Steps to selecting a dose for Nicotine Replacement Therapy (NRT)

SCORE

• 1 - 2 = low dependence

• 3 - 4 = low to mod dependence

• 5 - 7 = moderate dependence

• 8 + = high dependence

STEP 2: Assessing tobacco use history (including vaping) and prior quit attempts

Consider asking:

• Where do you smoke most often?

• Do you smoke socially, alone, or both?

• Have you made any previous attempts to quit, and if so, how many and what methods were used (e.g. willpower alone [“cold turkey”], NRT, prescription medications)?

  • Determine the patient’s perception of the cause of relapse and which methods they feel worked best for them.²

Having a complete understanding of your patient’s relationship with smoking can also guide NRT product selection.

Choosing the right strength and dosing frequency

NICORETTE^® & NicoDerm® Combination Therapy Dosing Guide

One cigarette delivers 1–2 mg of nicotine

NICORETTE® and NicoDerm® are the first and only brands in Canada authorized for use in combination.

Product dosing guides for monotherapy

NicoDerm® Patch*

Step 1 | Weeks 1 – 6†

• For a heavy smoker: Use one 21 mg patch daily

• For a light smoker: Use one 14 mg patch daily

Step 2 | Weeks 7 - 8

• For a heavy smoker: Use one 14 mg patch daily

• For a light smoker: Use one 7 mg patch daily

Step 3 | Weeks 9 - 10

• For a heavy smoker: Use one 7 mg patch daily

• For a light smoker: If needed, continue using one 7 mg patch daily

NICORETTE® QuickMist®

Step 1 | Weeks 1 – 6

• 1–2 sprays every 30–60 mins. Use 1 spray first, and if cravings do not disappear within a few minutes, use a second spray.

Step 2 | Weeks 7 - 9

• Start reducing the number of sprays/day. By the end of week 9, the number of sprays per day should be half of what was used in Step 1

Step 3 | Weeks 10 - 12

• Keep reducing the number of sprays/day. By week 12, no more than 2–4 sprays/day should be used.

Step 4 | After 12 weeks

• Stop using QuickMist®

NICORETTE® Gum‡

Step 1 | Weeks 1 – 2

• 10–20 pieces/day

Step 2 | Weeks 3 - 4

• 8–15 pieces/day

Step 3 | Month 2

• 4–10 pieces/day

Step 4 | Month 3

• 2–5 pieces/day

Step 5 | Month 4 - 6

• 1 piece if the urge to smoke returns

NICORETTE^® Lozenge^§

Step 1 | Weeks 1–6

• 8–15 lozenges/day

Step 2 | Weeks 7–9

• 4–8 lozenges/day

Step 3 | Weeks 10–12

• 2–4 lozenges/day

Step 4 | Week 13–14

• 1–2 lozenges/day if you feel the urge to smoke

NICORETTE® Inhaler‖

Step 1 | Weeks 1 – 12

• A minimum of 6 cartridges to a maximum of 12 cartridges/day

Step 2 | Weeks 13 - 24

• Reduce the number of cartridges gradually. Stop using the inhaler when down to 1–2 cartridges/day.

^{*For a person who smokes 10+ cigarettes/day.
†If a patient’s weigh is <45 kg (100 lbs) or have heart disease and your doctor has recommended NicoDerm®, start with Step 2.
‡If a patient typically smokes >25 cigarettes/day, use the 4 mg gum. If they smoke ≤25, use the 2 mg gum.
§If a patient typically smokes >25 cigarettes/day, use the 4 mg lozenge. If they smoke ≤25, use the 2 mg lozenge.
‖1 cartridge = 20 minutes of puffing.}

MAXIMUM DOSES: Patients should not exceed 1 patch daily, 2 sprays at a time/4 sprays per hour/64 sprays per day, 20 pieces of gum, 15 lozenges or 12 cartridges per day. See product inserts for more information.

Titrating combination therapy

• Use starting NRT patch dose for 6 weeks and reduce dose by 7 mg every 2 weeks thereafter

• If strong cravings return when attempting downward titration, consider remaining at the higher dose for longer

• NRT can be used for 10-12 weeks or longer if necessary

Gum, lozenge, inhaler or spray can be used after discontinuation of patch, as required

Quitting Method: Abrupt quit

Quitting Method: REDUCE TO QUIT®

REDUCE TO QUIT® with a target quit date³

1. Start NRT 2-4 weeks prior to quit date
   Use faster action NRT (such as gum or lozenge) to replace omitted cigarettes and when experiencing cravings
   Set goal to reduce daily cigarette consumption by ≥50% by target quit date.

2. Stop smoking on target quit date and follow regular dosing and titration regimen (see below) 

3. Extend NRT use as long as necessary to prevent relapse

Weeks 1 - 3
NicoDerm® Patch | 21 mg**

Weeks 4 - 6
NicoDerm® Patch | 21 mg**

Weeks 7 - 8
NicoDerm® Patch | 14 mg

Weeks 9-10
NicoDerm® Patch | 7 mg

Weeks 10+
No Patch

^{¶ For a person who smokes 10+ cigarettes/day.
** If a patient’s weigh is <45 kg (100 lbs) or have heart disease and your doctor has recommended NicoDerm®, start with Step 2.

†† If a patient typically smokes >25 cigarettes/day, use the 4 mg gum. If they smoke ≤25, use the 2 mg gum.

‡‡ If a patient typically smokes >25 cigarettes/day, use the 4 mg lozenge. If they smoke ≤25, use the 2 mg lozenge.
§§ 1 cartridge = 20 minutes of puffing.}

MAXIMUM DOSES: Patients should not exceed 1 patch daily, 2 sprays at a time/4 sprays per hour/64 sprays per day, 20 pieces of gum, 15 lozenges or 12 cartridges per day. See product inserts for more information.