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Smoking cessation - Management
Which dose of nicotine replacement therapy should I prescribe and for how long?

  • Smokers must use sufficient nicotine replacement therapy (NRT) in order to achieve good success rates. To ensure a sufficient dose, several expert reviewers advise regular use of intermittent (non-patch) formulations of NRT, topping up as needed.
  • NRT patches are available in two preparations (16-hour and 24-hour), each with three strengths prescribed in a programme of reducing dose, usually over 8–12 weeks:
    • 16-hour patch: 15 mg, 10 mg, 5 mg (Nicorette®).
    • 24-hour patch: 21 mg, 14 mg, 7 mg (Nicotinell®, NiQuitin®).
  • NRT gum is available in two strengths — 2 mg and 4 mg:
    • People who smoke more than 20 cigarettes per day: start with the 4 mg gum.
  • NRT lozenges are available in four strengths — 1 mg, 1.5 mg, 2 mg, and 4 mg:
    • Nicotinell®:
      • People who smoke less than 20 cigarettes per day: start with 1 mg lozenges.
      • People who smoke 20 to 30 cigarettes per day: start with 1 mg or 2 mg lozenges, depending on the person's characteristics and preference.
      • People who smoke more than 30 cigarettes per day: start with 2 mg lozenges.
    • Niquitin®:
      • People who have their first cigarette of the day more than 30 minutes after waking up: start with 2 mg lozenges.
      • People who have their first cigarette of the day within 30 minutes of waking up: start with 4 mg lozenges.
    • Nicopass® 1.5 mg lozenges are not suitable for smokers who are heavily dependent on nicotine.
  • NRT sublingual tablets — 2 mg:
    • 20 cigarettes or more per day: start taking two tablets (4 mg) sublingually each hour.
    • Fewer than 20 cigarettes per day: start taking one tablet (2 mg) sublingually each hour (increase to two tablets each hour if the person fails to stop smoking or has significant withdrawal symptoms).
  • NRT nasal spray and inhalator — one strength only:
    • All smokers: use when required, to relieve the urge to smoke.
  • Duration of NRT in people maintaining abstinence from cigarettes is usually 8–12 weeks (depending on which form of NRT is used and which dose is initiated), followed by a gradual reduction in dose.
  • Some people, in particular those who are more dependent on nicotine, may need higher doses of NRT for a longer duration to reduce the risk of relapse.

In depth

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