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Nicotine Replacement Therapy OTC

An important message is that nicotine replacement therapy (NRT) obtained over-the-counter (OTC) from pharmacies works as well as that obtained by prescription [1]. An extensive search strategy looked for randomised studies comparing OTC NRT with placebo, and OTC NRT with prescription NRT.


Four randomised trials studied 2,290 subjects over 2.5 to six months with slightly different definitions of quit rates. Pooled quit rates were 9.6% with OTC NRT and 4.0% with placebo (Figure 1). The pooled relative benefit was 2.4 (1.7 to 3.3), and the number needed to treat for one person to quit smoking was 18 (13 to 29).

Figure 1: OTC NRT versus placebo (open circles), or OTC NRT versus prescription NRT (filled circles)

Of four controlled studies of OTC NRT versus prescription NRT with 9,307 subjects over six to 12 months only two were randomised. Pooled quit rates were 8.9% with OTC NRT and 8.1% with prescription NRT (Figure 1). The pooled relative benefit was 1.1 (0.9 to 1.3), showing no difference.


There are a number of methodological issues in this meta-analysis. It makes useful reading, though, especially in relation to arguments about whether OTC NRT is less effective than prescription NRT, and about the absolute efficacy of NRT. There seems to be no difference, and that with NRT about 10 smokers in 100 will stop smoking with NRT, about twice as many as without it.


  1. JR Hughes et al. A meta-analysis of the efficacy of over-the-counter nicotine replacement. Tobacco Control 2003 12: 21-27.
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