Usual Adult Dose for Smoking Cessation

GUM:
Recommended dose:

• First cigarette within 30 minutes of waking up: 4 mg
• First cigarette more than 30 minutes after waking up: 2 mg

• Weeks 1 to 6: 1 piece of gum orally every 1 to 2 hours
• Weeks 7 to 9: 1 piece of gum orally every 2 to 4 hours
• Weeks 10 to 12: 1 piece of gum orally every 4 to 8 hours
• Maximum dose: 24 pieces/day

• The gum should be chewed slowly until a tingling sensation is felt, and then the gum should be parked between the cheek and gums. Patients should begin chewing again after the tingling sensation has gone. This process should be continued until most of the tingling sensation is gone (approximately 30 minutes).
• Patients should avoid eating or drinking for 15 minutes before and during use.
• Patients who took at least 9 pieces of gum per day in the first 6 weeks had an improved chance of quitting.
• Patients may use a second piece of gum within the hour if strong/frequent cravings occur; however, patients should be instructed to avoid continuous use of one piece after another.

• First cigarette within 30 minutes of waking up: 4 mg
• First cigarette more than 30 minutes after waking up: 2 mg

• Weeks 1 to 6: 1 lozenge orally every 1 to 2 hours
• Weeks 7 to 9: 1 lozenge orally every 2 to 4 hours
• Weeks 10 to 12: 1 lozenge orally every 4 to 8 hours
• Maximum dose: 20 lozenges/day

• The lozenge should be allowed to slowly dissolve in the mouth, occasionally moved from side to side, over 20 to 30 minutes or until completely dissolved. Patients should not chew/swallow lozenges and should minimize swallowing during use.
• Lozenges may produce warmth/tingling sensations.
• Patients should avoid eating or drinking for 15 minutes before and during use.
• Instruct patients to avoid using more than one lozenge at a time and to avoid continuous use of one lozenge after another.
• Patients who used at least 9 lozenges per day in the first 6 weeks had an improved chance of quitting.

• Recommended dose: At least 6 cartridges inhaled once a day for the first 3 to 6 weeks
• Maximum dose: 16 cartridges/day
• Duration of therapy: Up to 12 weeks

• Duration of therapy: Up to 12 weeks

• No dose reduction strategy has been more effective than any others in clinical trials; recommendations should be specific to each patient and may include suggestions to decrease use of the product, keeping a daily tally, and/or setting a target end date.

• Recommended dose: 1 to 2 sprays in each nostril every hour for up to 3 months
• Maximum dose: 40 mg/day

• Each dose spray provides approximately 0.5 mg of nicotine.

• Step 1 for 4 weeks, then step 2 for 2 weeks, and finally step 3 for 2 weeks

• Step 2 for 6 weeks, then step 3 for 2 weeks

• The patch should be applied to dry, clean, hairless area every 24 hours.
• When applying a new patch, open the pouch and remove the backing, then apply to the skin and hold the patch to the skin for 10 seconds. The pouch should be saved for later use. Patients should wash their hands after applying or removing the patch.
• When removing a used patch, the sticky ends should be folded together, placed in the pouch, and properly discarded.
• Patients should be instructed to move patch sites every day.
• Tell patients to avoid using more than 1 patch at a time. Patients should not cut the patch into smaller pieces.
• Patches may contain metal, which could result in burns in patients undergoing MRI procedures.
• Do not use a patch for more than 24 hours.
• Patients who experience vivid dreams may remove the patch at bedtime and apply a new patch in the morning.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Patients should avoid food or drinks for 15 minutes prior and during use of oral formulations.
• Gum: The gum should be chewed slowly until it tingles, and then parked between the cheek and gum. When the tingle sensation fades, patients should repeat the procedure until most of the tingling is gone.
• Inhaler/inhalator: Patients should inhale and exhale with the inhaler/inhalator as they would a cigarette. After use, cartridges should be disposed of properly and the mouthpiece should be stored for future use.
• Lozenges: The lozenge should be sucked until the taste becomes strong, and then parked between the cheek and gum. Once the taste fades, patients should repeat the procedure until the lozenge completely dissolves (approximately 30 minutes).
• Mouth spray: Prior to use, or if not used for 2 or more days, the mouth spray should be primed by pressing the top of the bottle 3 times.
• Transdermal patches: The patch should be applied to dry, clean, hairless areas of the body (e.g., shoulders/upper arms, chest, hip); patients should press the patch firmly to the skin to ensure that the patch is properly adhered. After use, the patch should be properly discarded.

• The manufacturer product information should be consulted.

• Use of nicotine replacement products for smoking cessation should be weighed against the risk of continued smoking and the likelihood of success.
• Nausea, fainting, and/or headaches occurred more frequently in patients not accustomed to inhaled tobacco smoke.
• Nasal spray formulations have been used safely in patients with chronic rhinitis and sinusitis.
• Limited data exist for use of oral film formulations in patients with recent myocardial infarction, unstable/worsening angina (including Prinzmetal's angina), severe cardiac arrhythmias, or recent cerebrovascular accident.
• Talc/skin oils may prevent proper application of patch formulations.

• Blood pressure
• Heart rate
• Blood sugar levels, especially when starting therapy
• Signs/symptoms of depression

• Patients receiving the nasal or mouth spray should avoid spraying the eyes during administration.
• In certain circumstances, patients may be told that they may continue to smoke during treatment with intermittent formulations; however, these patients may be at higher risk of developing side effects.
• Patients should be told to report mouth/jaw problems, signs/symptoms of nicotine overdose or palpitations, and/or allergic reactions to their healthcare provider.
• Patients should be counseled on the proper way to discard the product after use.
• Patients should be instructed to keep remaining doses of intermittent formulations for use during cravings.

Frequently asked questions

• How long does nicotine stay in your system?
• How long does nicotine withdrawal last?
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