Nicotine Replacement Therapy (NRT) can be an important tool for treating nicotine dependence in youth. Many pediatricians are uncertain about how to use this medication with adolescents, especially those who are under 18 years old. This page is intended to help pediatricians make informed decisions about using NRT with patients who wish to quit smoking or vaping. 

What is Nicotine Replacement Therapy (NRT)? 

  • NRT is a medication that addresses nicotine withdrawal symptoms by providing a controlled amount of nicotine, thus helping reduce the urge to smoke or vape.  
  • NRT is safe and effective in helping adults quit tobacco use, according to the CDC. 
  • NRT works best when paired with behavioral counseling interventions. 
  • NRT comes in five forms, including gum, patch, lozenge, nasal spray and inhaler. 
  • Three forms of NRT (gum, patch, lozenge) are available over-the-counter for adults 18+. 

Can Adolescents Use NRT? 

  • At present, the US Food and Drug Administration (FDA) has not approved NRT for youth under 18 years old.  
  • Research on the effectiveness of NRT for helping youth quit successfully is limited due to a lack of adequately-powered studies. Overall efficacy findings have been mixed, with generally more modest outcomes than in comparable adult trials. There is no evidence of serious harm from using NRT in adolescents under 18 years old, according to recommendation statements from the US Preventive Services Task Force.  
  • Given the effectiveness of NRT for adults and the severe harms of tobacco dependence, AAP policy recommends that pediatricians consider off-label NRT for youth who are moderately or severely addicted to nicotine and motivated to quit.  
  • Youth under 18 years old need a prescription from a healthcare provider to access all forms of NRT.  
  • Non-adherence and relapse after cessation of therapy is common, and close follow-up is recommended.  

Is NRT safe? 

  • NRT is safer than cigarettes, e-cigarettes, and other tobacco products because it delivers nicotine without the toxic chemicals and carcinogens in tobacco and e-cigarette products.  
  • NRT has low potential for misuse because the nicotine is absorbed slowly.  

What are the contraindications to NRT use? 

  • The only contraindication to NRT use is hypersensitivity to nicotine or any component of the medication. In addition, patients who are allergic to soya should not use the nicotine lozenge.  
  • Pediatricians should be aware of disease-related cautions when prescribing NRT, including cardiovascular disease, diabetes and hyperthyroidism. However, it is important to note that these cautions are relative, not absolute: NRT is safer than continued tobacco use.  
  • Pediatricians should review full clinical drug information in a professional prescribing reference to address individual concerns about prescribing. The decision to prescribe a drug is the responsibility of the medical provider, who must weigh the risks and benefits of using the drug for a specific situation.  

What does an NRT treatment plan look like?  

  • Pediatricians and other health care providers should inform patients of the benefits and drawbacks of the five NRT medications, screen for relative contraindications, and instruct patients in how to use the product appropriately.  
  • The choice of NRT medication for an individual patient should be based on preference, availability, and the patient’s experience of potential side effects.  
  • For best results, patients should be advised to pair a long-acting form of NRT (eg, nicotine patch) with a shorter-acting form (eg, gum, lozenge, spray or inhaler). This combination therapy allows the patient to keep a steady level of nicotine in their bloodstream throughout the day, while also responding to cravings. In addition, patients should be advised that NRT works best when paired with behavioral counseling interventions. 
  • The information below provides treatment information for nicotine gum, patch and lozenge. All three products are available over-the-counter for adults and by prescription for youth under 18 years old. There is also a nicotine nasal spray and a nicotine inhaler, which are available by prescription only within the adult population and are used far less frequently.   

Download NRT Information in a factsheet 


Types of NRT, dosing guidelines and coding info:

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American Academy of Pediatrics