Last update July 5, 2023

Nicotine Replacement Therapy (NRT)

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Nicotine is a stimulant alkaloid from the tobacco plant. It is used to alleviate nicotine withdrawal syndrome and as an aid to smoking cessation. Inhaled nasal, oral and transdermal administration.

Nicotine replacement therapy (gum, lozenges, skin patches, nasal spray, inhaler) may be a good option for the breastfeeding mother if she is unable to quit without pharmacological help  (Le Lous 2020, Baraona 2017, ABM 2015, Rowe 2013, Sachs 2013, Einarson 2009, Myr 2004, Ilett 2003). Some authors disagree (Maritz 2011, Alm 2006).

Nicotine is excreted in breast milk in a moderate amount (RD: 5 - 10%) that could be significant. (Ilett 2003)

Plasma cotinine levels in infants born to mothers using nicotine patches for smoking cessation were 13% of maternal plasma levels. No developmental problems were observed in these infants. (Ilett 2003)

Patch: Nicotine serum levels in the mother (hence in the milk) may be similar to those of women who smoke if high concentration patches are used. Lowest effective concentration ones for treatment of tobacco dependency are recommended (Ilett 2003). Patches should be taken off while sleeping. Short-acting products (chewing gum, lozenges) are more recommended during lactation. (Sachs 2013, Molyneux 2004)

Chewing gum and lozenges: Nicotine serum levels in the mother (hence in the milk) may be one-half than those in women who smoke but may arrive to be as high as in smokers. The fewer number of chewing gums effective for treatment of tobacco dependency is recommended, with a lapse of 2-3 hours before the next breast feed after taking a nicotine chewing gum.

Inhaler: Nicotine serum levels in the mother (hence in the milk) is usually one-eighth than those in women who smoke. The fewer number of inhalations that would be effective for treatment of tobacco dependency are recommended.

Offspring of women who smoke are at lower risk of harm to health when they are breastfed than formula fed. Breastfeeding minimizes risks originated by tobacco smoke exposure. Those risks are even lower with the use of Nicotine Replacement Therapy (patch, chewing gum, lozenges or inhaler)


See below the information of these related products:

  • Electronic cigarette, E-Cigarette, Vape, Vaping ( Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.)
  • Tobacco ( Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.)

Alternatives

We do not have alternatives for Nicotine Replacement Therapy (NRT) since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Nicotine Replacement Therapy (NRT) is also known as


Group

Nicotine Replacement Therapy (NRT) belongs to this group or family:

Tradenames

Main tradenames from several countries containing Nicotine Replacement Therapy (NRT) in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 30 %
Molecular weight 162 daltons
Protein Binding 5 %
VD 2 - 3 l/Kg
Tmax Or: 0.5-1; Inh: 0.5; TrD: 6-9 hours
2 (1 - 3). Cotinin.: 15 - 20 hours
M/P ratio 1.5 - 3 -
Theoretical Dose 0.01 - 0.026 mg/Kg/d
Relative Dose 7.5 - 9 %

References

  1. Hamilton WN, Masud N, Kouambo C, Tarasenko YN. Perinatal Smoking and E-cigarette Use and Their Relationship with Breastfeeding: PRAMS 2015-2020. Breastfeed Med. 2023 Oct 30. Consulted on Oct. 30, 2023 Abstract
  2. Le Lous M, Torchin H. [Smoking and Breastfeeding - CNGOF-SFT Expert Report and Guidelines on the management for Smoking Management During Pregnancy]. Gynecol Obstet Fertil Senol. 2020 Jul - Aug;48(7-8):612-618. Abstract
  3. Baraona LK, Lovelace D, Daniels JL, McDaniel L. Tobacco Harms, Nicotine Pharmacology, and Pharmacologic Tobacco Cessation Interventions for Women. J Midwifery Womens Health. 2017 Abstract
  4. ABM. Reece-Stremtan S, Marinelli KA. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  5. ABM Protocolo clínico de la ABM n.º 21: Pautas para la lactancia y el consumo de sustancias o trastorno por consumo de sustancias, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source) Full text (in our servers)
  6. Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, Prokopowicz A, Jablonska-Czapla M, Rosik-Dulewska C, Havel C, Jacob P 3rd, Benowitz N. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014 Abstract Full text (link to original source)
  7. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  8. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  9. Carson KV, Brinn MP, Robertson TA, To-A-Nan R, Esterman AJ, Peters M, Smith BJ. Current and emerging pharmacotherapeutic options for smoking cessation. Subst Abuse. 2013 Abstract Full text (link to original source) Full text (in our servers)
  10. Wong S, Ordean A, Kahan M; Maternal Fetal Medicine Committee; Family Physicians Advisory Committee; Medico-Legal Committee; Society of Obstetricians and Gynaecologists of Canada. Substance use in pregnancy. J Obstet Gynaecol Can. 2011 Abstract Full text (in our servers)
  11. Lucero CA, Moss DR, Davies ED, Colborn K, Barnhart WC, Bogen DL. An examination of attitudes, knowledge, and clinical practices among Pennsylvania pediatricians regarding breastfeeding and smoking. Breastfeed Med. 2009 Abstract Full text (link to original source) Full text (in our servers)
  12. Benowitz NL, Hukkanen J, Jacob P 3rd. Nicotine chemistry, metabolism, kinetics and biomarkers. Handb Exp Pharmacol. 2009;(192):29-60. Abstract Full text (link to original source)
  13. Einarson A, Riordan S. Smoking in pregnancy and lactation: a review of risks and cessation strategies. Eur J Clin Pharmacol. 2009 Abstract
  14. Dahlström A, Ebersjö C, Lundell B. Nicotine in breast milk influences heart rate variability in the infant. Acta Paediatr. 2008 Abstract
  15. Bogen DL, Davies ED, Barnhart WC, Lucero CA, Moss DR. What do mothers think about concurrent breast-feeding and smoking? Ambul Pediatr. 2008 Abstract
  16. Alm B, Lagercrantz H, Wennergren G. Stop SIDS--sleeping solitary supine, sucking soother, stopping smoking substitutes. Acta Paediatr. 2006 Abstract
  17. Le Houezec J. [What smoking cessation interventions are effective in pregnant women?]. J Gynecol Obstet Biol Reprod (Paris). 2005 Abstract
  18. Fontaine B. [Smoking and breastfeeding: how can we help mothers stop smoking?]. J Gynecol Obstet Biol Reprod (Paris). 2005 Abstract
  19. Molyneux A. Nicotine replacement therapy. BMJ. 2004 Abstract
  20. [No authors listed] Should the nicotine patch be used during breastfeeding? Child Health Alert. 2004 Abstract
  21. Pullon S, Webster M, McLeod D, Benn C, Morgan S. Smoking cessation and nicotine replacement therapy in current primary maternity care. Aust Fam Physician. 2004 Abstract
  22. Ilett KF, Hale TW, Page-Sharp M, Kristensen JH, Kohan R, Hackett LP. Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk. Clin Pharmacol Ther. 2003 Abstract
  23. Page-Sharp M, Hale TW, Hackett LP, Kristensen JH, Ilett KF. Measurement of nicotine and cotinine in human milk by high-performance liquid chromatography with ultraviolet absorbance detection. J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Abstract
  24. Dempsey DA, Benowitz NL. Risks and benefits of nicotine to aid smoking cessation in pregnancy. Drug Saf. 2001 Abstract
  25. Schatz BS. Nicotine replacement products: implications for the breastfeeding mother. J Hum Lact. 1998 Abstract
  26. Matheson I. [Nicotine chewing gums and lactation]. Tidsskr Nor Laegeforen. 1989 Abstract

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