Nicotine withdrawal can occur when a person who regularly consumes products containing nicotine (such as cigarettes, cigars, smokeless tobacco, and e-cigarettes) decides to quit. Nicotine affects all areas of the body—your heart, blood vessels, hormones, metabolism, and brain to name a few. The symptoms of nicotine withdrawal can be unpleasant and usually last about a month, but the benefits of quitting tobacco far outweigh the temporary symptoms associated with nicotine withdrawal.

This article reviews the common nicotine withdrawal symptoms as well as timelines and strategies to successfully quit.

How Does Nicotine Withdrawal Work?

Quitting smoking comes with the promise of many health benefits, like reduced risk of cancer, heart disease, and lung disease, plus improved quality of life and increased life expectancy.¹ So, why is it that when you quit, you end up feeling worse than you did when you were smoking?

The answer lies in a substance known as nicotine. Nicotine is an addictive chemical that’s found in all tobacco products. It works by stimulating the reward pathways in the brain, causing the brain to release a chemical called dopamine, a feel-good hormone. Dopamine acts as a chemical messenger, carrying information from the brain to the rest of the body that equates nicotine to pleasure.

After you start to quit smoking, your brain isn’t getting the regular hits of dopamine that it has become accustomed to, which can lead to nicotine withdrawal symptoms.

What Are the Symptoms of Nicotine Withdrawal?

Most people who use nicotine regularly will experience nicotine withdrawal symptoms when they stop. The length of time a person has been smoking, as well as their smoking habits, can lead to symptoms of nicotine withdrawal. It’s important to know that while these symptoms can be uncomfortable, they are not dangerous.² Withdrawal symptoms can be both physical and mental.

Physical Symptoms

Weight gain after quitting smoking is a common physical health concern. It is common for people who quit smoking to gain 5 to 10 pounds in the months after they quit.³ There are a couple of reasons for this weight increase.

Nicotine stimulates your metabolism, so quitting nicotine can reduce the number of calories you burn at rest by 7% to 15%, contributing to weight gain.³ Nicotine also suppresses your appetite and dulls your taste buds, so when you ditch the nicotine, you may start to feel hungrier and begin to enjoy food more than you did when you regularly consumed nicotine.

Although there are health risks associated with gaining weight, it has been proven that the benefits of quitting tobacco far outweigh the risks of gaining weight after quitting.⁴ According to the Centers for Disease Control and Prevention (CDC), the health benefits of quitting are almost immediate and get better over time.⁵

In addition to increased appetite and weight gain, other physical symptoms may include:^6,2

• Flu-like symptoms
• Headaches
• Constipation
• Dizziness
• Nausea

Mental Symptoms

There is a proven link between mental health and smoking. According to a 2014 study, people with mental health conditions like depression and anxiety are more likely to smoke, more likely to become dependent on nicotine, and have a harder time quitting.⁷

Smoking rates in people with mental health conditions are nearly twice as high as in the general public.⁸ Although nicotine withdrawal symptoms do include depression and anxiety, quitting smoking can eventually improve a person’s mental health similar to taking an antidepressant.⁸

Mental symptoms of nicotine withdrawal may include:^6,2

• Depressed or anxious mood
• Urges to smoke
• Irritability, anger, or frustration
• Difficulty concentrating
• Restlessness
• Insomnia

Cravings and Triggers

In addition to physical symptoms of nicotine withdrawal, it’s common for some people to experience cravings as well. Certain habits, like driving in the car or drinking coffee, can trigger a craving, leading to changes in mood, heart rate, and blood pressure.⁶

The four types or categories that triggers can fall into include:⁹

• Emotional: Feelings of stress, anxiety, boredom, or loneliness
• Pattern: Drinking coffee, driving, drinking alcohol, or after having sex
• Social: Going to a party or a bar or being around others who smoke
• Withdrawal: Smelling a cigarette or needing to do something with your hands

Identifying your triggers and learning to cope with them or avoid them altogether can help set you up for success and minimize psychological nicotine withdrawal symptoms.

Nicotine Withdrawal Timeline

Here’s what you can expect in the days, weeks, and months after quitting smoking.

Days

Symptoms of nicotine withdrawal can begin as soon as 30 minutes after your last cigarette. They usually peak at or around the third day and eventually subside within three to four weeks of your quit date.¹⁰ The severity of nicotine withdrawal symptoms can depend on your prior nicotine habits.¹⁰

What to expect in the first 24 hours:

• Effects of nicotine wear off and you may begin to crave another cigarette
• Restlessness
• Possibly feeling sadness or hopelessness
• Irritability
• Increased appetite

What to expect between 24 and 72 hours:

• Headaches as the nicotine leaves your body
• Decreased cravings as nicotine diminishes
• Increased anxiety because the nicotine is out of your system

What Are the Worst Days of Quitting Nicotine?

Nicotine withdrawal symptoms are usually the worst during the first week after quitting, peaking during the first three days. After that, the intensity of symptoms usually drops over the first month.

However, everyone is different, and some people have withdrawal symptoms for several months after quitting.⁶

Weeks

A study that followed 572 smokers from their quit date to one year after quitting found that the study participants experienced withdrawal symptoms for two to four weeks after their quit date. However, the study also reported that some quitters experienced more prolonged withdrawal, with symptoms persisting for months.¹¹

Months

Some people who quit smoking may experience cravings months after they quit. This can happen for a number of reasons, including smoking habits, environment, and behaviors. However, symptoms of nicotine withdrawal significantly decrease in the months after quitting.¹¹

Although the process is difficult, there are many health benefits to quitting tobacco, starting on the very first day and increasing in the years to come.

How Is Nicotine Withdrawal Treated?

There are different types of nicotine replacement therapies (NRT) designed to support people who are dealing with the physical symptoms of nicotine withdrawal. Examples of NRTs include nicotine gum, lozenges, nasal spray, inhalers, and skin patches.

Nicotine Replacement Therapy

Nicotine replacement therapy can help reduce the difficult withdrawal symptoms and cravings that most people say are the reason they don’t quit tobacco.¹² NRTs have been shown to increase the rate of quitting by 50%–70%.¹³

Over-the-counter (OTC) therapies include nicotine gum, lozenges, and some transdermal patches.¹²

While it can be a helpful aid in reducing physical cravings, it’s important to consider the emotional, social, and habitual aspects of smoking in addition to using NRT to quit.

Prescription Nicotine Replacement Methods

Nicotine patches: Some, but not all, nicotine patches require a prescription. Patches give a measured dose of nicotine through the skin. You’re weaned off nicotine by switching to lower-dose patches over several weeks. Potential symptoms using the patch include skin irritation, dizziness, and a racing heart.¹²

Nicotine nasal spray: The nasal spray delivers nicotine to the bloodstream rapidly because it’s absorbed through the nose to relieve symptoms and cravings quickly. Symptoms may include nasal irritation, runny nose, watery eyes, throat irritation, and coughing. These symptoms usually get better in one to two weeks.¹²

Nicotine inhalers: The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. Although they look similar to electronic cigarettes, they are not the same. They are the most expensive type of NRT and symptoms may include runny nose, coughing, upset stomach, and throat/mouth irritation.¹²

Non-Nicotine Prescription Medications

There are prescription drugs that have been shown to help people quit tobacco. Some of them can be used along with NRT. Usually, you start taking the medication in the weeks before the day you plan to quit.¹⁴

Varenicline (also called Chantix) helps people stop smoking by interfering with nicotine receptors in the brain.¹⁴ It lessens the pleasure a person gets from smoking. It also reduces the symptoms of nicotine withdrawal.

The antidepressant bupropion (Wellbutrin, Zyban, Aplenzin) in extended-release form may be prescribed to help reduce cravings and symptoms of nicotine withdrawal. It is usually started one to two weeks before quitting smoking to get the best results.

Other medications that may help with withdrawal symptoms include nortriptyline and clonidine.

Prescription medications can have side effects or may not be recommended if you have certain health conditions, so talk with your healthcare provider about which treatments are best for you.

Is It Better to Quit Smoking Cold Turkey?

It is safe to quit smoking without using NRTs or prescription medications, but it can be hard. Most people who quit without medicines experience worse urges and withdrawal symptoms. If you smoke half a pack a day or more, you are less likely to succeed at quitting if you don’t use a quit-smoking medicine.¹⁵

Some people who quit without using a medicine can quit on their own, while others get help and support from a quit coach, website, or app. Talk with your healthcare provider to determine a strategy that’s right for you.¹⁵

Tips on Managing Nicotine Withdrawal

Quitting tobacco and overcoming nicotine dependence is personal; there is no right or wrong way to go about it. Consider these tips that may help you through the quitting process:^16,17

• Eliminate all the cigarettes in your home, car, purse, backpack, and workplace before you quit.
• Get rid of things like lighters, matches, and ashtrays.
• Wash your clothes and anything else that smells of tobacco smoke.
• Drink plenty of water to help with dry mouth or sore throat.
• Push off urges by distracting yourself, changing your environment, and waiting for it to pass.
• Get support from a quit-smoking group (in person or online), app, or coach.
• Practice self-care, such as exercising, breathing exercises, meditation, or yoga.
• Get enough sleep.

Regardless of your approach, it’s important to celebrate the small wins along the way to maintain momentum. If quitting was easy, everyone would do it, so take time to acknowledge that you’re actually doing it!

Summary

Nicotine withdrawal symptoms can be uncomfortable, but they are not dangerous to your health and they don’t last forever. On the contrary, the benefits of quitting tobacco far outweigh the risks of withdrawal symptoms.

Some withdrawal symptoms include cravings, irritability, increased appetite, restlessness, sleep issues, and more. If you’re worried about the symptoms of nicotine withdrawal, you may benefit from using nicotine replacement therapy or medications to help with symptoms. Talk to your healthcare provider or pharmacist about your options.

Frequently Asked Questions

• Should you do a nicotine detox cold turkey?

It is safe to detox from nicotine without the use of medications or NRT. Consult with your healthcare provider to determine a strategy that’s right for you.

• How long does nicotine stay in your system?

Nicotine can stay in your blood and be detected in your urine for between one to three days.¹⁸¹⁹

Raja M, Garg A, Yadav P, Jha K, Handa S. Diagnostic methods for detection of cotinine level in tobacco users: a review. J Clin Diagn Res. 2016;10(3):ZE04-6. doi:10.7860/JCDR/2016/17360.7423

• How do you support someone going through nicotine withdrawal?

You can support someone going through nicotine withdrawal by keeping an open line of communication, listening without judgment, and providing distractions when possible.

Sources:

1. Centers for Disease Control and Prevention. Benefits of quitting.
2. Centers for Disease Control and Prevention. 7 common withdrawal symptoms.
3. MedlinePlus. Weight gain after quitting smoking: what to do.
4. Sahle BW, Chen W, Rawal LB, Renzaho AMN. Weight gain after smoking cessation and risk of major chronic diseases and mortality. JAMA Netw Open. 2021;4(4):e217044. doi:10.1001/jamanetworkopen.2021.7044
5. Centers for Disease Control and Prevention. Within 20 minutes of quitting poster.
6. National Cancer Institute. Handling nicotine withdrawal and triggers when you decide to quit tobacco.
7. Smith PH, Homish GG, Giovino GA, Kozlowski LT. Cigarette smoking and mental illness: a study of nicotine withdrawal. Am J Public Health. 2014;104(2):e127-e133. doi:10.2105/AJPH.2013.301502
8. Taylor GMJ, Baker AL, Fox N, Kessler DS, Aveyard P, Munafò MR. Addressing concerns about smoking cessation and mental health: theoretical review and practical guide for healthcare professionals. BJPsych Adv. 2021;27(2):85-95. doi:10.1192/bja.2020.52
9. U.S. Department of Health and Human Services. Know your triggers.
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11. Schlam TR, Piper ME, Cook JW, Fiore MC, Baker TB. Life 1 year after a quit attempt: real-time reports of quitters and continuing smokers. Ann Behav Med. 2012;44(3):309-319. doi:10.1007/s12160-012-9399-9
12. American Cancer Society. Nicotine replacement therapy to help you quit tobacco.
13. Wadgave U, Nagesh L. Nicotine replacement therapy: an overview. Int J Health Sci. 2016;10(3):425-435.
14. American Cancer Society. Prescription medicines to help you quit tobacco.
15. Centers for Disease Control and Prevention. Quitting without using a medicine.
16. American Cancer Society. Help for cravings and tough situations while you’re quitting tobacco.
17. Centers for Disease Control and Prevention. Tips for quitting.
18. Gormsen J, Hjørne F, Helgstrand F. Cotinine test in evaluating smoking cessation at the day of bariatric surgery. Scand J Surg. 2020;109(3):265-268. doi:10.1177/1457496919866017
19. Raja M, Garg A, Yadav P, Jha K, Handa S. Diagnostic methods for detection of cotinine level in tobacco users: a review. J Clin Diagn Res. 2016;10(3):ZE04-6. doi:10.7860/JCDR/2016/17360.7423

Important Notice: This article was originally published at www.verywellhealth.com by Teresa Maalouf, MPH where all credits are due. Medically reviewed by Anju Goel, MD.

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