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

STEP 1: Assessing their smoking habits and level of nicotine dependence¹

Use the Modified Fagerström Nicotine Tolerance Scale to assess dependence and determine the initial NRT dose.

PLEASE TICK (✓) ONE BOX FOR EACH QUESTION
How soon after waking do you smoke your first cigarette?	Within 5 minutes 5-30 minutes 31-60 minutes	☐3 ☐2 ☐1
Do you find it difficult to refrain from smoking in places where it is forbidden? e.g. Church, Library, etc.	Yes No	☐1 ☐0
Which cigarette would you hate to give up?	The first in the morning Any other	☐1 ☐0
How many cigarettes a day do you smoke?	10 or less 11 - 20 21 - 30 31 or more	☐0 ☐1 ☐2 ☐3
Do you smoke more frequently in the morning?	Yes No	☐1 ☐0
Do you smoke even if you are sick in bed most of the day?	Yes No	☐1 ☐0
Total Score
SCORE 1 - 2 = low dependence 3 - 4 = low to mod dependence 5 - 7 = moderate dependence 8 + = high dependence

Download the Modified Fagerström Nicotine Tolerance Scale.

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

Pick Your Starting Patch Based On Your Cigarette Usage

10 OR MORE CIGARETTES/DAY	WEEKS 1 – 6	WEEKS 7 & 8	WEEKS 9 & 10	WEEKS 11+
<10 CIGARETTES/DAY		WEEKS 1 – 6	WEEKS 7 & 8	WEEKS 9+
NICODERM^® PATCH	STEP 1 21 mg	STEP 2 14 mg	STEP 3 7 mg	In case strong cravings return: Started on Step 1? Talk to your doctor about remaining on Step 3 for weeks 11+. Started on Step 2? Stay on Step 3 for an additional 2 weeks. If needed, talk to your doctor about remaining on Step 3 for weeks 11+.
	+	+	+	NICORETTE^® oral formats can be used as required after the discontinuation of NICODERM^® Patch
NICORETTE^® QuickMist^®	1 spray every 1–2 hours as needed
	OR	OR	OR
NICORETTE^® GUM	1 piece of gum every 1–2 hours as needed
	OR	OR	OR
NICORETTE^® LOZENGE	1 lozenge every 1–2 hours as needed
	OR	OR	OR
NICORETTE^® INHALER	Use as needed. 1 cartridge = 20 minutes of puffing

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

Download the dosing instructions for combination therapy.

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
NICORETTE^® Inhaler^‖	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.

Download the dosing guides for monotherapy.

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

Find more HCP resources here.

Quitting Method: Abrupt quit

Set target quit date in the next 30 days

icon of a cigarette with a strikethrough symbol through it

On target quit date, stop smoking cigarettes and begin using combination NRT

Follow dosing and titration regimen

Extend duration of NRT as long as necessary to prevent relapse

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

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	4-6	7-8	9-10	10+
NICODERM^® Patch^¶	21 mg^**	21 mg^**	14 mg	7 mg	No patch
PLUS
NICORETTE^® Gum^††	10-20 pieces/day	8-15 pieces/day	4-10 pieces/day	2-5 pieces/day	1 piece if urge to smoke returns
OR
NICORETTE^® QuickMist^®	1-2 sprays every half hour	1-2 sprays every half hour	Reduce number of sprays per day by half	2-4 sprays/day	1 spray if urge to smoke returns
OR
NICORETTE^® Lozenge^‡‡	8-15 lozenges/day	8-15 lozenges/day	4-8 lozenges/day	2-4 lozenges/day	1-2 lozenges/day if urge to smoke returns
OR
NICORETTE^® Inhaler^§§	1 cartridge every 1–2 hours or as needed. Min = 6 cartridges. Max = 12 cartridges.	1 cartridge every 1–2 hours or as needed. Min = 6 cartridges. Max = 12 cartridges.	1 cartridge every 1–2 hours or as needed. Min = 6 cartridges. Max = 12 cartridges.	1 cartridge every 1–2 hours or as needed. Min = 6 cartridges. Max = 12 cartridges.	1 cartridge every 1–2 hours or as needed. Min = 6 cartridges. Max = 12 cartridges. After week 12, reduce the number of cartridges gradually

¶ 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.↩

Learn more about the REDUCE TO QUIT^® method.

Download the dosing instructions for REDUCE TO QUIT^® using combination therapy.