Nicotine Replacement Therapy
Type | Dosage Guidance | Precautions and Side Effects |
---|---|---|
All types | Variable by form | Use with caution within 2 weeks of myocardial infarction, in patients with serious arrhythmias, and in patients with unstable angina pectoris. |
Informed by individual clinical factors | Nicotine replacement therapy does not have an established favorable benefit/risk balance in pregnant or breastfeeding patients. | |
Gum | 2-mg or 4-mg per piece | Mouth soreness, hiccups, dyspepsia, and jaw ache. Usually mild and transient and often can be alleviated with improved chewing technique. |
4-mg gum is for patients smoking ≥25 cigarettes daily | ||
Use at least one piece every 1–2 hours as needed up to 12 weeks. | ||
Maximum: 24 pieces per day | ||
Inhaler | A cartridge delivers 4 mg of nicotine over approximately 80 inhalations | Local irritation in the mouth and throat, coughing, rhinitis. Usually mild and declines with use. |
Recommended dosage is 6–16 cartridges/day | ||
Recommended duration up to 6 months, with taper over in the final 3 months | ||
Lozenges | 2-mg or 4-mg per piece | Nausea, hiccups, and heartburn. A 4-mg lozenge is associated with increased headache and coughing. |
4-mg lozenge is recommended for patients who smoke their first cigarette within 30 minutes of waking | ||
Use at least nine lozenges per day in the first 6 weeks and up to 12 weeks | ||
Maximum: 20 per day | ||
Nasal spray | 0.5-mg dose delivered to each nostril (1 mg total) Start at 1–2 doses per hour, increasing until symptom relief | Nasal irritation (≥90%), nasal congestion, and sometimes transient changes in smell and taste. Not to be used in patients with severe reactive airway disease. |
Recommended range of 8–40 doses per day for 3–6 months | Highest dependence potential of nicotine replacement therapies. A total of 15%–20% of patients report using beyond the recommended period and 5% above the recommended dose. | |
Transdermal patch | 7-, 14-, and 21-mg doses | Local skin reactions (up to 50%), usually self-limited. Insomnia and/or vivid dreams. |
Individualize dose by previous experience with patch and amount smoked (one cigarette often yields roughly 1 mg nicotine) |
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