NRT (Nicotine Replacement Therapy): A Guide for Care Teams

NRT, or nicotine replacement therapy, is a licensed stop smoking medicine that gives the body nicotine without the harmful chemicals in tobacco smoke. It eases cravings and withdrawal while someone stops smoking. It comes as patches, gum, lozenges, inhalators, mouth sprays and nasal sprays, and works best when two types are combined and the person gets support.

This guide explains what NRT is, how the products differ, where vapes fit in, how to get free help in each UK nation, and what care staff can do in a short conversation. It doesn't give doses: the product leaflet, a pharmacist or the stop smoking service does that.

How NRT works

People who smoke are hooked on nicotine, but nicotine isn't what makes smoking so harmful. The NHS is clear that nicotine on its own doesn't cause cancer, lung disease, heart disease or stroke. Most of the damage comes from the other chemicals in cigarette smoke.

NRT gives the body smaller amounts of nicotine in a safer way, so the person can deal with the habit and the routine of smoking without strong cravings on top. The NHS advises using stop smoking products for at least 12 weeks, or longer if needed.

The types of NRT

NRT comes in several forms, which split into two groups:

• Long-acting: patches, worn on the skin, give a steady background level of nicotine through the day.
• Short-acting: gum, lozenges, inhalators, mouth sprays and nasal sprays are used when a craving hits, or before a situation where the person would normally smoke, such as after a meal or on a break.

Which products suit someone depends on their routine, their health and what they find easy to use. The stop smoking adviser or pharmacist helps the person choose, and checks the product leaflet with them.

Why combination NRT works better

NICE guidance on treating tobacco dependence says people should be told that the options most likely to help them stop are:

• a combination of short-acting and long-acting NRT
• varenicline or cytisinicline (prescribed tablets)
• nicotine-containing vapes (e-cigarettes)

Using one type of NRT on its own, or bupropion, is less likely to work. So a patch for the background level plus a fast-acting product for cravings is the usual combination. NICE also says behavioural support should be offered whichever option the person picks.

Vapes as a quit aid

The current UK position is cautious but supportive. The NHS page on vaping to quit (reviewed July 2026) says vaping isn't completely risk-free, but carries a small fraction of the risk of smoking, and that long-term risks aren't yet clear. NICE says vapes are likely to be substantially less harmful than smoking, and that people using them should stop smoking tobacco completely.

Vapes aren't currently available on NHS prescription, so a GP can't prescribe one, but local stop smoking services can advise on using one to quit. They're for adults who smoke, not children or people who don't smoke.

NHS stop smoking services across the UK

Local stop smoking services are free. The NHS describes support that usually lasts about 12 weeks, with carbon monoxide breath tests and a supply of, or prescription for, stop smoking treatment. People can ask their GP or pharmacist for a referral, or contact a service directly:

• England: search for a local service on the NHS website, or call the Smokefree National Helpline on 0300 123 1044.
• Scotland: Quit Your Way Scotland, 0800 84 84 84.
• Wales: Help Me Quit, 0800 085 2219.
• Northern Ireland: local services are listed on stopsmokingni.info.

NRT can also be bought from pharmacies, supermarkets and some other shops.

Very brief advice: Ask, Advise, Act

You don't need to be a stop smoking adviser to make a difference. NICE says to ask people whether they smoke at every opportunity, and to refer them to local support if you can't provide it yourself. The National Centre for Smoking Cessation and Training (NCSCT) model of very brief advice has three steps:

1. Ask whether the person smokes, and record it.
2. Advise that the best way to stop is a combination of specialist support and a stop smoking aid, such as medicine or a nicotine vape.
3. Act on their response: offer a referral to the local stop smoking service, or the support your own service provides.

The NCSCT says people are three times more likely to quit with support and a stop smoking aid. It isn't a lecture. If the person isn't interested today, record it, respect it and ask again another time.

What care teams should know

• Smoking affects some medicines. NICE names clozapine, olanzapine, theophylline and warfarin as medicines affected by smoking or stopping smoking, and says doses may need adjusting. If someone on these stops or cuts down, tell the prescriber or pharmacist promptly.
• Smoke-free settings. NICE says people who can't smoke while in hospital or another secondary care setting should be encouraged to use licensed nicotine products, with behavioural support, even if they're only stopping temporarily.
• Mental health. NICE recommends support from a specialist adviser with mental health expertise for people with severe mental health conditions who may need extra help. Our physical healthcare in mental illness training covers the wider picture, and mental health awareness training helps staff have these conversations well.
• Oxygen. Mersey Care NHS Foundation Trust warns that e-cigarettes pose the same risk as a lit cigarette near oxygen. No smoking or vaping near oxygen equipment. See our oxygen therapy training.
• It's the person's choice. Offer, inform and support. Follow your local policy and the person's care plan, including how NRT is recorded under your medicines policy.

How Kasorb can help

Our Smoking Cessation course equips nurses, practitioners and support staff to help the people in their care stop smoking. Over a full day, on-site or live online, it covers the effects of smoking and the cost to the NHS, the public health framework, the impact on physical health, nicotine dependence, nicotine replacement therapies, running stop smoking sessions and carbon monoxide monitoring.

It's one flat rate for the group, up to 12 staff on-site or 10 online. Your trainer has used these skills for real, and runs the day around the people your staff support. Each person gets a Kasorb certificate of completion that doesn't expire, emailed the next day. It isn't NCSCT certification.

FAQs

What does NRT stand for?

NRT stands for nicotine replacement therapy. It is a group of licensed stop smoking medicines, including patches, gum, lozenges, inhalators, mouth sprays and nasal sprays, that give the body nicotine without the harmful chemicals in tobacco smoke, easing cravings while someone stops smoking.

Can you use two types of NRT at the same time?

Yes. NICE says a combination of short-acting and long-acting NRT is one of the options most likely to help someone stop smoking. A common approach is a patch for steady background nicotine plus a faster product, such as gum or a mouth spray, for cravings. A pharmacist or stop smoking adviser can help.

Is NRT free on the NHS?

Local NHS stop smoking services are free, and the NHS says they provide a supply of, or a prescription for, stop smoking treatment alongside support. Prescription charges depend on where in the UK you live and your circumstances. NRT can also be bought from pharmacies and supermarkets.

How long should you use NRT for?

The NHS advises using stop smoking products for at least 12 weeks, or longer if needed. A stop smoking adviser or pharmacist can help plan how to reduce and stop NRT when the person is ready.

Is NRT safe during pregnancy?

The NHS says NRT is safe to use in pregnancy, but advises speaking to a healthcare professional, such as a midwife, GP or stop smoking adviser, before starting, so they can help choose the right product and plan support.