What to expect from nicotine withdrawal

If you’re ready to ditch your nicotine habit, you’re in good company. About 16% of male adults and approximately 12% of female adults were smokers in 2018. More than half of adult cigarette smokers reported making an attempt to quit smoking in the past year, according to data from the Centers for Disease Control and Prevention (CDC). However, attempting to stop is just the beginning of the process. Whether you’re successful often depends on how you handle nicotine withdrawal symptoms. 

Once you decide to quit smoking, it’s important to make a plan. Knowing what to expect during the withdrawal process helps you prepare both mentally and physically. There are plenty of ways to manage nicotine withdrawal symptoms. Here, learn what quitting nicotine does to your body, the most common withdrawal symptoms, different types of smoking cessation products, and other ways to treat side effects.  

What does quitting nicotine do to your body?

Nicotine is both physically and psychologically addictive, which is why it is so hard to quit smoking. Nicotine-containing products causes your brain to release a feel-good hormone called dopamine, which results in a pleasurable feeling. However, when you’re finished smoking, the effects of nicotine wear off quickly, triggering an urge or craving for more, according to the National Institute on Drug Abuse (NIDA). This cycle leads to smoking another cigarette to feel better. 

Nicotine is a potent psychoactive compound that quickly causes physical dependence and tolerance. Quitting smoking cigarettes—or another nicotine-containing product—interrupts this cycle, but because your body is dependent on having the drug in your system, it also causes your body to go through withdrawal. While nicotine withdrawal is not deadly, it can be pretty uncomfortable not only physically but emotionally too, says Andrea Papa, DO, the medical director for Harmony Bay Wellness who is double-board certified in psychiatry and addiction medicine. Nicotine withdrawal symptoms begin almost immediately, with most people experiencing cravings within the first couple of hours after the last nicotine dose.

7 nicotine withdrawal symptoms

The symptoms of nicotine withdrawal come on within hours of the last cigarette and are usually most intense the first three days, with the first few days being the most difficult to get through. According to the NIDA, most withdrawal symptoms subside within four weeks, but some continue to have bouts of intense craving symptoms for months. The withdrawal symptoms for smokers and people who use smokeless tobacco products are similar. 

1. Nicotine cravings 

Nicotine cravings, or an urge to smoke, are among the most common symptoms of withdrawal. The first cravings may occur within the first hours after cessation, according to Dr. Papa. The severity is typically related to the amount of nicotine, how long you used it, and how soon after waking you use nicotine. These urges often come and go over the course of several weeks to months. In rare cases, the National Cancer Institute says occasional mild cravings may last for six months. 

2. Increased appetite and weight gain

Increased appetite is typically the next symptom of nicotine withdrawal to appear. It often occurs in the first few days, according to Dr. Papa.This side effect of quitting can lead to weight gain in some people. 

Weight gain occurs due to decreased metabolic rate, increased activity of lipoprotein lipase, changes in food preferences, and increased caloric intake. A boost in your appetite is related to receptors in the brain. When you consume nicotine, your brain releases dopamine and serotonin, both neurotransmitters that reduce hunger. When you stop, that effect disappears. Additionally, nicotine speeds up metabolism, and without it your body may burn food more slowly, according to the National Library of Medicine. Additionally, the oral fixation of smokers often translates to an increase in food consumption after quitting smoking due to habit. 

3. Mood changes

Some people feel relief from low moods while using nicotine. That’s because according to the American Cancer Society, nicotine affects brain chemistry and emotions. You may experience increased irritability and anxiety as soon as three days after quitting, according to Dr. Papa. 

These mood changes, along with anger and frustration, typically peak within one week of quitting and last anywhere from two to four weeks, according to the National Cancer Institute. 

4. Trouble sleeping and restlessness 

Insomnia, fatigue, and restlessness are all common side effects of nicotine withdrawal, according to a 2019 review of literature. Part of the blame goes to the reduction in dopamine, which occurs when you quit. This brain chemical is involved in sleep regulation. 

5. Constipation and gas

Constipation and gas can affect some people in the first month after quitting nicotine. This is often related to disruptions in the digestive tract and generally peaks around two weeks but can remain a problem for up to four weeks, according to an older study. 

6. Difficulty concentrating 

Trouble concentrating, focusing, and brain fog are common in the first week. In fact, a 2014 review found that withdrawal is associated with deficits in neurocognitive function, including sustained attention, working memory, and response inhibition.

7. Cold-like symptoms

According to the American Cancer Society, you may also experience symptoms like dizziness, headache, cough, chest tightness, sore throat, and nasal drip. It may feel like you’ve caught the common cold. But, these are just more signs of nicotine withdrawal.

Is it bad to quit nicotine cold turkey?

While it is not necessarily dangerous to quit cold turkey, the likelihood of long-term abstinence from nicotine is very low when you stop using abruptly. Withdrawal symptoms are much worse than weaning off. And, “you have a very high chance of relapse,” says Dr. Papa. 

To increase your chances of quitting, get support. That can come in the emotional form of leaning on family and friends, enrolling in group or individual therapy, or creating a Quit Plan to reinforce your reasons for stopping. Or, it can be physical: a medication or nicotine replacement product. Many need both types of support to quit successfully. “Smoking cessation programs that combine both behavioral and pharmaceutical support increased cessation rates from 35% to 55%,” says Erika Gray, Pharm.D., the Chief Medical Officer and cofounder of Toolbox Genomics. 

How to treat nicotine withdrawal symptoms 

Quitting smoking is not easy. The good news is with the right help and support, withdrawal symptoms are temporary. In fact, most withdrawal symptoms last anywhere from a few days to a few weeks, with many people noticing a decrease in symptoms after the third day following stopping, according to the CDC. That said, some people experience side effects for several months. Working with your doctor or other healthcare provider on treatment options can help reduce the duration and severity of symptoms.  

Lifestyle changes

“One strategy to help people treat nicotine withdrawal symptoms is to use non-pharmacological approaches (a fancy way of saying not using medications) such as increasing levels of exercise to offset fatigue and boost endorphins,” says Dr. Gray. Focus on sleeping more. Use stress-reduction techniques such as meditation to lower stress levels and provide a distraction from everyday life. 

Nicotine replacement products

Treatment with nicotine replacement therapy (NRT) involves using a nicotine-containing product that gradually decreases the nicotine level over time. This helps reduce withdrawal symptoms and allows your body to adjust as you wean off. The NRTs also help break the behavior of cigarette smoking. Products are available by prescription or over-the-counter (OTC). 

Currently, there are five forms of NRT approved by the U.S. Food and Drug Administration, including the patch, gum, nasal spray, inhaler, and lozenges. Most smoking cessation products are recommended for eight to 12 weeks, but your healthcare provider may adjust the duration if needed.  

1. Nicotine gum

Nicotine chewing gum (nicotine polacrilex) is an NRT-based product you can purchase OTC in various strengths. Since it delivers nicotine through the mucous membranes in your mouth, it is fast-acting. Be sure to follow all of the Drug Facts Label (DFL) instructions. If you have questions, make sure to ask your pharmacist or a health care provider. The gum should only be chewed when you need an uptick in nicotine, otherwise it sits in your mouth next to your gumline. This is called the “chew and park” method. Side effects include mouth sores, bad taste, nausea, throat irritation, jaw discomfort, and racing heartbeat.

2. Nicotine lozenges

Nicotine lozenges are another NRT option available OTC. The lozenges are considered easier to use correctly compared to the gum. They come in two different strengths. For those who smoke within 30 minutes of waking, the 4 mg lozenge is the suggested starting dose. Per the American Cancer Society, the dose depends on when you have your first cigarette in the morning. In general, you will dissolve one lozenge every couple of hours. Possible side effects include sore throat, headache, nausea, coughing, hiccups, gas, trouble sleeping, heartburn, and racing heart. 

3. Nicotine patch

The nicotine patch, also called transdermal nicotine patch, is an OTC NRT product that adheres to your skin. It releases a measured dose of nicotine. The patch comes in different strengths that generally correspond with your tobacco use. If you smoke more than 10 cigarettes per day, the 21 mg patch is the suggested starting dose. You change the patch daily and should adhere it to a non-hairy area located below the neck and above the waist (like the upper arm or chest). Potential side effects include dizziness, skin irritation, headache, sleep problems, nausea, racing heartbeat, or muscle aches. 

4. Nicotine inhaler

A nicotine inhaler works by delivering a nicotine vapor into your mouth after puffing on it. The nicotine is then absorbed into the bloodstream from the oral mucosa, not the lungs. It requires a prescription from your doctor or another healthcare provider. Side effects may include coughing, throat irritation, runny nose, nausea, headache, nervousness, and racing heart. 

5. Nicotine nasal spray

A nicotine nasal spray delivers a dose of nicotine through the nose and into the bloodstream. It is considered a fast-acting NRT and requires a prescription. According to the American Cancer Society, nasal spray relieves withdrawal symptoms quickly. When using nasal spray, more than 80% of patients experience nasal irritation for up to three weeks. Other unwanted symptoms related to nicotine nasal spray are, watery eyes, sneezing, coughing, throat irritation, or a runny nose. Headache, nervousness, and an increased heart rate may also occur. 

Non-nicotine smoking cessation drugs (Chantix, Zyban)

Wellbutrin and Chantix are the two non-nicotine-containing prescription products approved by the FDA. 

• Wellbutrin (bupropion hydrochloride): Wellbutrin contains bupropion, an antidepressant, which inhibits the uptake of dopamine and norepinephrine. While the exact reason it helps with smoking cessation is unknown, it’s believed to decrease cravings and reduce withdrawal symptoms. It also decreases the dysphoria, depressed mood, that often occurs during nicotine withdrawal. 
• Chantix (varenicline tartrate): According to the FDA, Chantix works by reducing the rewards system of nicotine in the brain to help with cravings.

If you’re not responding positively to smoking cessation products, your doctor may prescribe an off-label medication. The American Cancer Society lists nortriptyline, clonidine, naltrexone, and cystine as prescription medications sometimes used to help people quit smoking. 

“When starting any medications, remember that it can take time for it to take effect,” Dr. Gray says. To have the best opportunity to limit withdrawal, be sure and stay consistent with the medication.

If you’re looking to manage a specific withdrawal symptom, consult the following table:

When to see a doctor

While you may notice mood changes or physical symptoms when you are withdrawing from nicotine, Vivek Cherian, MD, a Chicago-based internal medicine physician, says in general, there are no severe side effects that, unlike alcohol withdrawal, require medical attention. That said, if you feel increased sadness, depression, or anxiety that is not getting better with smoking cessation products, see a doctor. These psychological withdrawal symptoms may require medical attention. 

For more information regarding nicotine addiction and smoking cessation programs, check out the following resources:

• Smokefree (smokefree.gov)
• Quitline (1-800-QUIT-NOW) 
• Centers for Disease Control and Prevention fact sheets on various topics including smoking cessation, health effects of smoking like lung cancer, smokeless tobacco like e-cigarettes. 

It takes many people a few tries to quit for good. If at first you don’t succeed, try again!