Nicotine Replacement Therapy Guidelines

Introduction to Nicotine Absorption

The American Thorax Society recommends that nicotine gum must be chewed slowly and then parked between the cheek and gum because nicotine is absorbed through the oral mucosa, not through swallowing, with any swallowed nicotine being wasted and not contributing to smoking cessation 1
Nicotine must be absorbed through the buccal mucosa (mouth lining) to enter the bloodstream effectively, with swallowed nicotine being metabolized by the liver before reaching systemic circulation, rendering it therapeutically ineffective 1
The "parking" phase allows nicotine to be absorbed directly through the oral mucosa into the bloodstream, maximizing nicotine absorption and therapeutic benefit 1

Combination therapy, such as using a patch plus gum, nearly doubles quit rates compared to patch alone, achieving 36.5% abstinence at 6 months versus 23.4% for monotherapy, according to the guidelines from a medical society 2