytisine: prescription-only options

NRT is the most familiar way to quit, but it isn’t the only one. Two prescription medicines, varenicline and cytisine, work in a different way and are now both back on the table for UK patients who want to give themselves the best possible chance of stopping for good.

What is varenicline?

Varenicline is an oral prescription medicine that has been used in the UK for stop-smoking support for over 15 years. It was previously sold under the brand name Champix. Following a global recall in 2021 due to a manufacturing impurity, varenicline was unavailable in the UK for several years. It returned to the UK market in late 2024 as a generic medicine and is now once again routinely prescribed through NHS Stop Smoking Services and private prescribers.

Varenicline is taken as a tablet, usually for 12 weeks, with the dose stepped up over the first week. You start tablets one to two weeks before your chosen quit date, then continue at the full dose throughout the rest of the course.

What is cytisine?

Cytisine is a plant-derived medicine that has been used as a stop-smoking treatment in Eastern Europe for decades. Specifically, it has been licensed in countries like Poland and Bulgaria for over 50 years. In January 2024, cytisine was made available in the UK for the first time, following the publication of strong randomised trial evidence and a positive surveillance review by NICE.

Cytisine is taken as a tablet over a 25-day course, with the number of tablets per day reducing gradually as the course progresses. You start cytisine while still smoking, choose a quit date within the first five days, and stop completely by the end of the course.

NICE confirmed in its 2024 surveillance review that cytisine has comparable effect, safety, and cost to other recommended UK options. As a result, it now sits alongside varenicline and NRT as a recognised first-line treatment.

How do varenicline and cytisine work?

Both medicines act on the same target in the brain, the alpha 4 beta two nicotinic acetylcholine receptor, which is the receptor that nicotine binds to when you smoke. They are partial agonists, meaning they activate the receptor partially while also blocking nicotine from fully binding to it.

That dual action does two useful things at once. Firstly, it eases the cravings and withdrawal symptoms that drive most relapses. Secondly, it reduces the rewarding feeling of smoking if you do light a cigarette during the course, which makes slipping back into the habit much less satisfying.

It’s a different mechanism from NRT. NRT replaces nicotine with a slower, safer source. Varenicline and cytisine act directly on the receptor.

How effective are they?

The evidence is genuinely strong. The 2023 Cochrane network meta-analysis of pharmacological and e-cigarette interventions for smoking cessation ranked nicotine-containing e-cigarettes, varenicline, and cytisine as the three most effective options, all with high-certainty evidence (Lindson et al., 2023).

Varenicline roughly triples the chance of stopping smoking compared with no treatment, and outperforms most single NRT products in head-to-head trials. Cytisine roughly doubles the chance compared with placebo, and trial data suggest it has comparable effectiveness to varenicline.

For context, combination NRT (a patch plus a fast-acting product) also roughly doubles quit rates. Varenicline, cytisine, and combination NRT are therefore all reasonable evidence-based starting points, with the right choice depending on you, your medical history, and your preferences.

Side effects to know about

Varenicline is generally well tolerated. The most common side effects are nausea, vivid dreams, sleep disturbance, headache, and constipation, and most settle within the first few weeks. Mood changes have been reported in a small number of patients, so any new low mood, anxiety, or unusual thoughts during treatment should be reported to a prescriber promptly.

Cytisine has a similar but generally milder side effect profile. The most common reports include mild nausea, dry mouth, headache, and changes in appetite. Mood changes are uncommon but should still be flagged to a prescriber if they occur.

Both medicines are unsuitable in pregnancy and breastfeeding, and both need careful prescriber assessment in patients with a history of significant cardiovascular or psychiatric conditions.

Who might benefit from varenicline or cytisine?

Either medicine can suit moderate to heavy smokers, particularly those who have tried NRT before without success. They can also suit patients who want a structured course rather than open-ended NRT use, and those who prefer tablets over patches, gum, or sprays.

How does this fit alongside NRT?

NRT is the right answer for many people who want a simple, low-friction route they can buy without a prescription. Varenicline and cytisine are options to consider if NRT alone hasn’t worked before, or if you want a structured prescription medicine that targets the brain’s nicotine receptors directly.

In real-world UK practice, prescribers also sometimes combine approaches. Behavioural support is recommended alongside any pharmacological option, and some patients use NRT for the first one or two weeks of a varenicline or cytisine course while the tablets reach a steady level.

Zyban (bupropion): the older prescription option that still works

Alongside varenicline and cytisine, there is a third prescription medicine licensed in the UK for stopping smoking, and it has been around the longest of the three. Zyban is the brand name for bupropion when used as a stop-smoking treatment.

What is Zyban?

Zyban is an oral prescription medicine licensed specifically for smoking cessation in adults. It contains the active ingredient bupropion, the same molecule that’s used in higher doses as an antidepressant under brand names like Wellbutrin in some countries. In the UK, bupropion at the lower 150mg sustained-release dose is licensed only for stopping smoking, not for depression.

Zyban has been licensed in the UK since 2000, so it’s the longest-established non-NRT smoking cessation medicine on the market. It returned to broader use in recent years following the temporary unavailability of varenicline, and it remains a useful option for patients who can’t use NRT, varenicline, or cytisine.

How is Zyban taken?

Zyban is taken as a tablet, typically over a 7 to 9 week course. You start the tablets one to two weeks before your chosen quit date, while still smoking. Treatment usually begins at one tablet a day for the first six days, then increases to two tablets a day, taken at least 8 hours apart, for the rest of the course. You set your quit date for the second week, then continue at the full dose throughout.

The course is structured rather than open-ended, which some patients prefer. There’s a clear start, a clear end, and a defined plan in between.

How does Zyban work?

Zyban works differently from NRT, varenicline, and cytisine. Instead of acting directly on nicotine receptors, it influences the levels of two chemical messengers in the brain, dopamine and noradrenaline. The exact mechanism of smoking cessation isn’t fully understood, but the practical effect is that it reduces cravings and withdrawal symptoms while making smoking itself feel less rewarding.

That’s a useful difference. For patients who haven’t responded to nicotine-based treatments, or who can’t use them, an alternative mechanism can be exactly what’s needed.

How effective is Zyban?

The Cochrane evidence on bupropion for smoking cessation is solid. Bupropion roughly doubles quit rates compared with placebo, broadly in line with combination NRT and cytisine, and slightly behind varenicline in head-to-head comparisons (Lindson et al., 2023). It’s a recognised first-line option in NICE guidance NG209 for treating tobacco dependence in adults, alongside NRT, varenicline, cytisine, and nicotine-containing e-cigarettes.

The 2024 UK Cochrane evidence update also confirmed bupropion as one of the main pharmacotherapies with established efficacy for smoking cessation, particularly when combined with behavioural support.

Side effects to know about

Zyban is generally well tolerated, but it has a more distinctive side effect profile than the other prescription options.

The most common side effects include dry mouth, insomnia, headache, dizziness, and nausea. Most settle within the first one to two weeks. Sleep disturbance is the most common reason patients ask to stop early, and dosing the second tablet earlier in the day, well away from bedtime, usually helps.

The most clinically important consideration with Zyban is the small but real increase in seizure risk. For this reason, Zyban is not suitable for anyone with a history of seizures, eating disorders such as anorexia or bulimia, or any condition that lowers the seizure threshold. It also interacts with several medicines, so a thorough prescribing review is genuinely important.

Mood changes have been reported less frequently than with varenicline, but any new low mood, agitation, or unusual thoughts during treatment should be reported to a prescriber promptly.

Who might benefit from Zyban?

Zyban is a useful option for patients who:

• Have not responded to NRT, varenicline, or cytisine in previous quit attempts
• Cannot use nicotine-based products for medical reasons
• Want a structured course rather than open-ended NRT use
• Prefer a tablet over patches, gum, or sprays
• Have a clinical profile where varenicline or cytisine is not suitable

It’s not the right choice for everyone. People with seizure history, eating disorder history, severe liver disease, or certain medication interactions need a different approach. As always, a prescriber will weigh up your individual picture before deciding.

Who shouldn’t use Zyban?

Zyban is contraindicated in:

• Anyone with a current or past seizure disorder
• Anyone with a history of anorexia nervosa or bulimia
• Pregnancy and breastfeeding
• Anyone with severe liver cirrhosis
• Anyone with a CNS tumour
• Anyone in acute alcohol or benzodiazepine withdrawal
• Anyone currently taking, or recently stopped taking, an MAOI antidepressant

This is why prescribing assessment matters. It’s a quick conversation upfront that prevents bigger problems later.

How does Zyban fit alongside NRT, varenicline, and cytisine?

NRT remains the easiest first step for most people, and the only option that doesn’t require a prescription. Varenicline and cytisine work directly on the brain’s nicotine receptors and have particularly strong evidence behind them. Zyban offers a different mechanism, working on dopamine and noradrenaline rather than nicotine receptors, which makes it a useful alternative when the others haven’t worked or aren’t suitable.

In some cases, prescribers also combine approaches. Zyban can be used alongside NRT in selected patients, although this should always be done under prescriber supervision. The right combination depends on your medical history, prior quit attempts, and preferences.

Smoking cessation treatments at a glance

Feature	NRT	Zyban (bupropion)	Varenicline	Cytisine
UK legal status	GSL (mostly), some P, rare POM	Prescription only	Prescription only	Prescription only
How it’s taken	Patches, gum, lozenges, mouth spray, inhalator, nasal spray	Oral tablet	Oral tablet	Oral tablet
How it works	Replaces nicotine via a slower, safer route	Acts on dopamine and noradrenaline in the brain	Partial agonist at alpha 4 beta 2 nicotinic receptors	Partial agonist at alpha 4 beta 2 nicotinic receptors
Typical course length	8 to 12 weeks (often longer)	7 to 9 weeks	12 weeks	25 days
Quit date timing	On the day NRT starts	1 to 2 weeks after starting tablets	1 to 2 weeks after starting tablets	Within first 5 days of starting
Effectiveness vs placebo	Roughly doubles quit rates (especially in combination)	Roughly doubles quit rates	Roughly triples quit rates	Roughly doubles to triples quit rates
Most common side effects	Skin irritation (patches), mouth or throat irritation, hiccups, nausea	Insomnia, dry mouth, headache, nausea	Nausea, vivid dreams, sleep disturbance, headache	Mild nausea, dry mouth, headache, appetite changes
Key cautions	Cardiovascular history, pregnancy (specific products)	Seizure history, eating disorder history, liver disease, MAOI use	Cardiovascular history, mood changes	Cardiovascular history, mood changes
Pregnancy and breastfeeding	Some products with caution under midwife or prescriber review	Not recommended	Not recommended	Not recommended
Best suited to	Most adult smokers; those wanting an off-the-shelf option	Patients who can’t or don’t want to use nicotine; those needing a different mechanism	Moderate to heavy smokers; those who haven’t succeeded with NRT	Moderate to heavy smokers; those wanting a shorter course
Combinable with NRT?	N/A	Sometimes, under prescriber supervision	Sometimes, under prescriber supervision	Sometimes, under prescriber supervision
Available from Courier Pharmacy?	Yes, through our online range and free pharmacist support	Yes, after online consultation and prescriber review	Yes, after online consultation and prescriber review	Yes, after online consultation and prescriber review

Patient experiences and challenges

The most common thing we hear from patients who have tried to quit before is, “I tried the patches, and they didn’t work for me.” Often, the patches were the wrong strength. Or there was no fast-acting product to handle breakthrough cravings. Or there was no follow-up support. Or the quit attempt was three days long, and the brain hadn’t even settled yet.

Quitting smoking is rarely a single event. Most successful quitters take more than one attempt. That isn’t a failure of willpower. It’s how addiction unwinds in real life. Each attempt teaches you something useful about your triggers, your timing, and what kind of support you need.

There’s still a quiet stigma around smoking, particularly the idea that smokers should “just stop.” That framing isn’t only unhelpful; it’s wrong. Nicotine is one of the most addictive substances known, ranked alongside heroin and cocaine on dependence measures. People who quit deserve recognition, not lectures. At Courier Pharmacy, our advice is warm, non-judgmental, and focused on what will actually work for you.

There’s also a persistent myth that nicotine itself causes most smoking-related cancers. It doesn’t. Almost all of the cancer risk in smoking comes from the thousands of other chemicals produced when tobacco burns. Nicotine is addictive, but on its own, in measured doses, it is far less harmful than the smoke that usually delivers it.

Innovative and new treatments for nicotine dependence

Options have widened in the past few years. Cytisine, a plant-derived medicine that has been used in Eastern Europe for decades, was finally licensed in the UK in January 2024. NICE confirmed in its 2024 surveillance review that cytisine has a comparable effect, safety, and cost to other recommended treatments. It’s now another option for UK prescribers and patients to consider.

Varenicline, which had a stock shortage in 2023, returned to the UK market in late 2024. Combination NRT remains a reliable workhorse, often paired with vaping or short-course oral medication for moderate to heavy smokers. Zyban also continues to play a useful role, particularly for patients who can’t use the other options.

Compounding has a smaller role in nicotine dependence than in some of our other clinical areas, but personalised support around timing, dose, and combinations is where Courier Pharmacy adds real value. Hybrid approaches, such as combining NRT with a vape during the early weeks, are increasingly used in NHS Stop Smoking Services and can suit patients for whom NRT alone has not been enough.

Looking to the future: research and hope

Smoking cessation research is in a quietly exciting period. The 2023 Cochrane network meta-analyses, which now rank e-cigarettes, varenicline, and cytisine as high-certainty effective options, have reshaped how clinicians think about quitting. Behavioural science is also advancing, with mobile apps, text-message support, and digital coaching showing measurable benefits in real-world trials.

The bigger picture is even more encouraging. UK smoking rates have halved over the last twenty years, and the under-25s in particular are smoking far less than previous generations did. The smokefree 2030 target is ambitious, but it’s no longer unthinkable.

How Courier Pharmacy helps with nicotine replacement therapy

We take quitting smoking seriously. People often come to us after trying once or twice on their own and wondering if they’re the problem. They aren’t. The plan was the problem.

Our approach leans on personalisation and guidance. Even though most NRT is available without a prescription, we offer a free pharmacist-led check-in to look at how much you smoke, when you smoke, what you’ve tried before, and what got in the way. From there, we match you with the right NRT format, the right strength, and, where appropriate, the right combination, then we follow up to make sure it’s actually working. If you’d benefit from a prescription option such as varenicline, cytisine, or Zyban, or from a referral to your local NHS Stop Smoking Service, we’ll say so honestly.

This is also where our brand ambassador, Dr Ada Jex-Cori, comes in. She represents our whole ethos: listening, challenging one-size-fits-all care, and building healthcare that fits the person, not the system. Behind her is a real team of pharmacists who do this work every day, and a community of patients we genuinely enjoy hearing from.

Frequently asked questions about nicotine replacement therapy

What is nicotine replacement therapy?

Nicotine replacement therapy (NRT) is a group of medicines that supply controlled amounts of nicotine to your body without the harmful chemicals in tobacco smoke. It comes in patches, gum, lozenges, mouth sprays, inhalators, and nasal sprays, and it helps you manage cravings and withdrawal while you break the habit of smoking.

Do I need a prescription for NRT?

In most cases, no. NRT products on general sale are GSL medicines, which means you can buy them without a prescription, including online from Courier Pharmacy, in pharmacies, and in supermarkets. Some NRT formulations are P (Pharmacy) medicines and need a brief pharmacist check before supply, and a small number of related options are Prescription Only Medicines. A pharmacist can help you choose the right product and strength, which often makes the difference between success and giving up.

How does NRT help you stop smoking?

NRT eases the chemical side of nicotine withdrawal. Instead of going completely without nicotine on day one, you give your body a steady, lower-risk supply while you break the behavioural side of smoking. This makes it far more realistic to stick with the change. NICE confirms that NRT, especially in combination, significantly increases your chances of quitting.

Which NRT product is best for me?

It depends on how much you smoke and how soon after waking up you have your first cigarette. Heavier or earlier-morning smokers usually need a 24-hour patch plus a fast-acting product like gum or spray. Lighter smokers may do well with a single product. The NCSCT recommends combination NRT for most adult smokers. A short conversation with our pharmacy team is the easiest way to match the right product to you.

What is combination NRT?

Combination NRT means using a long-acting patch alongside a fast-acting product such as gum, lozenge, mouth spray, or inhalator. The patch handles steady background cravings. The fast-acting product handles sudden urges. Combination NRT roughly doubles quit rates compared with a single product, which is why NICE and the NCSCT recommend it as a first-line option for most adult smokers.

Is NRT safe?

NRT is generally safe and well-tolerated when used as directed, and far safer than continuing to smoke. People with cardiovascular conditions, pregnancy, or recent heart events should still chat to a pharmacist before starting, and certain products are unsuitable in specific situations.

Can I use NRT during pregnancy?

Many NRT products can be used in pregnancy when stopping smoking would otherwise be very difficult. UK guidance favours short-acting NRT, such as gum, lozenges, mouth spray, or inhalator, over 24-hour patches, with 16-hour patches as an alternative if needed. Always speak to a midwife, GP, or pharmacist before starting NRT during pregnancy.

How long should I use NRT?

Most people use NRT for 8 to 12 weeks, gradually stepping the dose down as cravings settle. Some people benefit from a longer course, especially after a heavy smoking history or previous relapse. Long-term use of NRT is far safer than smoking, so a longer course is preferable to going back to cigarettes.

What are the side effects of NRT?

Most side effects are mild. Patches can cause skin irritation. Gum can cause hiccups, throat irritation, or jaw ache. Lozenges and mouth sprays can cause mouth or throat irritation. Inhalators can cause coughing. Nasal sprays can cause nasal irritation. Most settle within the first week or two, and switching products usually fixes any persistent issues.

Is NRT addictive?

NRT can produce mild dependence, but it is far less reinforcing than cigarettes because nicotine is delivered slowly rather than in fast spikes. The long-term harm of staying on NRT is also much smaller than the long-term harm of continuing to smoke. NICE and the NCSCT both confirm that NRT is safe to use for as long as it helps prevent relapse.

Can I use NRT alongside vaping?

Yes, this is increasingly common in NHS Stop Smoking Services and is supported in UK clinical practice. Many people use a combination of NRT and a vape during the early weeks of quitting and then taper one or both. Speak to a pharmacist about how to do this safely.

How can Courier Pharmacy help with nicotine replacement therapy?

We offer free pharmacist-led guidance, personalised NRT plans, access to patches, gum, lozenges, sprays, and inhalators from trusted UK brands, and follow-up support to help you stay on track. We’ll also flag if a prescription option, such as varenicline, cytisine, or Zyban, or your local NHS Stop Smoking Service, would suit you better.

More than a condition: our community

Healthcare shouldn’t only happen when you’re buying something. That’s why Courier Pharmacy runs free fortnightly drop-in talks and clinics at Insomnia in Derby, from 10 am to 12pm, open to anyone living with long-term or complex conditions, including those trying to quit smoking. It’s a calm space to ask questions, compare notes, and meet others going through similar experiences. No cost, no pressure, and you’re welcome to bring a friend. Learn more about our community talks on the courierstaging.mystagingwebsite.com community page.

How this content was created

Written by the Courier Pharmacy editorial team and reviewed by a GPhC-registered pharmacist. Grounded in the latest NHS guidance, NICE NG209, the NCSCT combination NRT guide, ONS smoking statistics, peer-reviewed evidence, and the real questions patients bring to our drop-in clinics in Derby.

References

[1] NHS (n.d.) Quit with nicotine replacement therapies (NRT). NHS Better Health.

[2] National Institute for Health and Care Excellence (NICE) (2025) Tobacco: preventing uptake, promoting quitting and treating dependence. NICE guideline NG209: treating tobacco dependence.

[3] National Centre for Smoking Cessation and Training (NCSCT) (2024) Combination nicotine replacement therapy (NRT) briefing 2024-25.

[4] Office for National Statistics (2025) Adult smoking habits in the UK: 2024.

[5] Action on Smoking and Health (ASH) (2025) Smoking facts at a glance: UK statistics on smoking, vaping, and tobacco harm.

[6] National Institute for Health and Care Excellence (NICE) (2024) 2024 exceptional surveillance of tobacco: preventing uptake, promoting quitting and treating dependence (NICE guideline NG209).

[7] BSW Integrated Care Board (2024) BSW Stop Smoking Community Quick Guide.

[8] Lindson, N., Theodoulou, A., Ordóñez-Mena, J.M., Fanshawe, T.R., Sutton, A.J., Livingstone-Banks, J., Hajizadeh, A., Zhu, S., Aveyard, P., Freeman, S.C., Agrawal, S. and Hartmann-Boyce, J. (2023) ‘Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses’, Cochrane Database of Systematic Reviews, 9, CD015226. doi: 10.1002/14651858.CD015226.pub2.