Smoking Cessation: What to Tell patients About Over-the-Counter Treatments

Introduction
Smoking remains a leading cause of preventable disease and death, making smoking cessation counseling a routine part of clinical care.
Over-the-counter (OTC) nicotine replacement therapy (NRT) products are widely available and often serve as first-line pharmacologic options.
This article provides practical guidance for clinicians on how to counsel patients regarding the proper use, safety, and selection of OTC smoking cessation treatments.
Key Points
Treatment approach: Effective smoking cessation typically combines pharmacotherapy and behavioral counseling.
Nicotine patches:
Provide steady nicotine levels for baseline craving control.
Should not be cut, as this disrupts drug delivery.
Common adverse effects include skin irritation, insomnia, and vivid dreams.
Oral NRT (gum and lozenges):
Useful for breakthrough cravings.
Gum should be used with the “chew and park” technique to avoid nausea.
Lozenges should dissolve slowly and be rotated in the mouth to reduce irritation.
Combination therapy: Using a nicotine patch plus a rapid-acting NRT (gum or lozenge) is often more effective than monotherapy for managing cravings.
Patient counseling:
Avoid smoking while using NRT.
Avoid electronic cigarettes, which are unregulated tobacco products and may contain toxic substances.
Rotate application sites and follow tapering schedules to minimize adverse effects.
Safety perspective: For most patients, the risks of continued smoking exceed the risks of NRT, even in those with underlying medical conditions.
Conclusion
OTC nicotine replacement therapies are safe, effective, and accessible tools for smoking cessation.
Proper patient education on dosing, technique, and combination use improves adherence and quit success.
Clinicians should individualize therapy based on patient preference and medical history while reinforcing that quitting smoking yields immediate and long-term health benefits.

Burghardt, Kyle, and Vicki L. Ellingrod. “Smoking Cessation: What to Tell Patients About Over-the-Counter Treatments.” Current Psychiatry, vol. 11, no. 1, Jan. 2012, pp. 43–45.