What is safer, electronic cigarette (e-cigarette) use or nicotine replacement therapy (NRT) with nicotine gum?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: May 5, 2025View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

Nicotine gum is safer than vaping. Nicotine gum delivers nicotine without the harmful chemicals produced by heating and vaporizing e-liquids. Typical nicotine gum comes in 2mg or 4mg strengths, with users generally chewing one piece every 1-2 hours as needed for cravings, not exceeding 24 pieces per day. While nicotine itself is addictive, nicotine replacement therapies like gum have been thoroughly studied and approved for smoking cessation. Vaping, though potentially less harmful than smoking traditional cigarettes, still exposes users to potentially harmful chemicals including propylene glycol, vegetable glycerin, flavorings, and in some cases, vitamin E acetate which has been linked to lung injuries. Additionally, vaping devices may have inconsistent nicotine delivery and quality control issues. The long-term effects of vaping remain unclear due to its relatively recent emergence, whereas nicotine gum has decades of safety data supporting its use. For those trying to quit smoking or reduce nicotine dependence, medically approved options like nicotine gum provide a safer pathway than vaping. According to the most recent study 1, the US Preventive Services Task Force recommends the use of nicotine replacement therapy, including nicotine gum, as a safe and effective way to aid in smoking cessation.

Some key points to consider when using nicotine gum include:

  • Starting with a lower dose (2mg) and increasing to a higher dose (4mg) if necessary, especially for heavy smokers 1
  • Using the gum in combination with other forms of nicotine replacement therapy, such as patches, for increased effectiveness 1
  • Being aware of the potential for nicotine dependence and monitoring usage to avoid excessive consumption
  • Considering the use of behavioral therapy in conjunction with nicotine gum to support cessation efforts 1

Overall, the evidence suggests that nicotine gum is a safer and more effective option for smoking cessation than vaping, with a longer history of safety data and fewer potential health risks. Nicotine gum is the recommended choice for those trying to quit smoking or reduce nicotine dependence.

From the Research

Comparison of Vaping and Nicotine Gum

  • There are no direct studies comparing the safety of vaping and nicotine gum in the provided evidence.
  • However, the studies provide information on the effectiveness and safety of nicotine replacement therapy (NRT), including nicotine gum, for smoking cessation 2, 3, 4, 5, 6.
  • Nicotine gum is a form of NRT that has been shown to be effective in aiding smoking cessation, with a risk ratio of abstinence of 1.49 (95% CI 1.40 to 1.60) compared to placebo 6.
  • The safety of NRT, including nicotine gum, has been evaluated in several studies, with minor irritation of the site of administration being a common adverse effect 5, 6.
  • There is no evidence to suggest that NRT increases the risk of heart attacks 5.
  • Vaping, on the other hand, is not mentioned in the provided studies as a form of NRT or a method for smoking cessation.
  • Therefore, based on the available evidence, it is not possible to directly compare the safety of vaping and nicotine gum.

Effectiveness of Nicotine Gum

  • Nicotine gum has been shown to be effective in aiding smoking cessation, with a risk ratio of abstinence of 1.49 (95% CI 1.40 to 1.60) compared to placebo 6.
  • The effectiveness of nicotine gum is largely independent of the intensity of additional support provided or the setting in which it is offered 3, 5, 6.
  • Higher doses of nicotine gum (4 mg) may be more effective than lower doses (2 mg) in highly dependent smokers 3, 4, 5.

Safety of Nicotine Gum

  • The safety of nicotine gum has been evaluated in several studies, with minor irritation of the site of administration being a common adverse effect 5, 6.
  • There is no evidence to suggest that nicotine gum increases the risk of heart attacks 5.
  • Nicotine gum may cause non-ischaemic chest pain and palpitations in rare cases, but these events are extremely rare 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Nicotine replacement therapy for smoking cessation.

The Cochrane database of systematic reviews, 2002

Research

Nicotine replacement therapy for smoking cessation.

The Cochrane database of systematic reviews, 2012

Research

Nicotine replacement therapy versus control for smoking cessation.

The Cochrane database of systematic reviews, 2018

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.