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Combination Nicotine Replacement Therapy Infographic

Combination Nicotine Replacement Therapy (NRT)
 

Text version of infographic

Combination Nicotine Replacement Therapy (NRT)

Recommended Starting Dose:

If daily cigarette consumption is 10 or more cigarettes, prescribe a 21 mg patch plus either 2 mg lozenges or 2 mg gum (4 mg lozenges or gum can be considered in highly dependent patients).

If daily cigarette consumption is less than 10 cigarettes, prescribe a 14 mg patch plus either 2 mg lozenges or 2 mg gum.

Start on target quit date:

Nicotine patch plus short acting NRT. Use 1 patch every 24 hours to maintain basal nicotine levels. 6-10 lozenges or pieces of gum per day as needed for breakthrough cravings.

Example combo NRT use for one day:

Place a new patch in the morning for use through the entire day. Use a lozenge or piece of gum for cravings or urges to smoke, one every few hours. Situations associated with smoking may trigger an urge to smoke, such as a morning cup of coffee, a stressful situation, after a meal, driving, having a beer or an alcoholic beverage, or an episode of insomnia.

Reduce dosage over the next 2 -6 months:

Example taper schedule:

  • Week 1 – use a 21 mg patch and 6 lozenges or pieces of gum per day
  • Week 2 – use a 21 mg patch and 4 lozenges or pieces of gum per day
  • Week 3 – use a 21 mg patch and 2 lozenges or pieces of gum per day
  • Week 4 – use a 21 mg patch and 1 lozenge or piece of gum per day
  • Week 5 – use a 14 mg patch and 4 lozenges or pieces of gum per day
  • Week 6 – use a 14 mg patch and 2 lozenges or pieces of gum per day
  • Week 7 – use a 7 mg patch and 3 lozenges or pieces of gum per day
  • Week 8 – use a 7 mg patch and 1 lozenge or piece of gum per day

Tapering may be extended past 6 months, particularly for patients with high nicotine dependence or trouble reducing dose of NRT.

Patients have a better chance of quitting when they combine medication with behavioral counseling. The VA quitline offers convenient telephone counseling for patients at 1-855-QUIT-VET/ 1-855-784-8838.