Quitting smoking day by day - what you feel in the first 3 months

Quitting smoking usually follows a similar pattern day by day: the first 3 days are the hardest, withdrawal symptoms are clearly stronger throughout the first week than in the following weeks, and they ease within a month. This is how the US National Cancer Institute (NCI) describes it (1). According to a review of studies, irritability, anxiety, insomnia and difficulty concentrating usually last 2 to 4 weeks (2), although in some people they persist for several months. At the same time, the body recovers. The level of carbon monoxide in the blood falls to that of a non-smoker after 12 hours according to the WHO, or after 48 hours according to the NHS, and circulation and breathing improve over the following weeks.

In brief

• Nicotine withdrawal symptoms are strongest in the first week and peak in the first 3 days. Irritability, anxiety, insomnia and difficulty concentrating usually ease after 2-4 weeks.
• In one study, mouth ulcers appeared in about 40% of people who quit smoking, most often in the first 2 weeks. In 60% of them, the ulcers cleared within 4 weeks.
• After you stop smoking, your heart rate usually slows down. If palpitations come with chest pain, shortness of breath or fainting, you need urgent medical help.
• The time frames given for improvement (20 minutes, 48 hours, 2-12 weeks) are approximate and come from WHO and NHS materials. They do not describe how the changes will progress in a particular person.

Which day after quitting smoking is the worst?

The first 3 days after quitting smoking are usually the hardest. According to the NCI, this is when nicotine withdrawal symptoms peak, although the whole first week is harder than the weeks that follow.

Not every symptom is at its strongest on the same day. The urge to smoke appears as early as an hour or two after the last cigarette and often comes back over the first days or weeks. Anxiety, if it appears, usually builds up over the first 3 days and lasts several weeks. Anger and irritability are strongest in the first week and last 2 to 4 weeks (1). If you feel worst on the fourth or fifth day, that is still a typical course of symptoms.

The first week is also when it is easiest to go back to smoking. In a review of studies of people who quit without any help, most of those who went back to cigarettes did so within the first 8 days (3). Plan how you will cope with the urge to smoke during these days before you quit. It is harder to do this at the moment when the urge is strongest.

How do symptoms and health change in the first 3 months without a cigarette?

In the first week without a cigarette, withdrawal symptoms dominate. During this time, the main changes are that your heart rate slows, your sense of taste and smell improves, and the amount of carbon monoxide in your blood falls. Between weeks 2 and 12, the symptoms ease and circulation and lung function improve.

If you take clozapine, olanzapine or theophylline, agree a treatment plan with your doctor before your quit day.

The time frames for improvement in the table come from WHO (4) and NHS (5) educational materials. They describe the average course of changes and do not determine how the changes will progress in a particular person. These sources give different times for the fall in carbon monoxide levels in the blood. According to the WHO, the level returns to normal after 12 hours; according to the NHS, it halves after 8 hours and falls to that of a non-smoker after 48 hours. Both times are approximate. Withdrawal symptoms should become fewer from week to week, so a symptom that gets worse instead of easing needs to be discussed with a doctor.

What should you do in the first days, weeks and months without a cigarette?

In the first 3 days, the most important thing is to ride out the cravings. In the following weeks, you also need to look after your sleep, mood and appetite, and after a month, watch out for situations in which you used to smoke.

The first 3 days without a cigarette

According to the NHS, a single strong craving lasts up to 15 minutes. It is easier to ride it out if you know in advance what you will do: go for a short walk, drink a glass of water or keep your hands busy. According to the NCI, it also helps to get rid of the cigarettes in your home and change what you usually did after coffee and meals. We write more about what to do during those few minutes, and when nicotine cravings mean that treatment needs to change, in our article on nicotine cravings.

Components of tobacco smoke speed up the breakdown of caffeine in the liver. In a small study of 12 people who smoked at least 20 cigarettes a day, the body cleared caffeine about 36% more slowly after quitting, and the change occurred within a few days (6). In another study, of 162 people quitting smoking, caffeine levels in saliva in those who kept drinking coffee were roughly twice as high after 3 weeks as before quitting. However, cutting out caffeine completely did not ease the other withdrawal symptoms of the participants in this study, and it increased tiredness in the first 3 days (7). So if you feel restless or have palpitations after quitting smoking, you can try drinking less coffee, without stopping it abruptly.

From day 4 to the end of the first month without a cigarette

Irritability, anxiety and insomnia usually ease within 2-4 weeks (2). According to the NCI, a mild dip in mood may start as early as the first day; it then lasts a few weeks and resolves within a month. If your mood gets worse from week to week, you need to consult a doctor. We write about how to tell nicotine withdrawal symptoms apart from depression in our article on irritability, anxiety and sadness after quitting smoking.

Appetite also increases during this period. In a meta-analysis of clinical trials, people who quit smoking without the help of medication gained an average of 1.1 kg after a month and 2.9 kg after 3 months (8). We have collected ways to limit this weight gain without going back to cigarettes in our article on weight gain after quitting smoking.

From one to three months without a cigarette

After a month, most withdrawal symptoms are mild, but the urge to smoke does not disappear overnight. The NCI states that cravings become less frequent over time. Occasional mild cravings can still occur months or even years later, however. They are usually triggered by situations associated with smoking, such as alcohol, stress or the company of smokers. We describe why the urge to smoke can come back after a few months in our article on when the urge to smoke stops.

What physical symptoms are typical after quitting smoking?

In studies, people who were quitting smoking more often had mouth ulcers, cold symptoms, coughing and bleeding gums. Dizziness and constipation may result from nicotine withdrawal, but the evidence for this is weaker. Hughes's 2007 review did not include sleepiness or tiredness among withdrawal symptoms.

Dizziness and headaches after quitting smoking

Dizziness and headaches in someone who is quitting smoking are not always caused by nicotine withdrawal itself. They can also be caused by a medicine for quitting smoking or by too much nicotine. The summaries of product characteristics (SmPCs) for Desmoxan capsules (cytisine) (9) and Tabex (10) give the same percentages of patients with these symptoms: depending on the study, headache was reported by less than 1% to 17% of patients, and dizziness occurred in 2-4% of participants. For Desmoxan tablets (11), both symptoms are classed as very common, meaning they occur in at least 1 in 10 people. Too much nicotine can cause these symptoms in someone using nicotine patches, gum or lozenges. According to the SmPC for the NiQuitin patch (12), the symptoms of nicotine overdose include headache and dizziness, nausea, sweating and pallor. If such symptoms appear, the patch must be removed immediately and you need to see a doctor.

According to the NHS (13), you need to see a doctor about dizziness if it does not go away or keeps coming back, or if it comes with problems with vision or hearing, numbness or weakness in the face, arms or legs, fainting or changes in heart rate. A sudden, very severe headache needs urgent help, as does a headache accompanied by numbness or weakness in the body, difficulty speaking or walking, or confusion (14).

Heart palpitations after quitting smoking

After you stop smoking, your heart rate usually slows down. In a study of 30 heavy smokers, heart rate and blood pressure fell further the longer the break from smoking lasted (up to 18 hours), while anxiety and low mood increased (15).

So if you have palpitations after quitting smoking, it makes sense to look for a cause other than the lack of nicotine itself. According to the NHS (16), palpitations are often triggered by stress and anxiety, lack of sleep, caffeine, alcohol, nicotine and medicines. Anxiety and poorer sleep are withdrawal symptoms, and after quitting smoking there is more caffeine in the blood. For Desmoxan capsules, a faster heart rate has also been described in less than 1% to 14% of people taking cytisine. Smoking during the course of treatment may make the side effects of nicotine worse. Contraindications to the medicine include clinically significant heart rhythm disorders, unstable angina and a recent heart attack or stroke.

You need to consult a doctor if palpitations keep coming back, become more frequent or last longer than a few minutes, especially if you have heart disease or heart disease runs in your family. Palpitations with chest pain, shortness of breath, feeling faint or fainting need urgent medical help. The NHS advises against driving yourself to hospital in this situation.

Flu-like symptoms in the first 2 weeks without a cigarette

Ussher et al. followed 174 people who were quitting smoking using nicotine patches and support. Participants who had not smoked for 6 weeks had more cold symptoms after the first and second weeks. A sore throat, coughing and sneezing were already more common after the first week (17). Symptoms were assessed once a week, so the study does not show on which day they were strongest.

Hughes's 2007 review does not list fever among either confirmed or possible withdrawal symptoms. A high fever, shortness of breath, chest pain, coughing up blood or a cough that is rapidly getting worse need an urgent medical consultation (18), regardless of how many days have passed since your last cigarette.

Mouth ulcers, bleeding gums and lip changes in the first 6 weeks

Mouth ulcers after quitting smoking are common. In the study by McRobbie et al., they appeared in about 40% of 1,234 people who had not smoked for at least a week, most often in the first 2 weeks. They were usually mild, but in 8% of participants they were severe. In 60% of people with mouth ulcers, the ulcers cleared within 4 weeks. They were more common in people who were more strongly dependent. According to the authors, the ulcers were caused by quitting smoking itself, not by the effects of medicines (19).

Your gums may bleed more often after quitting smoking than before. In a small study of 27 people, 4-6 weeks after quitting smoking the gums bled on probing at 32% of the sites checked, compared with 16% before, even though the participants were taking better care of their oral hygiene. The authors attribute this to smoking having suppressed the inflammatory response of the gums, which returns once smoking stops (20). That is why it is a good idea to tell your dentist that you are quitting smoking.

Hughes's review also does not list cracked or peeling lips among withdrawal symptoms. Dry mouth, on the other hand, is one of the most common side effects of cytisine: for Desmoxan capsules and Tabex, it is reported in 35% of patients.

If a mouth ulcer has not healed within 3 weeks, bleeds, or becomes increasingly painful and red, you need to see a doctor or dentist (21). Very painful and swollen gums, loose teeth, red patches or a lump in the mouth or on the lip need an urgent dental appointment (22).

Cough, constipation and insomnia after quitting smoking

At first, your cough may get worse after quitting smoking, because the lungs are clearing out mucus (18). If a cough lasts more than 3 weeks, you need to see a doctor. Constipation may be a result of nicotine withdrawal (2), and the NHS lists it among the less common, temporary complaints. Insomnia is a confirmed withdrawal symptom and is strongest in the first week. Sleep disturbances, including strange dreams, are also side effects of cytisine; for Desmoxan capsules and Tabex, they are reported in 1-21% of patients.

Is it a withdrawal symptom or a side effect of a stop-smoking medicine?

Withdrawal symptoms and the side effects of stop-smoking medicines are often the same, so the symptom alone usually does not reveal the cause. For Desmoxan capsules, the side effects described include changes in appetite, mainly an increase (47%), irritability (36%), mood changes (15%) and anxiety (11%), but these symptoms may result from quitting smoking itself. Before you consult a doctor or pharmacist, check when the symptom appeared: after the first dose of the medicine or after you quit smoking. Also say whether you are still smoking. When taking cytisine, you have to stop smoking by day 5 of the course at the latest. We write about how to tell the effects of cytisine from nicotine withdrawal symptoms in our article on the side effects of cytisine, and we describe the 25-day course in our article on cytisine (Desmoxan, Tabex, Recigar).

Cytisine and varenicline partially stimulate nicotinic receptors. In this way, they ease withdrawal symptoms while also making smoking less enjoyable (23). The WHO recommends nicotine replacement therapy, varenicline, bupropion and cytisine for the treatment of tobacco dependence (24). The choice of medicine depends on the number of cigarettes smoked, previous attempts to quit, other conditions and the medicines you take. In nicotine dependence treatment at Nasz Gabinet, we start with a medical interview. If there are no contraindications, the doctor issues an e-prescription for the chosen medicine. Throughout the 3 months of the treatment plan, the app reminds you to take your doses, counts your smoke-free days and serves as a diary. For an additional fee, you can also book consultations with a psychologist.

Which symptoms after quitting smoking need urgent medical attention?

The following symptoms need urgent medical help, even if they appeared while you were quitting smoking. They may indicate a heart, lung or nervous system disease or a mental health crisis, so you should not wait for them to go away on their own:

• pain or pressure in the chest, shortness of breath, feeling faint or fainting, including when combined with palpitations
• a sudden, very severe headache, numbness or weakness in the face, an arm or a leg, difficulty speaking, keeping your balance or walking, confusion
• coughing up blood, difficulty breathing, a cough that is rapidly getting worse, feeling very unwell
• thoughts of taking your own life

If you have suicidal thoughts, tell a doctor or someone close to you straight away, and do not stay alone with them. If the danger is immediate, you need emergency medical help.

The medicines you take need to be discussed separately with your doctor. Tobacco smoke speeds up the breakdown of clozapine, olanzapine and theophylline, among others, so their levels in the blood rise after quitting smoking. This also applies to people using nicotine patches, because the interaction is caused by components of the smoke, not by nicotine itself. According to the NHS Specialist Pharmacy Service (25), the change may be visible after just 3 days, and it takes 2-4 weeks to level out completely. If you take one of these medicines, agree with your treating doctor how your treatment should continue before your quit day. This article does not replace a medical consultation.

Frequently asked questions

How long do nicotine withdrawal symptoms last?

Nicotine withdrawal symptoms usually last 2 to 4 weeks. They are strongest in the first week, peak in the first 3 days and generally become clearly weaker within a month (1, 2). In some people, they last several months, and occasional mild cravings can come back even months later.

How long does it take for nicotine to leave the body?

Nicotine leaves the blood quickly: its half-life averages 2 hours, and it stays at a significant level for 6-8 hours after the last cigarette. Cotinine, a breakdown product of nicotine, stays longer: its half-life averages 16 hours (26). Withdrawal symptoms last longer because they result from the nervous system having adapted to regular doses of nicotine (27).

Can you have a fever after quitting smoking?

Fever is not among the confirmed or possible nicotine withdrawal symptoms in Hughes's 2007 review. In the first 2 weeks after quitting smoking, a sore throat, coughing, sneezing and other cold symptoms are more common (17). A high fever, shortness of breath, chest pain or coughing up blood need an urgent medical consultation, because they may indicate an infection or another illness.

Sources

1. National Cancer Institute. Handling Nicotine Withdrawal and Triggers When You Decide To Quit Tobacco. cancer.gov
2. Hughes JR. Effects of abstinence from tobacco: valid symptoms and time course. Nicotine Tob Res. 2007;9(3):315-327. PMID 17365764, DOI
3. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004;99(1):29-38. PMID 14678060, DOI
4. World Health Organization. Tobacco: Health benefits of smoking cessation. 2020. who.int
5. NHS Better Health. What could happen when you quit smoking. nhs.uk
6. Faber MS, Fuhr U. Time response of cytochrome P450 1A2 activity on cessation of heavy smoking. Clin Pharmacol Ther. 2004;76(2):178-184. PMID 15289794, DOI
7. Swanson JA, Lee JW, Hopp JW, Berk LS. The impact of caffeine use on tobacco cessation and withdrawal. Addict Behav. 1997;22(1):55-68. PMID 9022872, DOI
8. Aubin HJ, Farley A, Lycett D, Lahmek P, Aveyard P. Weight gain in smokers after quitting cigarettes: meta-analysis. BMJ. 2012;345:e4439. PMID 22782848, DOI
9. Charakterystyka Produktu Leczniczego Desmoxan, 1,5 mg, kapsułki twarde (cytyzyniklina) [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
10. Charakterystyka Produktu Leczniczego Tabex, 1,5 mg, tabletki powlekane (cytyzyna) [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
11. Charakterystyka Produktu Leczniczego Desmoxan, 1,5 mg, tabletki (cytyzyniklina) [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
12. Charakterystyka Produktu Leczniczego NiQuitin Przezroczysty, 21 mg/24 godz., system transdermalny [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
13. NHS. Dizziness. nhs.uk
14. NHS. Headaches. nhs.uk
15. Morrell HER, Cohen LM, al'Absi M. Physiological and psychological symptoms and predictors in early nicotine withdrawal. Pharmacol Biochem Behav. 2008;89(3):272-278. PMID 18294681, DOI
16. NHS. Heart palpitations. nhs.uk
17. Ussher M, West R, Steptoe A, McEwen A. Increase in common cold symptoms and mouth ulcers following smoking cessation. Tob Control. 2003;12(1):86-88. PMID 12612369, DOI
18. NHS. Cough. nhs.uk
19. McRobbie H, Hajek P, Gillison F. The relationship between smoking cessation and mouth ulcers. Nicotine Tob Res. 2004;6(4):655-659. PMID 15370162, DOI
20. Nair P, Sutherland G, Palmer RM, Wilson RF, Scott DA. Gingival bleeding on probing increases after quitting smoking. J Clin Periodontol. 2003;30(5):435-437. PMID 12716336, DOI
21. NHS. Mouth ulcers. nhs.uk
22. NHS. Gum disease. nhs.uk
23. Livingstone-Banks J, Fanshawe TR, Thomas KH et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2023;5(5):CD006103. PMID 37142273, DOI
24. World Health Organization. WHO clinical treatment guideline for tobacco cessation in adults. 2024. who.int
25. NHS Specialist Pharmacy Service. Considering drug interactions with smoking. sps.nhs.uk
26. Benowitz NL, Hukkanen J, Jacob P 3rd. Nicotine chemistry, metabolism, kinetics and biomarkers. Handb Exp Pharmacol. 2009;(192):29-60. PMID 19184645, DOI
27. Benowitz NL. Nicotine addiction. N Engl J Med. 2010;362(24):2295-2303. PMID 20554984, DOI
28. NHS Specialist Pharmacy Service. Managing specific interactions with smoking. sps.nhs.uk